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Patient Safety Learning

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  1. Patient Safety Learning
    A troubled trust’s inpatient wards for people with a learning disability or autism have been rated “inadequate”, with staff criticised for resorting to restraint too readily which sometimes injured patients.
    Care Quality Commission inspectors visited Lanchester Road Hospital in Durham and Bankfields Court in Middlesborough, run by Tees, Esk and Wear Valleys Foundation Trust, in May and June.
    They found most people were being nursed in long-term segregation and some patients had very limited interaction with staff.
    Among the CQC’s main criticisms was of high levels of restrictive practice used by staff, including seclusion, restraint and rapid tranquilisation.
    Inspectors said incidents were not always recorded and staff did not learn from them to reduce levels of restrictions in place. They also warned staff were not always able to understand how to protect people from poor care and abuse.
    Karen Knapton, CQC’s head of hospital inspection, said: “Three people had been injured during restraints, and 32 incidents of injury had been reported for healthcare assistants, some requiring treatment.
    “This is unacceptable and measures must be put in place to keep patients and staff safe.”
    Read full story (paywalled)
    Source: HSJ, 5 October 2022
  2. Patient Safety Learning
    The physical and mental health of tens of thousands of cancer patients in England and Wales is deteriorating because they are having to wait months for financial support from the government, a charity has warned.
    Macmillan Cancer Support said many are waiting as long as five months to receive their personal independence payment (PIP), which is paid to people with long-term physical and mental health conditions or disability, and who have difficulty doing certain everyday tasks or getting around.
    Health leaders said the “unacceptable” situation had now become critical, with thousands of cancer patients increasingly desperate for help.
    Research for the charity found that among people with cancer who receive PIP, more than one in four (29%) have reported a deterioration in physical or mental health while they wait to receive it. This rises to almost half (46%) among those who wait more than 11 weeks to receive their first payment.
    Macmillan is launching a “Pay PIP Now” campaign, saying it is hearing from patients going into debt, skipping meals and cancelling medical appointments due to travel costs, all because of delays to PIP. It wants ministers to cut the average wait times for PIP from 18 weeks at the moment to 12.
    Research suggests most people with cancer suffer a financial impact from their diagnosis, including from being unable to work while having treatment, increased heating bills to stay warm and the cost of attending appointments.
    Read full story
    Source: The Guardian, 6 October 2022
  3. Patient Safety Learning
    Several ambulance trusts have moved to the highest level of alert in the wake of severe pressure on emergency services in recent days.
    Internal data seen by HSJ suggests ambulance response times have deteriorated dramatically, while the average time for call handlers to answer 999 calls has increased to almost two minutes in some areas.
    Staff across the country have been sounding the alarm over the pressures, with one senior source saying the situation was “really dire” again, after a period in which pressures had eased in August and September.
    The internal data showed ambulance trusts in the South West, East of England, London and the West Midlands had all declared the highest level of alert, known as REAP 4. More are expected to follow.
    The average response time for category 2 calls in the South West – including suspected heart attacks and strokes – was 1 hour 24 minutes, with 10% of these calls responded to in more than 3 hours 11 minutes. The target is 18 minutes.
    Emergency departments have also faced severe pressure. An emergency care consultant in Plymouth tweeted that patients were facing 70-hour waits to be admitted to wards, with some waiting 18 hours to be handed over by ambulance staff. Fionna Lowe added: “I have taken to asking families to feed their relatives. It has never been this bad.”
    Read full story (paywalled)
    Source: HSJ, 4 October 2022
     
  4. Patient Safety Learning
    An artificial intelligence (AI) tool that scans eyes can accurately predict a person’s risk of heart disease in less than a minute, researchers say.
    The breakthrough could enable ophthalmologists and other health workers to carry out cardiovascular screening on the high street using a camera – without the need for blood tests or blood pressure checks – according to the world’s largest study of its kind.
    Researchers found AI-enabled imaging of the retina’s veins and arteries can specify the risk of cardiovascular disease, cardiovascular death and stroke.
    They say the results could open the door to a highly effective, non-invasive test becoming available for people at medium to high risk of heart disease that does not have to be done in a clinic.
    “This AI tool could let someone know in 60 seconds or less their level of risk,” the lead author of the study, Prof Alicja Rudnicka, told the Guardian. If someone learned their risk was higher than expected, they could be prescribed statins or offered another intervention, she said.
