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Patient Safety Learning

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  1. Patient Safety Learning
    The Prime Minister has confirmed a £3.7bn funding package to facilitate the construction of 40 new hospitals around the England by 2030, with a further eight schemes invited to bid for future funding.
    Talked about over the coming months, the funding announcement comes as the first official confirmation to deliver on the Government’s manifesto commitment.
    New standards are set to be developed over the coming months to help standardise the design of new hospitals and make use of modular construction methods to speed up the build process.
    Originally launched last September with a £2.8bn investment which provided six new hospitals with the funding to go ahead, alongside seed funding for trusts to work up business cases, the health infrastructure plan (HIP) represents the largest hospital building programme in the UK for a generation.
    The trusts which received seed funding will now all be fully funded to deliver 25 new hospitals. An additional site – a new hospital in Shotley Bridge – has also been added to the programme.
    The new Shotley Bridge hospital represents a commitment from the Government to ensure much of the funding also goes to rebuilding across the North of England, as part of its levelling up agenda.
    As part of welcoming new schemes to bid for funding for the eight further new hospitals down the line, the Government also committed that a proportion of these would be new mental health hospitals.
    Prime Minister Boris Johnson said: “The dedication and tireless efforts of our nurses, doctors and all healthcare workers have kept the NHS open throughout this pandemic. But no matter what this virus throws at us, we are determined to build back better and deliver the biggest hospital building programme in a generation."
    Read full story
    Source: NHE, 5 October 2020
    40hospitals.pdf
  2. Patient Safety Learning
    NHS Payouts linked to medication blunders have doubled in six years, fuelling record spending, official figures show.
    The NHS figures show that in 2019/20, the health service spent £24.3 million on negligence claims relating to medication errors - up from £12.8 million in 2013/14. The statistics show that in the past 15 years, almost £220 million has been spent on claims relating to the blunders.
    Previous research has suggested that medication errors may be killing up to 22,000 patients in England every year. Errors occur when patients are given the wrong drugs, doses which are too high or low, or medicines which cause dangerous reactions.
    In some cases, patients have been given medication which was intended for another person entirely, sometimes with fatal consequences. Other studies suggest that 1 in 12 prescriptions dispensed by the NHS involve a mistake in medication, dose or length of course. 
    In some cases, patients have died after being given a dose of morphine ten times that which should have been administered, with other fatalities involving fatal reactions. Confusion often occurs when drugs are not labelled clearly, or when packaging of different medications looks similar.
    Jeremy Hunt, now chairman of the Commons Health and Social Care Committee, said the NHS needed to make far more progress preventing harms, instead of seeing an ever increasing negligence bill.
    He said: “It is nothing short of immoral that we often spend more cleaning up the mess of numerous tragedies in the courts, than we actually do on the doctors and nurses who could prevent them."
    Read full story (paywalled)
    Source: The Telegraph, 3 October 2020
  3. Patient Safety Learning
    A further £8.7million is to be dished out to seven NHS hospital trusts to introduce digital records and e-prescribing. The money is part of a £78million investment which was announced in February 2018 and aims to accelerate the roll out of electronic prescribing systems across the NHS.
    The latest funding is part of the third wave of the investment, which will be handed out over three years. In 2018/ 19, £16.2 million was awarded, £29.4 million was given in 2019/20 and another £12 million will be invested later this year.
    The seven trusts which will benefit from this latest round of finding are:
    Portsmouth Hospitals NHS Trust (£1.7m) Solent NHS Trust (£988,000) Sussex Community NHS Foundation Trust (£637,000) United Lincolnshire Hospitals NHS Trust (£1.26m) North Cumbria Integrated Care NHS Trust (£2m) East Lancashire Hospitals NHS Trust (£1.6m) Birmingham Community NHS Trust (£531,000) National director of patient safety, Dr Aidan Fowler, said: “Patient safety is of paramount importance and is something we are continuously looking at ways to improve, whether through new technology, such as the introduction of electronic prescribing, or by building a safety culture where all NHS staff feel supported and safe to speak up.”
    Read full story
    Source: Digital Health, 1 October 2020
  4. Patient Safety Learning
    Melissa Vanier, a 52-year-old postal worker from Vancouver, had just returned from holiday in Cuba when she fell seriously ill with COVID-19. “For the entire month of March I felt like I had broken glass in my throat,” she says, describing a range of symptoms that included fever, migraines, extreme fatigue, memory loss and brain fog. “I had to sleep on my stomach because otherwise it felt like someone was strangling me.”
