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Patient Safety Learning

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  1. Patient Safety Learning
    Unfilled specialised medical consultant roles and an over-reliance on overworked, internationally trained graduates for non-consultant hospital doctors are among key risks to patient safety identified by the Irish Medical Council.
    The council, which is the regulatory body for the medical profession, sets out the risks to healthcare for the first time in its workforce intelligence report that breaks down the make-up of the medical register and explains why doctors are leaving the health system.
    More than a third of all clinically active doctors are on the general register, which is a key risk to patient safety because consultant and specialist roles are not being filled and “a considerable proportion” of non-consultant hospital doctors are required to perform the duties of consultants.
    The report found that the majority of non-consultant hospital doctors are trained overseas and that the health system overly relied on these doctors who reported being “overworked, undervalued, experiencing discrimination and unable to access specialist training.”
    “Aside from the individual impact on the doctors, the treatment of international medical graduates has serious implications for patient safety,” the council said.
    In another risk identified by the regulatory body, more than a quarter of doctors reported working more than 48 hours a week, in breach of the European Working Time Directive.
    This has further serious implications for patient safety,” the council said.
    Read full story
    Source: Irish Times, 1 September 2022
  2. Patient Safety Learning
    NHS trusts across London are set to start moving patients from A&E onto wards “irrespective” of whether there are beds available, The Independent has learned.
    The new model, which involves moving patients every two hours out of A&E and onto wards called acute medical units, has prompted concerns that patients could be “double lodged” on hospital wards.
    The move follows the trial of a new system by North Bristol NHS Trust last month, which said it would be moving three patients every hour from A&E onto wards in a bid to address severe ambulance handover delays.
    On Thursday, health secretary Steve Barclay said that the “number one” priority for the NHS currently is tackling ambulance handover delays, with a “small” number of trusts accounting for half of all delays.
    In a memo seen by The Independent, NHS clinicians in one hospital were told that London trusts would be rolling out the North Bristol model at “pace” ahead of winter. The system involves moving one patient from A&E onto a ward every two hours “irrespective of bed availability”.
    Speaking to The Independent, one NHS director said the move would lead to “double lodging” patients, which means squeezing more patients into wards, and that this could be “dangerous” for patients.
    However, A&E doctors told The Independent that the move should be welcomed, as it spreads the crowding and risk for patients across hospital departments rather than confining it to A&E.
    Read full story
    Source: The Independent, 4 September 2022
  3. Patient Safety Learning
    Trying to strike a balance between free speech and public health, California’s Legislature on Monday approved a bill that would allow regulators to punish doctors for spreading false information about Covid-19 vaccinations and treatments.
    The legislation, if signed by Gov. Gavin Newsom, would make the state the first to try to legislate a remedy to a problem that the American Medical Association, among other medical groups and experts, says has worsened the impact of the pandemic, resulting in thousands of unnecessary hospitalisations and deaths.
    The law would designate spreading false or misleading medical information to patients as “unprofessional conduct,” subject to punishment by the agency that licenses doctors, the Medical Board of California. That could include suspending or revoking a doctor’s license to practice medicine in the state.
    While the legislation has raised concerns over freedom of speech, the bill’s sponsors said the extensive harm caused by false information required holding incompetent or ill-intentioned doctors accountable.
    “In order for a patient to give informed consent, they have to be well informed,” said State Senator Richard Pan, a Democrat from Sacramento and a co-author of the bill. A paediatrician himself and a prominent proponent of stronger vaccination requirements, he said the law was intended to address “the most egregious cases” of deliberately misleading patients.
    Read full story (paywalled)
    Source: New York Times, 29 August 2022
  4. Patient Safety Learning
    Record NHS waiting lists cannot be attributed to the pandemic as the health service has been “steadily declining” for a decade, a report says.
    The number of people waiting for routine hospital treatment in England has almost tripled from 2.5 million in April 2012 to 6.78 million, after reaching 4.6 million in February 2020.
    While Covid accelerated this trend, analysis suggests that even without the pandemic waiting lists for elective care would stand at 5.3 million.
    The Quality Watch report, by the Nuffield Trust and Health Foundation think tanks, says the NHS was “already stretched beyond its limits” before Covid struck.
    Analysis of performance figures show waiting times for scans, A&E and cancer care have been increasing for many years amid chronic staff shortages.
    This deterioration means thousands of cancer patients each month face unacceptably long waits for treatment — damaging their survival chances.