    Speaking from a health conference in Copenhagen, Rudnicka, a professor of statistical epidemiology at St George’s, University of London, added: “It could end up improving cardiovascular health and save lives.”
    Read full story
    Source: The Guardian, 4 October 2022
  5. Patient Safety Learning
    A care home that will close after admitting "shortcomings in care" and failures in leadership has been labelled "not safe" by inspectors.
    The Elms in Whittlesey, Cambridgeshire will shut later this month, and the Care Quality Commission (CQC) has found the service to be inadequate.
    In May, the BBC first reported the concerns of relatives about The Elms after their loved ones died in 2019, weeks after a meeting in which worries were raised about "poor care".
    Inquests into the deaths of the residents - George Lowlett, Margaret Canham and David Poole - remain ongoing. HC-One also apologised to the family of Joyce Parrott, who died in April 2020.
    Inspectors found "people were not safe and were at risk of avoidable harm" and described multiple occasions when people had "not received their medicines as prescribed".
    Other findings included:
    Staff had not referred all potential safeguarding events to the local authority A failure to "establish systems to ensure people were effectively safeguarded from abuse" The provider had failed to learn when things went wrong "Widespread and significant shortfalls" in leadership No reliable record of the staff that had worked at the home and a reliance upon agency staff, which "resulted in people not receiving consistent care" Read full story
    Source: BBC News, 5 October 2022
  6. Patient Safety Learning
    A ‘leading’ cancer service has reported a series of safety incidents which contributed to patients being severely harmed or dying, HSJ  has reported.
    An internal report at Liverpool University Hospitals Foundation Trust suggests the incidents within the pancreatic cancer specialty were partly linked to patient pathways being ill-defined following the merger of its two major hospitals.
    The report lists seven incidents involving severe harm or death, and five involving moderate harm. It is not clear how many of the patients died.
    The trust was formed in 2019 through the merger of the Royal Liverpool and Aintree acute sites, with the consolidation of clinical services an integral part of the plans. However, there were no formal plans to change the configuration of pancreatic cancer services, which already operated under a “hub and spoke” model.
    In one finding relevant to all 12 incidents, the report said: “Patient ownership and clinician accountability (local vs specialist) have not been defined following the merger of the legacy trusts and subsequent service reconfigurations.
    “This has contributed to system failures in the provision of timely quality care, particularly in patients with time-critical clinical uncertainty.”
    Read full story (paywalled)
    Source: HSJ, 5 October 2022
  7. Patient Safety Learning
    Bereaved families fear their experiences will be “diluted” in the UK Covid-19 Inquiry after it was confirmed their evidence would be submitted to a third-party company.
    Instead of the usual “pen portraits” heard in the inquiry, families will submit their evidence to a private research company as part of a parallel listening exercise that will analyse the responses and feed back the findings to the inquiry chaired by Baroness Heather Hallett.
    Matt Fowler, co-founder of the Covid-19 Bereaved Families for Justice campaign, said while families believe the start of the inquiry is a step in the right direction after campaigning for two years, they fear being excluded from the inquiry because of the listening exercise.
    “All bereaved families want from the inquiry is the same outcome that anyone should, for lessons to be learnt from our loss that can stop the monumental scale of death that took place from happening again,” Matt said following the preliminary hearing. “As Baroness Hallett herself has acknowledged, for that to happen the experiences of the bereaved must be learnt from, so why is she leaving us out in the cold instead of working with us?”
    A&E doctor Saleyah Ahsan, from east London, worked in intensive care units during the pandemic. She said she remembers holding hands with people and telling them they needed to be incubated as they desperately called their families – some died in intensive care.
    “It is very important that stories jump off the page and are real because they are real,” 
    She added: “If we really want to make sure we get this right there is only this inquiry, it has to be right. I am a medic, I see the numbers are rising, it’s autumn. Thankfully we’ve got a booster but hospitals are getting busy – I’m worried.”
    Read full story
    Source: The Independent, 4 October 2022
  8. Patient Safety Learning
    Tina Hughes, 59, died from sepsis after doctors allegedly delayed treating the condition for 12 hours while they argued over which ward to treat her on.
    Ms Hughes was rushed to A&E after developing symptoms of the life-threatening illness on September 8 last year. Despite paramedics flagging to staff they suspected sepsis, it was not mentioned on her initial assessment at Sandwell General Hospital, in West Bromwich.