    By the third week of March, Vanier had tested negative for Sars-CoV-2 – the virus that causes Covid-19. But although the virus had left her body, this would prove to be just the beginning of her problems. In May, she noticed from her Fitbit that her heart rate appeared to be highly abnormal. When cardiologists conducted a nuclear stress test – a diagnostic tool that measures the blood flow to the heart – it showed she had ischaemic heart disease, meaning that the heart was not getting sufficient blood and oxygen.
    Similar stories illustrate a wider trend – that the coronavirus can leave patients with lasting heart damage long after the initial symptoms have dissipated.
    Cardiologists are still trying to find out exactly why some people are left with enduring heart problems despite having had an apparently mild bout of COVID-19. The underlying mechanisms are thought to be slow and subtle changes that are quite different to those that put strain on the heart during the acute illness, especially in patients who have been hospitalised with the disease.
    Some cardiologists have suggested that treatments such as cholesterol-lowering drugs, aspirin or beta blockers may help patients with lingering cardiovascular effects many weeks or months after the initial infection, but the evidence remains limited.
    “It is too early to share data on this,” says Mitrani. “But these therapies have proven efficacy in other inflammatory heart muscle diseases. They have anti-inflammatory effects and we believe may help counter some of the lingering pro-inflammatory effects from Covid-19.”
    But for patients such as Vanier, there remains a long and uncertain road to see whether her heart does fully recover from the impact of the virus. “Psychologically this has been brutal,” she says. “I haven’t been back to work since I went on holiday in February. The heart hasn’t improved, and I now have to wait for more tests to see if they can find out more.”
    Read full story
    Source: The Guardian, 4 October 2020
  5. Patient Safety Learning
    Omnicell UK & Ireland, a leading provider of automated healthcare and medication adherence solutions, hosted a health summit on the eve of World Patient Safety Day, to discuss the impact of medication errors on patients and the NHS. The session focussed on the role technology can play in preventing such issues.
    The summit, this year held via webinar, comes off the backdrop of the Department of Health and Social Care disclosing that in England 237 million mistakes occur every year at some point in the medication process.  These errors cause serious issues for patient safety, but also place a significant cost burden on an already stretched NHS. The 2019 Patient Safety Strategy published by NHS England and NHS Improvement also found the NHS failed to save 11,000 lives a year due to safety concerns with the cost of extra treatment needed following incidents being over £1bn.
    A number of high-profile panel members answered a series of questions from the audience on solutions and best practice to improve patient safety with the aim of debating and sharing ideas on how to meet challenges and the impact of COVID-19.
    One of the panelists, Patient Safety Learning's Chief Digital Office Clive Flashman, agreed with the other panel members that the NHS had become more collaborative and familiar with technology since Covid: “We’ve seen a definite increase in telehealth and telemeds. Covid has forced cultural blockers that were there before to be removed out of necessity. There has been a growth in robotic pharmacy automation to free up staff time from high volume administration tasks to do more complex work that adds value for patients.”
    But with the second-wave of COVID-19 still a very real threat he advised: “We don’t want to wait until the next wave to learn a lesson – we need to learn lessons now. Quality Improvement Leads should be focussed on what went right and what went wrong over that period between March and May. They need to be looking at what we can learn from that now and what we can do differently next time. If we don’t do that, we won’t succeed in the second wave where we might fail.”
    Ed Platt, Automation Director, Omnicell UK & Ireland, added: “Challenges within the NHS throughout Covid has forced them to embrace technology and drive innovation."
    "It’s important that when things go back to normal, we don’t go back to the same status quo. We need to invest in the right infrastructure in hospitals so unnecessary demands and stress are not put on pharmacy, supply managers and nurses so they are free to focus on patient care not administration tasks."
    Read full story
    Source: NHE, 17 September 2020
    You can watch the webinar on demand here
  6. Patient Safety Learning
    A 33-year-old woman says she's been suffering awful coronavirus symptoms for six months and says it's "ruined her life".
    Stephanie, from London, says her symptoms began in mid-March when she started experiencing loss of taste and smell, body aches, headaches, a fever, shivering, hot and cold sweats, and sickness. But six months later she still has had no sense of taste and smell, she suffers brain fog and chronic fatigue and says just walking across her flat leaves her chest feeling tight.
    The photographer, who lives alone, says she sleeps for 10-12 hours but is still always tired. "I'm only 33," she said.
    Stephanie wants to raise awareness of 'long Covid' and says more research needs to be done on how to treat the long-term effects of the disease.
    She said she's scared she'll 'never be the same again'.
    Stephanie says she has a hospital appointment on Friday to have tests on her lungs and heart as doctors are concerned she has lung damage.
    She added: "I think some people don't believe in long Covid, so I want to raise awareness of what people are going through. We need more research of how to treat people with long Covid because there isn't much available, it's so awful."