    The report found waiting times for 15 key diagnostic tests, such as MRI or CT scans, had also rocketed. In April 2012 632,236 patients were on waiting lists for these tests. This backlog increased to one million by February 2020 before hitting 1.6 million this year.
    Read full story (paywalled)
    Source: The Times, 5 September 2022
  5. Patient Safety Learning
    Senior health officials are to face questioning over why pregnant women are still being prescribed sodium valproate despite its known risks as a cause of birth defects or developmental delays.
    Campaigners for families affected by the drug will also give evidence to the Health and Social Care Committee in a one-off session later this month. Alongside campaigners on sodium valproate, the Committee will also hear from campaigners from Association for Children Damaged by Hormone Pregnancy Tests and on behalf of “Sling the Mesh” campaign.
    MPs will examine government progress on recommendations made in the Independent Medicines and Medical Devices Safety (IMMDS) Review, which specifically looked into sodium valproate, hormone pregnancy tests and vaginal mesh. An update by Ministers on progress to implement the government’s response was due this summer.  A Minister from the Department of Health and Social Care has been invited to appear before the Committee.
    The IMMDS Review’s report called for better communication to inform women of the risks of sodium valproate in pregnancy. Despite an NHS ‘valproate pregnancy prevention programme’, 247 women since April 2018 were found to have been prescribed the drug in a month in which they were pregnant, 25 as recently as April to September last year.
    Health and Social Care Committee Chair Jeremy Hunt MP said:
    “It is incredibly concerning to know that women of child-bearing age can still be prescribed the epilepsy drug sodium valproate despite its known risks as a cause of birth defects or developmental delays.
    It has been two years since Baroness Cumberlege called for urgent action to prevent this happening. However, dozens of pregnant women were prescribed the drug last year while data published last month has shown that safety requirements were not being fully met.
    We’re calling in a Minister and senior health officials as well as campaigners to address our concerns.”
    Read full story
    Source: UK Parliament, 2 September 2022
     
  6. Patient Safety Learning
    Ministers will introduce legislation as soon as parliament returns on Monday to tackle the NHS’s worsening staffing crisis by making it easier for overseas nurses and dentists to work in the UK.
    The move is part of a drive by the health secretary, Steve Barclay, to increase overseas recruitment to help plug workforce gaps in health and social care.
    Barclay believes thousands of extra health professionals will come as a result of new rules making it easier for medical regulators to register those who have qualified abroad. If the change proves successful it will help pave the way for more nurses and dentists coming to work in Britain from countries such as India, Sri Lanka, Kenya, the Philippines and Malaysia.
    However, critics claim the policy is a stop-gap that is no substitute for ramping up the supply of homegrown staff and risks worsening the lack of health workers in other countries that are struggling with shortages of their own.
    Read full story
    Source: The Guardian, 5 September 2022
  7. Patient Safety Learning
    A senior NHS leader has warned of a “life-threatening” situation in which clinically vulnerable people are being admitted to hospital after having their energy supplies disconnected.
    Sam Allen, chief executive of North East and North Cumbria Integrated Care Board (ICB), has written to Ofgem today to raise “serious concerns” that vulnerable people have seen their electricity or gas services disconnected as a result of non-payment.
    In the letter, which the ICB has published on its website, Ms Allen said the impact of energy supplies being cut off “will be life threatening for some people” and place additional demand on already stretched health and social care services.
    She wrote: “It has come to light that we are starting to see examples where clinically vulnerable people have been disconnected from their home energy supply which has then led to a hospital admission.
    “This is impacting on people who live independently at home, with the support from our community health services team and are reliant on using electric devices for survival.
    “An example of this is oxygen; and there will be many other examples. There is also a similar concern for clinically vulnerable people with mental health needs who may find themselves without energy supply.
    “Put simply, the impact of having their energy supply terminated will be life threatening for some people as well as placing additional demands on already stretched health and social care services.”
    Read full story (paywalled)
    Source: HSJ, 5 September 2022
  8. Patient Safety Learning
    Former patients and families of those affected by some of Northern Ireland's worst health scandals have called for accountability at every level of the health service.
    The collective of campaigners gathered at Stormont in protest on Saturday.
    They have demanded change, saying "enough is enough".
    They included those affected by systemic failures identified in neurology, urology, care homes and hyponatraemia.
    Danielle O'Neill, a former patient of the neurologist Dr Michael Watt, whose practice led to Northern Ireland's largest patient recall, was among them.