    A second assessment six hours later also failed to mention sepsis while medics disagreed over whether to treat her on a surgical ward or a high dependency unit.
    The grandmother-of-five was eventually transferred to the acute medical unit at 3am the next morning where sepsis was finally diagnosed, but she continued to deteriorate and was admitted to intensive care four hours later and put on a ventilator.
    She died the following morning.
    A serious incident investigation report by Sandwell and West Birmingham Hospitals NHS Trust has since found there was "a delay in explicit recognition of sepsis".
    Read full story (paywalled)
    Source: The Telegraph, 4 October 2022
  9. Patient Safety Learning
    A young teenager with complex needs in local authority care has been deprived of their liberty and held in hospital for several months because no secure placement could be found anywhere in England, a family court has heard.
    General hospitals are not registered to provide secure accommodation for children in this situation, and do not have the specialist staff required to provide the care and therapeutic input needed.
    High court judges have repeatedly raised concerns that children in urgent need of secure accommodation are waiting months to find a place, to the detriment of their mental health.
    England has an acute shortage of secure therapeutic placements for children with severe emotional and psychological needs. Government figures published in March show there are just 132 spaces in secure homes for children with urgent and complex needs.
    On any given day, about 50 children – twice as many as in the previous 12 months – were seeking a placement. About 30 children – an increase of a third on the previous 12-month period – end up placed hundreds of miles from home in Scotland due to the lack of available secure units in England.
    A Department for Education spokesperson said: “All children and young people deserve to grow up in stable, loving homes, and local authorities have a statutory duty to ensure that there are enough places for their looked-after children.
    “We are supporting local authorities through providing £259m to maintain capacity and expand provision in secure and open children’s homes.
    “This will provide high quality, safe homes for some of our most vulnerable children. It will mean children can live closer to their families, schools, and health services, in settings that meet their needs.”
    Read full story
    Source: The Guardian, 4 October 2022
  10. Patient Safety Learning
    Underperforming hospitals face special measures before what ministers warn will be one of the worst winters in the history of the NHS.
    Thérèse Coffey, the health secretary, told a fringe event at the Conservative Party conference that there was too much “variation in what patients experience” as her department plans to impose closer control on failing hospitals.
    Robert Jenrick, the NHS minister, said that the government “shouldn’t be tolerant of those parts of the NHS which are underperforming” and had demanded quicker improvement from more than a dozen hospitals.
    He acknowledged that NHS staff were overstretched in the aftermath of the pandemic, saying that he wanted to “put boosterism to one side” and accept that the shortage of doctors and nurses was the biggest problem facing the health service.
    However, he also questioned why some hospitals were doing so poorly when other nearby hospitals with similar problems were seeing much shorter waits.
    “A very striking dynamic is the variability that we see within the NHS and I think this is where we as Conservatives have a message, which is that we shouldn’t be tolerant of those parts of the NHS which are underperforming.”
    Read full story (paywalled)
    Source: The Times, 4 October 2022
  11. Patient Safety Learning
    The latest NHS workforce figures have shown that a record number of staff voluntarily resigned from their jobs during the first quarter of this financial year.
    According to the data, almost 35,000 NHS workers resigned voluntarily, which was up from 28,105 during the same period in 2021, and 19,380 in 2020. It is also higher than in any equivalent first quarter over the last 10 years.
    The most common reason for leaving during quarter one of 2021-22 was ‘work-life balance’, with almost 7,000 NHS workers citing this as their reason for leaving their jobs.
    Close to 2,000 NHS workers also left in the same period in search of a ‘better reward package’, with almost 1,000 reporting ‘incompatible working relationships’. In it unclear from the NHS digital data whether they left the NHS altogether.
    Read full story (paywalled)
    Source: HSJ, 3 October 2022
  12. Patient Safety Learning
    If doctors had tested a nine-year-old girl's blood sooner they may have changed the treatment she received before her death, an expert witness has confirmed to a medical tribunal.
    The hearing was told this was a "significant failure" in the care of Claire Roberts.
    Claire died at the Royal Belfast Hospital for Sick Children in 1996. In 2018 a public inquiry concluded she died from an overdose of fluids and medication caused by negligent care. At the time, her parents were told a viral infection had spread from her stomach to her brain.