    Read full story
    Source: Mirror, 1 October 2020
  7. Patient Safety Learning
    From the moment coronavirus reached UK shores, public health advice stressed the importance of washing hands and deep-cleaning surfaces to reduce the risk of becoming infected.
    The advice was informed by mountains of research into the transmission of other respiratory viruses: it was the best scientists could do with such a new pathogen. But as the pandemic spread and data rolled in, some scientists began to question whether the focus on hand hygiene was as crucial as it seemed.
    The issue has resurfaced after Monica Gandhi, a professor of medicine at the University of California, San Francisco, told the US science magazine Nautilus that the easiest way to catch the virus was through droplets and aerosols sprayed from an infected person’s mouth or nose.
    “It’s not through surfaces,” she said. “We now know the root of the spread is not from touching surfaces and touching your eye. It’s from being close to someone spewing virus from their nose and mouth, without in most cases knowing they are doing so.”
    Gandhi’s is not a lone voice. Her comments follow a prominent paper in the Lancet from Emanuel Goldman, a professor of microbiology at Rutgers University in New Jersey. He was sceptical about the relevance of scientific studies that showed the virus could survive on surfaces for days at a time.
    “In my opinion,” he wrote, “the chance of transmission through inanimate surfaces is very small, and only in instances where an infected person coughs or sneezes on the surface, and someone else touches that surface soon after the cough or sneeze.” He defined soon as within one to two hours.
    Dr Julian Tang, an honorary associate professor of respiratory sciences at the University of Leicester, thinks hand washing should stay but agrees the risk from contaminated surfaces has been overplayed.
    He points to documents from the UK government’s Scientific Advisory Group for Emergencies (Sage) that estimate hand washing can reduce acute respiratory infections by only 16%. Meanwhile, he adds, the World Health Organization has warned about surfaces being a likely route of transmission while conceding there are no reports demonstrating infection this way.
    Tang believes that a preoccupation with contaminated surfaces distracted countries from taking airborne transmission seriously and played down the necessity of wearing masks. “What we’ve always said is that the virus transmits by all routes. There might be some transmission by hand and fomites and we’re not opposed to hand washing, but the emphasis is wrong,” he told the Guardian.
    Read full story
    Source: 5 October 2020
  8. Patient Safety Learning
    The Care Quality Commission (CQC) is to target poorly performing NHS maternity units after a series of maternity scandals. It is drawing up plans to spot high-risk maternity units and will use data on their patient outcomes and culture to draw up a list of facilities for targeted inspection.
    The watchdog has voiced concerns over the wider safety of maternity units in the NHS after a number of high-profile maternity scandals in the past year.
    Almost two-fifths of maternity units, 38%, are rated as “requires improvement” by the CQC for their safety.
    The Independent has joined with charity Baby Lifeline to call on the government to reinstate a national maternity safety training fund for doctors and midwives. The fund was found to be successful but axed after just one year.
    On Tuesday, the CQC’s chief inspector of hospitals, Professor Ted Baker, told MPs on the Commons Health and Social Care Committee that he was concerned about the safety of mothers and babies in some maternity units which had persistent problems.
    “Those problems are of dysfunction, poor leadership, of poor culture, of parts of the services not working well together,” he said. “This is not just a few units; this is a significant cultural issue across maternity services.”
    Now the CQC has confirmed it is planning to draw up a list of poor-performing units or hospitals where it suspects there could be safety issues. The new inspection programme will specifically look at issues around outcomes and teamworking culture although the full methodology has yet to be decided.
    Read full story
    Source: The Independent, 4 October 2020
     
  9. Patient Safety Learning
    A Dublin teenager has told of his harrowing battle with COVID-19 and is urging other young people to take the disease seriously.
    Jack Edge, 17, from Rathfarnham, had no underlying health conditions when he contracted the virus in April. Five months on and three hospital admissions later, the Leaving Cert student is still suffering from the "destruction" the virus wreaked on his body.
    Jack first displayed symptoms of COVID-19 on 15 April and five days later was admitted to Tallaght University Hospital. Within hours of being hospitalised, he was fighting for his life. Jack had to be put on a ventilator to help him breathe for 12 days. As his condition stabilised, he was transferred to a high dependency unit.
    Jack said: "I couldn't sleep for three days. Every time I closed my eyes, there was just dizziness and loads of colours. "I literally stayed in the bed for 72 hours, just staring at the wall. I had a lot of dark times in the hospital, since I do struggle with anxiety too."
    "But the care I received was absolutely amazing. They came in and talked to me if I needed to talk, as I would often get lonely, as it was mainly just me in an isolation room."