    "It's important for us to stand here today as a collective with all of the other scandals to show that we demand an individual duty of candour," she said.
    "We demand accountability, we demand justice.
    "There have been far too many health scandals in our health service."
    Read full story
    Source: BBC News, 4 September 2022
  9. Patient Safety Learning
    A doctor who was sacked for raising patient safety concerns has won a case against England's hospital regulator, the Care Quality Commission (CQC).
    Orthopaedic surgeon Shyam Kumar worked part-time for the CQC as a special adviser on hospital inspections, but Manchester Employment Tribunal found that he was unfairly dismissed.
    Between 2015 and his dismissal in 2019, Mr Kumar wrote to senior colleagues at the CQC with a number of serious concerns.
    They included a hospital inspection, at which he claims patient safety was significantly compromised when a group of whistleblowing doctors was prevented from discussing their concerns.
    Mr Kumar said, on many occasions, he reported concerns about a surgeon at his own trust, Morecambe Bay, who had carried out operations that were "inappropriate" and of an "unacceptable" quality and harmed patients.
    He warned the CQC that the trust management wanted to bury it "under the carpet". The tribunal noted that his concerns were found to be justified and the surgeon eventually had conditions placed on his licence to practise.
    The CQC "accepted the findings".
    Mr Kumar, who has been awarded compensation, says his concerns were ignored.
    "The whole energy of a few individuals in the CQC was spent on gunning me down, rather than focusing on improvement to patient safety and exerting the regulatory duties," he said.
    Read full story
    Source: BBC News, 5 September 2022
  10. Patient Safety Learning
    When the new Royal Liverpool Hospital opens its doors in October, every patient will have a single room with an en-suite bathroom.
    That set-up is unusual for acute hospitals in England, but many feel it is the future for all new buildings.
    "There's the privacy and dignity from the patient's point of view," says Jacqui Stamper, the hospital's associate chief nurse. "If they're in the room and talking to the doctors or the nurses, there isn't somebody just the other side of a curtain listening."
    "And then there's the infection prevention side of it as well.
    "It's absolutely the state of the art way of hospital care really."
    The new system will require staff to work differently, so patients can be properly monitored.
    Each ward has been broken up into smaller zones of between six and eight beds, and each zone has its own base where the nurses will sit.
    The trust which runs the hospital is currently running workshops to get staff used to the layout.
    "Nursing staff will be used to working in a bigger team than a couple of people, so it is a different way of working," Ms Stamper says.
    "We're listening to our staff and their concerns and answering those to see how we can address them going forward."
    Read full story
    Source: BBC News, 2 September 2022
  11. Patient Safety Learning
    On a Thursday in mid-August, the doors of a hospital's emergency department two hours west of Toronto were shut.
    A note posted on the front said the ER was closed for the day. It would reopen the following morning at 08:00, but close again for the evening. Patients who needed urgent care were asked to go to nearby hospitals - a 15- to 35-minute drive away.
    It was the ninth time since April that the Huron Public Healthcare Alliance - a network of four hospitals serving around 150,000 people in western Ontario - had to temporarily close or cut back hours at one of its emergency departments.
    Canada is one of the richest countries in the world. Its universal publicly funded healthcare system has been touted by progressive politicians in the US, the country's southern neighbour, who see it as a needed alternative to an American system where millions remain uninsured. 
    But in recent months, Canada's system has been described by workers and hospital executives as being in a state of "crisis". That includes struggling emergency rooms.
    Toronto ER physician Dr Raghu Venugopal said he has seen stretchers lining the hallways, occupied by patients suffering from ailments like a broken hip or abdominal pains.
    On some days, those patients may wait anywhere from two to four days to be admitted to hospital, all while a team of two nurses tends to a total of 50 to 60 patients on the unit.
    Other patients are being examined in the waiting room because the lack of staff has forced parts of the ER to close, meaning there is limited space for doctors to see them privately.
    "We are in a standard-less void where anything goes, and it is shocking," Dr Venugopal said.
    Read full story
    Source: BBC News, 2 September 2022
     
  12. Patient Safety Learning
    An estimated 430,000 Britons were still suffering from Long Covid two years after first contracting the virus, according to data released by the Office for National Statistics (ONS).
    One in every 32 people in the UK was estimated to have some form of Long Covid at the end of July, equivalent to 2 million people. Of those, around 1.5 million said their symptoms were adversely affecting their daily activities, while 384,000 said their ability to undertake daily activities had been “limited a lot”.