    The General Medical Council (GMC) said one of the doctors involved in Claire's care, Dr Heather Steen, acted dishonestly in trying to conceal the circumstances of her death.
    Dr Steen denied allegations that she acted dishonestly and engaged in a cover-up.
    The Medical Practitioners Tribunal Service (MPTS) heard from a defence expert witness on Monday who said doctors not checking the sodium levels in Claire's blood earlier was a "significant failure" in her care.
    Dr Nicholas Mann told the tribunal he would have ordered more blood tests on Claire on the morning after she was admitted to hospital but he said he did not know if this would have prevented her death.
    "There should have been more attention to her fluids and electrolytes on the day after admission. Whether that would have altered the final outcome I don't know but certainly it would have been sensible to do that," he said.
    The tribunal also heard that Claire's death was not referred to a coroner, despite this being something all of the doctors caring for her would have had a duty to do.
    It was also told that a letter sent to Claire's parents from the hospital in 2005 contained inaccuracies.
    During questioning of Dr Mann, a barrister for the GMC highlighted the involvement of Dr Steen in compiling the letter which was signed by another doctor. Tom Forster KC said it was the GMC's case that Claire's family were given incorrect information about potential causes of her death despite these not being definitively diagnosed.
    Read full story
    Source: BBC News, 3 October 2022
  13. Patient Safety Learning
    Lung cancer screening should be offered to over-55s who have smoked, government advisers have said.
    New guidance from the UK National Screening Committee has called for a mass introduction of checks for all present and former smokers between the ages of 55 and 74. While the NHS offers routine screening for other types of cancer, including breast, bowel and cervical, there is no lung cancer screening programme.
    Lung cancer is the UK’s deadliest form and every year 48,000 people are diagnosed, with 35,000 deaths. The death rate is so high because it is often spotted when symptoms develop and it is too late for treatment. Only 5% of those diagnosed with lung cancer at the latest stage survive for five years, but when picked up early more than half survive.
    Officials have recommended targeted screening to cut death rates. It involves a CT scan which takes a detailed picture of the lungs to look for abnormalities.
    The National Screening Committee said that targeting all of those who have smoked would reduce deaths because 70% of lung cancer cases are caused by smoking.
    Read full story (paywalled)
    Source: The Times, 30 September 2022
  14. Patient Safety Learning
    Hundreds of thousands more women than men have been prescribed powerful anti-anxiety drugs which experts warn are harder to come off than heroin, The Independent can reveal.
    New information obtained under freedom of information (FOI) laws shows women in England were 59% more likely to be prescribed benzodiazepines – better known by the brand names of Valium, Xanax and Temazapam – than men between January 2017 and December 2021.
    Benzodiazepines are commonly prescribed for anxiety and insomnia, with the drug’s withdrawal symptoms including depression, acute anxiety, insomnia, vivid nightmares, headaches, vomiting, shakes, cramps and, in the worst cases, seizures which can cause death.
    Many countries explicitly state benzodiazepines should not be taken for more than four weeks, while research has found benzodiazepines can cause memory loss and Alzheimer’s.
    In September 2020, the US Food and Drug Administration announced its “black box warning” must be placed on all benzodiazepines to inform patients withdrawal from the drugs can be life-threatening.
    Stephen Buckley, head of information at Mind, a leading UK mental health charity, told The Independent it was difficult to “know the exact reasons behind why women are more likely to be prescribed benzodiazepines than men” but said the FOI “findings support others which show gender discrepancies in prescribing have been occurring for a long time”.
    “Previous research in some parts of the world has found that male prescribers were more likely to prescribe benzodiazepines to female patients than male patients. Research into the reasons behind gender differences in prescribing psychiatric medication is important.”
    Read full story
    Source: The Independent, 3 October 2022
    Related reading:
    Medicines, research and female hormones: a dangerous knowledge gap Gender bias: A threat to women’s health
  15. Patient Safety Learning
    The first preliminary hearing of the UK Covid public inquiry will begin today.
    The session, in London, will focus on the UK's pandemic preparedness before 2020. It will be largely procedural, involving lawyers and an announcement about who will be giving evidence. Public hearings where witnesses are called will not start until the spring.
    The inquiry formally started in the summer, with a listening exercise.
    But this first preliminary hearing is still being seen as an important milestone for the families who lost loved ones.