    However, surviving COVID-19 was just the first step for Jack. On 28 May, he was readmitted to hospital in excruciating pain. Doctors told him he may have suffered nerve damage associated with the virus.
    "I’m currently taking 18-20 tablets a day. Tablets for the nerve damage, for pain and for my anxiety. "
    "I basically have to learn to walk again. I do two to two-and-a-half hours of physio every day, depending on how much energy I have. I wake up some days and I get really upset. I still don’t know why this happened to me or how I got it."
    Jack hopes that by sharing his story he can raise awareness of the dangers and debilitating long-term effects of COVID-19 for young people.
    Read full story
    Source: RTE News, 2 October 2020
  10. Patient Safety Learning
    Next Thursday we’ll see more waiting list data released.
    What is contained in it is probably why Sir David Sloman’s office has taken nearly a month to not answer this question: Your letter to system leaders said you would “eliminate” 52-week waits, by when?
    The regional director’s office could not answer, nor could it reveal which hospitals were going to be the high-volume centre to burn through the lists in the six major specialities.
    There are a couple of likely reasons for their not being able to say when the long waiters would be eliminated.
    NHSI/E’s phase three letter set “mad” targets that don’t feel very real to many on the ground. I/E central will know this and have their own reasons for setting stretching-to-the-point-of-snapping targets, but trusts don’t really want to be held to submitting impossible commitments then being chastised for missing them (management teams have been moved on for this kind of thing in less fraught times).
    The second reason is that the picture is likely to be scary and also to have an impact on the ongoing three-way negotiation between the NHS, the independent sector - which will be hosting a lot of this work - and the workforce that will actually do it in both places.
    There is even less transparency than usual from the regional director’s office and I/E generally when asked anything at all about how effectively private sector facilities are being used, or how much it is costing.
    Much more surprising is the fact that Sir David’s office cannot yet name where each of the ICS’s six high-volume centres will be.
    Read full story (paywalled)
    Source: HSJ, 1 October 2020
  11. Patient Safety Learning
    October is Speak Up Month – a chance to raise awareness of Freedom to Speak Up and the work which is going on in organisations to make speaking up business as usual. 
    2020 has been an extraordinary year, and all NHS workers, whatever their role, have been under increased pressure from the COVID-19 crisis.
    Throughout October the National Guardian Freedom to Speak Up will be sharing their Alphabet of Speak Up – from Anonymity to Zero Tolerance. 26 days to explore the issues, the people, the values, the challenges – everything which goes into what Freedom to Speak Up means in health.
    #SpeakUpABC
    National Guardian Freedom to Speak Up
  12. Patient Safety Learning
    As she lay dying in a Joliette, Que., hospital bed, an Atikamekw woman clicked her phone on and broadcast a Facebook Live video appearing to show her being insulted and sworn at by hospital staff.
    Joyce Echaquan's death on Monday prompted an immediate outcry from her home community of Manawan, about 250 kilometres north of Montreal, and has spurred unusually quick and decisive action on the part of the provincial government.
    The mother of seven's death will be the subject of a coroner's inquiry and an administrative probe, the Quebec government said today. A nurse who was involved in her treatment has been dismissed.
    But that dismissal doesn't ease the pain of Echaquan's husband, Carol Dubé, whose voice trembled with emotion as he told Radio-Canada his wife went to the hospital with a stomach ache on Saturday and "two days later, she died."
    Echaquan's relatives told Radio-Canada she had a history of heart problems and felt she was being given too much morphine. 
    In the video viewed by CBC News, the 37-year-old is heard screaming in distress and repeatedly calling for help. Eventually, her video picks up the voices of staff members. One hospital staff member tells her, "You're stupid as hell." Another is heard saying Echaquan made bad life choices and asking her what her children would say if they saw her in that state.
    Dubé said it's clear hospital staff were degrading his wife and he doesn't understand how something like this could happen in 2020.
    Read full story
    Source: CBC News, 29 September 2020
  13. Patient Safety Learning
    Nearly half of trust chairs fail to “effectively deal with non-performing board members” according to a major study of the role of NHS non-executive directors seen by HSJ.
    The Henley Business School conducted in-depth research over a two-year period for its report 'The Independent Director in Society: Our Current Crisis of Governance & What to Do About It' which is published later this month. The research included a survey of NHS non-executive directors, which reveals that they have a broadly positive view about their contribution but also reveals significant areas of concern.
    Only 55% of respondents agreed with the statement that NHS trust chairs “effectively deal with/remove non-performing and/or disruptive board members”. Just 47% said chairs had “positive relations with the media.”