    Lindsay Jackson's mother, Sylvia, 87, died from Covid during the first lockdown, after contracting it at a care home.
    Ms Jackson, of the Covid-19 Bereaved Families for Justice campaign group, said it was essential lessons were learned.
    She was "really pleased" the inquiry was finally starting but it had taken too long to reach this stage. 
    "It's two-and-a-half years since the pandemic started," she said.
    "We lost so many people. If people have done things wrong, they need to be held accountable.
    "For me, my family and the others who lost loved ones, it's important that answers are found to the questions that we have."
    Read full story
    Source: BBC News, 4 October 2022
  16. Patient Safety Learning
    People who have recently been diagnosed with dementia, or who are diagnosed with the condition at a younger age, are among those at increased risk of suicide, researchers have found. The findings have prompted calls for greater support for those experiencing such cognitive decline.
    While previous research has explored a potential link between dementia diagnosis and suicide risk, the results have been inconclusive, with some suggesting a raised risk and others a reduced risk.
    Now researchers say certain groups of people with dementia are at increased risk of suicide.
    “What it tells us is that period immediately after diagnosis is when people really need support from the services that provide the diagnosis,” said Dr Charles Marshall, co-author of the research and a clinical senior lecturer and honorary consultant neurologist at the Wolfson Institute of Population Health at Queen Mary University of London.
    In the first three months after being told they had dementia, those diagnosed before the age of 65 had an almost seven times greater risk of suicide compared with those without dementia – although this reduced somewhat over time.
    Marshall said it was unclear whether the findings were down to dementia itself causing people to feel suicidal, or factors such as people being concerned they may become a burden to their family.
    Read full story
    Source: The Guardian, 3 October 2022
  17. Patient Safety Learning
    Charities are warning that young cancer patients facing soaring living costs are in a "desperate" situation.
    Both Macmillan Cancer Support and Young Lives vs Cancer say they've seen dramatic increases in the number of people asking for emergency grants.
    Research suggests tens of thousands of 18 to 39-year-olds with cancer are struggling to pay basic living costs.
    Shell Rowe was among those who told BBC Newsbeat they're worried about becoming financially independent.  She was diagnosed with stage four non-Hodgkin's lymphoma at age 20 in 2019, just as she was about to study film in California for her third year of university.
    "Prices have skyrocketed. I haven't been able to work and haven't been able to save and get a job," she says. "How am I ever going to be able to be financially independent? It really scares me."
    More than half of the 18 to 39-year-olds with cancer surveyed by Macmillan and Virgin Money said they needed more financial support to manage the rising cost of living.
    One in four young people are getting further into debt or have fallen behind paying rent and energy bills because of increased living costs, according to the survey of 2,000 people across all age groups.
    More than a tenth (11%) of those surveyed say they've had to delay or cancel medical appointments due to the rising cost of petrol. Many people have to travel long distances for treatment, often in their own cars or a taxi because the risk of infection rules out taking public transport.
    "It's never been as bad as this. Young people with cancer are in really desperate circumstances, because of the cost-of-living crisis," says Rachel Kirby, chief executive of Young Lives vs Cancer. "No young cancer patient should have to think about the choice of putting fuel in the car to get to treatment, or whether they can heat their homes. But those are the kinds of situations they're facing," 
    Read full story
    Source: BBC News, 3 October 2022
  18. Patient Safety Learning
    Only a handful of integrated care systems have so far managed to implement a key expansion in their support for patients in mental health crisis.
    Internal NHS England documents, seen by HSJ, suggest that only 7 out of 42 health systems have begun offering enhanced mental health crisis support through the 111 helpline.
    This was a key target set out by the NHS long term plan in 2019, to be fully rolled out by next year. Some areas of the country have implemented the expansion, but others are lagging well behind, the document suggests.
    Currently, all areas offer separate 24/7 all-age crisis lines run by individual mental health trusts, offering brief psychological interventions and advice.
    But HSJ has been told of national problems affecting the existing helplines, with callers facing long waits. In a recent review, Healthwatch England said the services are having to “pick and choose” who to help because of high demand, which in effect led to “service rationing”.
    Siân Balsom manager for Healthwatch York, said: “People are overwhelmingly positive about the NHS. But there’s an acceptance that crisis support is not going to be there for people. That feels like a really bad place to be in.
    “We know people in the voluntary sector feel like they are holding people they don’t have the skills and experience to support. [They] feel they are holding people in the wrong service because the right service is not there for them.
    “People are trying to do a good job, but the system is more under pressure than it has ever been and there are clearly a lot of people who are experiencing significant mental illness who are not able to get support right there and then.”
    Read full story (paywalled)
    Source: HSJ, 3 October 2022
  19. Patient Safety Learning
    Every hospital in the UK is under significant pressure and a new Covid surge is “a very heavy straw on the camel’s back”, health leaders have warned.
    At least eight hospitals declared a critical incident, cancelled operations or asked people not to come to A&E unless they were seriously ill last week. One of Britain’s most senior emergency doctor said there were links between incidents like these and the rapid rise in hospitalisations for Covid, up nearly 37% in a week to 7,024. While the Office for National Statistics said it was too early to say if an autumn Covid wave had begun, health leaders said ministers need to urgently address staffing shortages.
    Dr Adrian Boyle, the incoming president of the Royal College of Emergency Medicine told the Observer: “Our system is under-resourced. We don’t have enough beds, and we don’t have the workforce for the demand that we’re being asked to deal with.
    “Covid just makes everything that much harder and it’s entirely valid to link this with critical incidents being called around the country. All hospitals are feeling significant levels of pressure at the moment. Covid is a very heavy straw on the camel’s back.”
    Read full story
    Source: The Guardian, 1 October 2022
  20. Patient Safety Learning
    Both patients and healthcare staff have a central role to play in ensuring the safe use of medicines, Health Minister Robin Swann has said.
    Minister for Health Robin Swann was speaking at an event to mark the roll out of the ‘Know, Check, Ask’ Campaign across all healthcare sectors in Northern Ireland. The aim of the campaign is to increase awareness and understanding about the importance of using medicine safely.
    The call for action of the campaign is for:
    Patients to Know Check Ask – Before you take it:
    KNOW your medicines and keep an up-to-date list. CHECK that you are using your medicines in the right way. ASK your healthcare professional if you’re not sure. Health Care staff to Know Check Ask – Before you give it:
    KNOW your medications. CHECK you have the right: patient, medicine, route, dose and time. ASK your patient if they understand and ask your colleagues when you are unsure. Minister Swann added “I want to encourage and help patients to be more curious about their medication, know what medication they are using, how to use it safely and feel able to ask their health care professionals questions about their medicines.  Patients should also feel able and confident to report problems with their medication early and so help reduce avoidable harm.”
    Read full story
    Source: Department of Health, 30 September 2022
  21. Patient Safety Learning
    Hospital authorities in Wales have been accused of attempting to cover up failings in the delivery of a baby born with significant brain damage.
    Gethin Channon, who was born on 25 March 2019 at Singleton Hospital, in Swansea, suffers from quadriplegic cerebral palsy, a severe disability that requires 24/7 care.
    There were complications during his birth, due to him being in an abnormal position that prevented normal delivery, and he was eventually born via caesarean section.
    An independent review commissioned by Swansea Bay University Health Board (SBUHB), which manages Singleton Hospital, found “several adverse features” surrounding Gethin’s delivery that were omitted from or “inaccurately specified” in the hospital’s internal report.
    The investigation, carried out by obstetrician Dr Bill Kirkup, said SBUHB had “significantly” downplayed the “suboptimal” care received by Gethin and his mother, Sian, and had erroneously attributed his condition to a blocked windpipe.
    It also suggests that amendments were retrospectively made to examination notes taken by staff during the course of Ms Channon’s labour.
    The family said that SBUHB, which was flagged by national inspectors in the months after Gethin’s birth due to “concerns” over its ability to deliver “safe and effective” maternity care, had “covered up” the failings in their case.
    SBUHB said it had been “working tirelessly” with the family to investigate and address their concerns, and that it would be inappropriate to comment on specific allegations as the process was ongoing.
    Read full story
    Source: The Independent, 2 September 2022
  22. Patient Safety Learning
    A “perilous” shortage of homecare workers is the biggest reason thousands of people are languishing longer in hospital than needed, driving up waiting lists and making people sicker, figures reveal.
    Almost one in four people unable to be discharged – sometimes for weeks – were trapped in hospital because they were waiting for home care, as agencies hand back contracts because staff are quitting owing to low pay, leaving 15% of jobs vacant.