    The survey was undertaken before the onset of the pandemic, but nearly a third of the respondents disagreed with the statement that NHS chairs were “effective in a crisis”. However, almost every survey respondent claimed trust chairs had “high moral values” which were “aligned with those of the organisation.”
    All but 2% of respondents backed the idea that non-executive directors “have a sense of duty to see things are done both ethically and morally”, while 94% claimed they were “truly independent”. However, a fifth claimed it was impossible for non-executive directors to be effective “given the mandate of the NHS”.
    Read full story (paywalled)
    Source: HSJ, 1 October 2020
  14. Patient Safety Learning
    General practices will struggle to cope with a second wave of COVID-19 unless urgent measures are put in place to support them, the BMA has warned.
    It said that practices in England were reporting that they did not have the capacity to carry out all of the work required of them while managing ongoing patient care, dealing with the backlog of care put on hold during the first wave of the pandemic, and reconfiguring services.
    Richard Vautrey, chair of the BMA’s General Practitioners Committee England, said, “GPs, like all doctors, are extremely concerned that without decisive action now services will be overwhelmed if we see another spike in the coming weeks and months.”
    In the report, the committee called for a package of measures to support the GP workforce, including making occupational health services available to all staff to ensure that they are properly risk assessed and to provide free supplies of personal protective equipment. It also called for the suspension of routine inspections by the Care Quality Commission and of the Quality and Outcomes Framework, as part of efforts to reduce bureaucracy.
    NHS England’s covid support fund for practices should be rolled over until March 2021 and expanded to ensure that all additional costs such as additional telephony and cleaning are included, it added.
    Vautrey said, “The measures we’ve outlined are aimed at supporting practices and their staff to deliver high quality care while managing the increased pressures of doing so during a pandemic, and it is vital that the government and NHS England listen and implement these urgently, to ensure that primary care can continue to operate safely through what looks to be an incredibly difficult winter.”

    Read full story
    Source: BMJ, 1 October 2020
  15. Patient Safety Learning
    The surgeon at the centre of a body parts scandal operated on patients who were dangerously sedated so that their procedures could be carried out simultaneously, according to a leaked investigation seen by The Independent.
    Renowned hip surgeon Derek McMinn and two anaesthetists at Edgbaston Hospital, Birmingham, were accused of putting “income before patient safety” in the internal investigation for BMI Healthcare, which runs the hospital.
    It comes after a separate review found that McMinn had hoarded more than 5,000 bone samples from his patients without a licence or proper permission to do so over a period of 25 years, breaching legal and ethical guidelines. Police are investigating a possible breach of the Human Tissue Act.
    According to the report on sedation by an expert from another hospital, the two anaesthetists, Imran Ahmed and Gauhar Sharih, sedated patients for so long that their blood pressure fell to dangerous levels in order to allow McMinn to carry out near-simultaneous surgery.
    It found this meant long delays in the operations starting, with one sedated patient being subjected to prolonged anaesthesia for longer than one hour and 40 minutes – recommended best practice is 30 minutes.
    Another patient was apparently "abandoned" for an hour and 26 minutes after their surgery was only partially completed while McMinn began operating on another patient.
    The report’s author, expert anaesthetist Dr Dhushyanthan Kumar of Coventry’s University Hospital, said this was unsafe practice by all three doctors and urged BMI Healthcare to carry out a review of patients to see if any had suffered lasting brain damage. Both anaesthetists work for the NHS – Ahmed at Dudley Group of Hospitals, Sharih at University Hospitals Birmingham – without restrictions on their ability to practise.
    Read full story
    Source: The Independent, 30 September 2020
  16. Patient Safety Learning
    Doctors and carers should look out for signs of confusion or strange behaviour in frail older people because it could be an early warning sign of COVID-19, research suggests.
    Even if they have no cough or fever, delirium is more common in vulnerable over-65s than other, fitter people of the same age. But it's not yet clear why this extreme confusion or delirium happens.
    In this King's College London study, data from more than 800 people over the age of 65 was analysed. They included 322 patients in hospital with COVID-19, and 535 people using the Covid Symptom Study app to record their symptoms or log health reports on behalf of friends and family. All had received a positive test result.
    The researchers found that older adults admitted to hospital who were classified as frail were more likely to have had delirium as one of their symptoms, compared with people of the same age who weren't frail.
    For one in five patients in hospital with Covid, delirium was their only symptom.
    The study calls for more awareness of it in hospitals and care homes.
    Read full story
    Source: BBC News, 30 September 2020
  17. Patient Safety Learning
    Almost nine in ten maternity services experienced a decline in emergency pregnancy appointments during the pandemic due to women avoiding healthcare providers amid coronavirus chaos, a study has found.
    The Royal College of Obstetricians and Gynaecologists, who carried out the research, said women refrained from attending appointments due to anxiety around going into a hospital and fears of overwhelming the NHS, as well as not being clear if the appointments were essential.
    Researchers found 70% of maternity services reported a reduction in antenatal appointments, while 60% of units stopped the option of giving birth at home or in a midwife-led unit. Over half of services said postnatal appointments after childbirth had been reduced.
    The findings come as maternity services warn staff must not be sent to work in other parts of the hospital in the wake of a second wave of coronavirus.
    Royal College of Obstetricians & Gynaecologists and the Royal College of Midwives, who together represent the overwhelming bulk of maternity staff, say there must not be a repeat of the acute and widespread maternity staff shortages which played out during the health emergency’s peak.
    Read full story
    Source: The Independent, 30 September 2020
     
  18. Patient Safety Learning
    The stress and anxiety caused to patients by "poor communication" from NHS bodies in England during the covid pandemic has been criticised by MPs.
    While recognising the huge burden placed on the NHS, their report said cancelled treatments and surgery had left some "in limbo" and others "too scared" to seek medical help. The report also questioned why weekly testing of NHS staff had not yet begun. And it called for their mental and physical wellbeing to be supported.
    Jeremy Hunt, who chairs the Health and Social Care Committee, which compiled the report, praised the "heroic contribution" made by front-line NHS staff during the pandemic, which had saved many lives. But he said the pandemic had "massively impacted normal NHS services" and this situation could have been improved with clearer communication to patients and better infection control measures in hospitals.
    The report, based on evidence from doctors, nurses, patient groups and NHS leaders, said the case for routine testing for all NHS staff in all parts of the country was "compelling" and it should be introduced as soon as possible before winter to help reduce the spread of the virus.
    The government and NHS England told the committee they wanted to bring in routine testing of staff but any plans depended on the capacity available.
    Read full story
    Source: BBC News, 1 October 2020
  19. Patient Safety Learning
    Most operations have been cancelled at a hospital in a COVID-19 hotspot in south Wales after an outbreak of the virus involving more than 80 people.
    Hospital chiefs said transmission had taken place within the Royal Glamorgan hospital at Llantrisant and some wards where patients and staff had been infected were closed.
    The hospital, which is within Rhondda Cynon Taf, one of the areas under local lockdown restrictions, said it was trying to speed up the testing of patients and staff.
    In a statement, it said: “Significant temporary service restrictions will be put in place at Royal Glamorgan hospital from 2pm Wednesday 30 September as increased action is taken to contain a COVID-19 outbreak within the hospital.
    Teams have been working at pace to implement robust measures to manage the outbreak. However, additional cases linked to transmission within the hospital have been confirmed in recent days with the number of cases currently standing at 82."
    Andrew RT Davies, shadow health minister for the Welsh Conservatives, called on the Welsh government to explore using field hospitals and other health facilities to alleviate pressure on the Royal Glamorgan.
    He added: “This is very concerning, particularly as many of the additional cases are linked to transmission within the hospital, and so questions over processes and protocols must be asked.”
    Read full story
    Source: The Guardian, 30 September 2020
  20. Patient Safety Learning
    A frailty index is rationing treatment for older and disabled people who catch coronavirus, says Patience Owen. Patience has has a debilitating connective tissue disorder and, like thousands of others with rare conditions, is already in a minority within a minority, marginalised by our NHS, battling increasing disability day by day.
    Back in March, without consultation and days before the first lockdown, the Clinical Frailty Scale (CFS), a worldwide tool used to swiftly identify frailty in older patients to improve acute care, was adapted by the National Institute for Health and Care Excellence (NICE). It asked NHS staff in England to score the frailty of Covid patients. Rather than aiming to improve care, it seems the CFS – a fitness-to-frailty sheet using scores from one to nine – was used to work out which patients should be denied acute care. Nice’s new guidelines advised NHS trusts to “sensitively discuss a possible ‘do not attempt cardiopulmonary resuscitation’ decision with all adults with capacity and an assessment suggestive of increased frailty”.
    "Checking the scale, I found I would score five, the 'mildly frail' category, and therefore should I get Covid I could be steered towards end-of-life care. Bluntly, if I catch the virus, the NHS may help me to die, not live," says Patience.
    By early April, there was a proliferation of illegal “do not resuscitate” (DNR) notices in care homes for people with learning disabilities, and for older people in care homes and in hospitals. Many acutely ill patients stayed at home with Covid symptoms in the belief that they risked being denied care in hospital. Following warnings by the healthcare regulator, the Care Quality Commission, and other medical bodies, that the blanket application of the notices must stop, and legal challenges by charities, exclusions were made to the NICE guidelines.