    A fifth of people unable to be discharged were also waiting for short-term rehabilitation and 15% were waiting for a bed in a care home, according to analysis of data obtained using freedom of information requests and public records by Nuffield Trust and the Health Foundation.
    It estimated that in April this year, one in six patients were in hospital because of delayed discharge, and the discharge of patients with a hospital stay of more than three weeks was delayed by 14 days on average.
    “People are ending up in hospital for malnutrition and dehydration, problems which, even if you supported people a little bit at home, would stop,” said Jane Townson, the director of the Homecare Association.
    “More providers are having to turn down work than usual and some are having to hand back people because they can’t do it.”
    Read full story
    Source: The Guardian, 3 October 2022
  23. Patient Safety Learning
    Healthcare Improvement Scotland have been commissioned to lead a review into the neonatal death rates.
    It follows the higher than expected deaths in both March 2022 and September last year, as published by Public Health Scotland.
    At least 18 babies under four weeks old died in March – a rate of 4.6 per 1,000 births.
    The wider inquiry is understood to have been triggered because the mortality rate passed an "upper control" threshold of 4.4 per 1,000 births. The average mortality rate among newborns is just over 2 per 1,000 births.
    The Scottish Government said the investigation is expected to take no longer than six to nine months once the review team is formed.
    Public health minister Maree Todd said: “Every death is a tragedy for the families involved. That is why earlier this year I committed to this review to find out if there is a reason for the increase.
    “I appreciate how difficult this time is for anyone affected and I would encourage them to access support if they wish to do so. There is information about organisations and help available on the National Bereavement Care Pathways Scotland as well as the Scottish Government website.”
    Read full story
    Source: The Scotsman, 30 September 2022
  24. Patient Safety Learning
    Surgical blunders have soared 60% in five years – and extreme mistakes are now a daily occurrence in the NHS.
    Some 13,921 people were treated for damage caused by botched operations in the year to March 31 – up from 8,695 in England in 2016/17.
    Cases involved an “unintentional cut, puncture, perforation or haemorrhage”.
    Separately, a report from NHS England shows 134 patients fell victim to so-called Never Events from April 1 to July 31.
    Extreme errors included two women left infertile after their ovaries were wrongly removed. Injections and invasive tests were given to the wrong patients and in 39 cases foreign objects, such as drill bits and wires, were left inside bodies.
    There were 57 cases of surgery on the wrong body part and 12 instances of patients being given the wrong implant or prosthesis.
    The Royal College of Surgeons in England said: “If the system is overstretched, there is a risk that mistakes will happen.”
    Rachel Power, chief executive of the Patients Association, said: “When Never Events occur, the physical and psychological effects can stay with a patient for life.”
    Read full story
    Source: The Mirror, 1 October 2022
  25. Patient Safety Learning
    Hannah Rusby reassures her patient he’s in good hands. He is in his eighties, skeletal, confused and struggling to answer basic questions. His breathing is rapid.
    After a few minutes of probing questions and basic tests, Rusby knows this is serious — after months of decline while living alone, the man is critically ill and needs to go to hospital urgently.
    With more than 500,000 people waiting for social care assessments across England, emergency calls such as this are increasingly common. 
    “We are becoming a middleman for all the other services,” said Rusby, who qualified as a paramedic seven years ago and works for the London Ambulance Service (LAS). She said the job increasingly involves responding to people who fall through society’s cracks.
    Daniel Elkeles, 49, chief executive of the LAS, agrees: “There are lots of patients who, if something else were available, we wouldn’t need to take them to hospital. As the population has got older and frailer, it’s unsurprising that an increasing number of the calls are not traditional emergencies.”
    He believes paramedics can be the link between GPs, community nursing and social care.
    From next week, the LAS will pilot having three cars covering six boroughs in southwest London. Each will have a paramedic and a community nurse and will respond to 999 calls from elderly people who have fallen at home.
    They’re going to see every frail elderly person who has fallen [and] hasn’t broken a bone, and our aim is to keep all of those patients at home. The community nurse will assess the house to make sure it’s safe then refer the patient to their GP and an urgent community response team,” said Elkeles.
    The service hopes this will mean as many as 1,000 fewer people going to A&E a year.
    Read full story (paywalled)
    Source: Sunday Times, 2 September 2022

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