    These included “younger people, people with stable long-term disabilities, learning disabilities or autism”. Yet the guidelines remain in place, in spite of the fact that they appear to contravene the Human Rights Act (including the right to life, article 2, and the right to non-discrimination, article 14). 
    A spokeswoman for NICE says it is “very aware of the concerns of some patient groups about access to critical care, and we understand how difficult this feels. Our COVID-19 rapid guideline on critical care was developed to support critical care teams in their management of patients during a very difficult period of intense pressure."
    “'Difficult' is a hollow word for the feeling of being selected to die," says Patience. "It’s difficult not to conclude that those with long-term conditions and disabilities, like myself, have become viewed as a sacrificial herd."

    Read full story
    Source: The Guardian, 29 September 2020
  21. Patient Safety Learning
    Experts say robust legal protections are needed to inspire public confidence. The UK government has set out plans to amend drug regulations in case it decides that COVID-19 vaccines should be used before they are licensed, in a bid to roll them out more quickly.
    In a consultation on the proposals that ran from 28 August to 18 September the Department of Health and Social Care for England explained that if a suitable vaccine emerged with strong evidence of safety, quality, and efficacy the government would seek to license it through the usual route but could supply it in the meantime.
    The document added, “A COVID-19 vaccine would only be authorised in this way if the UK’s licensing authority was satisfied that there is sufficient evidence to demonstrate the safety, quality, and efficacy of the vaccine. ‘Unlicensed’ does not mean ‘untested.”
    The consultation, and the timeframe in which it was conducted, prompted some people to post their concerns on social media. 
    However, the Human Medicine Regulations 2012 already allow the licensing authority to temporarily authorise the supply of an unlicensed product in response to certain public health threats, including the suspected spread of pathogens. The proposed change would allow conditions to be attached “to ensure product safety, quality, and efficacy”
    The 2012 regulations also give healthcare professionals and manufacturers immunity from being sued in the civil courts for the use of some unlicensed products recommended by the licensing authority in response to a public health threat. The new regulations would extend the immunity to drug companies that have not manufactured the product but placed it on the market with the approval of the licensing authority, and they clarify the consequences for a breach of conditions imposed by the authority.
    Social media posts play into existing concerns that many people might not accept the vaccine, as surveys indicate. Lawyers have told the Department for Health and Social Care that to inspire public confidence it must provide redress for the few people who might experience adverse effects.
    Bozena Michalowska, a partner specialising in product liability at the law firm Leigh Day, said, “I do not believe that people will want to play Russian roulette with their health by taking a vaccine which they know nothing about, especially when they know that the risks they take are just taken by them and not a shared risk and they will not have sufficient protection should things go wrong.”
    Read full story
    Source: The BMJ, 28 September 2020
  22. Patient Safety Learning
    Covid survivor Tam McCue is one of the lucky ones. Earlier in the year he was in intensive care in the Royal Alexandra Hospital in Paisley where he had been on a ventilator for nearly two weeks.
    At one point Mr McCue, who could barely speak, didn't think he would live. 
    Fast forward five months and Mr McCue, of Barrhead, East Renfrewshire, is back from the brink.
    He became desperately ill but, thankfully, it only went as far as his lungs. With coronavirus some patients have have suffered multiple organ failure which also affected their heart, kidneys, brain and gut.
    Mr McCue describes his recovery as a "rollercoaster".
    He added: "It's a slow process. You think you can do things then the tiredness and fatigue sets in."
    He said: "It lies in the back of your mind. As years go on, how are you going to be? Is it going to get you again? It does play on you. It definitely does."
    As part of his recovery Mr McCue is attending the Ins:pire clinic online. It is normally a face-to-face rehabilitation clinic which involves multiple specialties, including pharmacists, physiotherapists and psychologists. Mr McCue is one of the first Covid survivors to take part in the five-week programme, which started earlier this month.
    Read full story
    Source: BBC Scotland News, 29 September 2020
  23. Patient Safety Learning
    Official data from mid-September shows that nearly 6,400 people had waited more than 100 days following a referral to cancer services.
    The leaked data reveals for the first time the length of the cancer waiting list in the wake of the first pandemic peak, during which much diagnostic and elective cancer care was paused.
    The list consists of those waiting for a test, the outcome of a test, or for treatment. NHS England and Improvement only publish waiting times for patients who have been treated – not the number still waiting – so this information has been secret.
    The data, obtained from official emails seen by HSJ, showed the total number of people on the cancer waiting list grew substantially, from 50,000 to around 58,000, between the start of August and the middle of September. 
    Of the 6,400 people recorded to be waiting more than 104 days on 13 September, 472 had a “decision to treat classification”, meaning they have cancer and are awaiting treatment. 
    NHS England has said reducing the cancer waiting list would be overseen by a national “taskforce”, which is being chaired by national director for cancer Peter Johnson.
    Experts have warned the delays already stored up in the system could cost tens of thousands of lives as patients go undiagnosed or have their diagnosis and treatment later than they otherwise would.
    HSJ asked NHS England if harm reviews had been carried out for those on the waiting list and whether it had discovered if those waiting longer than104 days had been harmed, but did not receive an answer.
    Read full story (paywalled)
    Source: HSJ, 29 September 2020
  24. Patient Safety Learning
    The NHS is facing a "triple whammy" of rising COVID-19 cases, a major backlog in treatment and reduced capacity due to infection-control measures, according to health bosses. 
    The NHS Confederation report on the English NHS said more investment was desperately needed. The NHS bosses also called on ministers to be "honest and realistic" about waiting lists for treatment.
    It comes despite the government promising an extra £3bn this winter. That money - announced over the summer - was intended to help hospitals cope with the extra-infection control measures required and to pay for patients to be treated privately for routine treatment, such as knee and hip replacements. 
    But hospitals are still performing only half the number of routine operations they normally would. Two million patients have already waited longer than 18 weeks for treatment, the highest number since records began, in 2007.
    And services in other areas, such as cancer care, are running at about three-quarters capacity. 
    Of the more than 250 bosses who responded to the confederation's survey:
    fewer than one in 10 said the current level of funding allowed them to deliver safe and effective care nearly nine in 10 said a lack of funding would be a significant barrier to achieving waiting-time targets for everything from mental-health care to cancer treatment and routine operations. Read full story
    Source: BBC News, 29 September 2020
  25. Patient Safety Learning
    When Sarah found herself suffering sudden bouts of breathlessness in May, she took herself to hospital. But after her COVID-19 swab test came back negative, doctors said she was probably anxious, and sent her home.
    Despite this, Sarah’s symptoms continued to worsen. A week later, she was rushed to hospital in an ambulance. Paramedics told her that based on her clinic observations, she should be in a coma.
    Then came more surprising news: She had tested positive for coronavirus
    Sarah’s story – given to a patient safety charity under a pseudonym – is one that resonates with Dr Claudia Paoloni, president of the Hospital Consultants and Specialists Association. She detailed another case in which a patient tested negative twice: once when she was first admitted to hospital and once later in her hospital stay. She finally tested positive on her third test – by which time she was on a ventilator in intensive care.
    Paolini believes COVID-19 swab tests produce a troublingly high rate of false negative results, and the problem lies in the reliance on a single test.
    “To use as a one-off test in any capacity to exclude someone from having COVID-19 is a folly.” 
    If you want to exclude someone from having the virus, Paoloni said, you must do multiple tests and collect multiple negative results. “If the test and tracing system is not working, which is the case here, transmission will continue unabated in the community.”
    The most recent data published by the Office for National Statistics says the test’s sensitivity - which it says can tell us how likely it is to return a false-negative result, may be somewhere between 85% and 98%. 
    Dr Deenan Pillay, Professor of Virology at University College London and member of Independent Sage, a group of scientists providing transparent advice during the crisis, said a significant number of self-administered tests could be coming back negative for people who do in fact have the virus.
    “The single biggest reason why a swab from someone who has COVID-19 comes up as negative is the quality of the swab that is taken,” Dr Pillay said. “Swabbing your nose and throat in a way that will pick up the virus means really scraping down the side of the wall of the nose or back of the throat to get cells from the lining of the throat. That’s not a pleasant thing to do.”
    This is of course true for at-home testing, which relies on the patient or a family member to collect the swab. But it could be true at testing centres, too.
    Tom, a 29-year-old from London whose name has been changed for this story, said there were no medical staff on site when he visited a Covid testing centre in London. The only people he interacted with were staff from a third-party contractor paid to carry out testing.
    “The man simply handed me a test, read out the instructions to self-administer the test, and asked me to do it myself,” he said.
    Pillay agrees that testing methods are likely to have an impact on false negative results. “I have seen the documentation given out at testing centres and it is very confusing,” he said. “Centres often expect you to administer the test yourself or get someone else in your car to administer it for you, all of which creates difficulties.” 
    Pillay believes the solution lies in having medically trained staff at testing centres. “The way the system is developed at the moment, outsourced to private companies like Deloitte and Lighthouse Labs, is just woeful,” he said.
    “The whole system is failing at the moment. And it’s happening just as the numbers of infections are starting to rise,” Dr Pillay said.
    Read full story
    Source: Huffpost, 27 September 2020
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