    Fatigue continues to be the most common symptom reported by individuals with long Covid, with 62% reporting weakness or tiredness. More than a third, 37%, of those surveyed reported shortness of breath as one of their symptoms, while difficulty concentrating (33%) and muscle ache (31%) were the next most cited symptoms.
    Kelly Fearnley, a foundation doctor at Bradford Royal Infirmary, said: “Long Covid is not only crippling the health of the nation, it is destroying the health of our economy.
    “Research efforts so far have been slow and underfunded, and fail to reflect the scale and urgency of the problem.
    “Not only are some people not recovering, they are deteriorating. People have not only lost their health and independence, they are losing their jobs, financial security and homes.”
    Read full story
    Source: The Guardian, 1 September 2022
  13. Patient Safety Learning
    Health secretary Steve Barclay says trust chief executives should be held accountable for ambulance handover delays in a ‘fair’ way that recognises factors outside their control.
    Mr Barclay made a wide ranging speech at a Policy Exchange event on Thursday. However, the content of the speech was much less radical than earlier press reports in which it was suggested he would tell the NHS to “scrap targets”, “declare war on pointless pen-pushers”, and deprioritise “cancer, maternity and mental health”. 
    Last month, the health secretary summoned the chief executives of six of the NHS trusts which are recording the longest waits for ambulance handovers at their emergency departments.
    Mr Barclay was asked by HSJ what the consequences would be for leaders who failed to improve the situation. He said: “It’s not about blaming the chief executives, it’s about understanding what are their challenges and how do we then get clarity on that.
    “Once we’ve agreed on that, then you can have performance management to hold individual chiefs to [account on] the bits that are within their control, distinct from bits that may be the ambulance trust’s or others in the system.”
    He said the government and NHS England would ask what was “within the chief exec’s control” and how a trust’s performance compared to that of its peers? Trusts would be asked to “comply” with best practice or explain why they were not. The Department of Health and Social Care and NHSE would then be able to decide “what are the things where it [the trust] needs wider support?”
    Read full story (paywalled)
    Source: HSJ, 2 September 2022
  14. Patient Safety Learning
    Half of healthcare facilities worldwide lack basic hygiene services with water and soap or alcohol-based hand rub where patients receive care and at toilets in these facilities, according to a new report by WHO and UNICEF. Around 3.85 billion people use these facilities, putting them at greater risk of infection, including 688 million people who receive care at facilities with no hygiene services at all.
    “Hygiene facilities and practices in health care settings are non-negotiable. Their improvement is essential to pandemic recovery, prevention and preparedness. Hygiene in health care facilities cannot be secured without increasing investments in basic measures, which include safe water, clean toilets, and safely managed health care waste,” said Dr Maria Neira, WHO Director, Department of Environment, Climate Change and Health. “I encourage Member States to step up their efforts to implement their 2019 World Health Assembly commitment to strengthen water, sanitation and hygiene (WASH) services in health care facilities, and to monitor these efforts.” 
    The latest report, “Progress on WASH in health care facilities 2000–2021: special focus on WASH and infection prevention and control”, has for the first time established this global baseline on hygiene services – which assessed access at points of care as well as toilets – as more countries than ever report on critical elements of WASH services in their hospitals and other health centres. For hygiene, data are now available for 40 countries, representing 35% of the world’s population, up from 21 countries in 2020 and 14 in 2019.
    The newly established global estimate reveals a clearer and more alarming picture of the state of hygiene in health care facilities. Though 68% of health care facilities had hygiene facilities at points of care, and 65% had handwashing facilities with water and soap at toilets, only 51% had both and therefore met the criteria for basic hygiene services. Furthermore, 1 in 11 (9%) of health care facilities globally have neither.
    “If health care providers don’t have access to a hygiene service, patients don’t have a health care facility,” said Kelly Ann Naylor, UNICEF Director of WASH and Climate, Environment, Energy, and Disaster Risk Reduction (CEED). “Hospitals and clinics without safe water and basic hygiene and sanitation services are a potential death trap for pregnant mothers, newborns, and children. Every year, around 670,000 newborns lose their lives to sepsis. This is a travesty – even more so as their deaths are preventable.”
    Read full story
    Source: WHO, 30 August 2022
     
  15. Patient Safety Learning
    Guidelines for confirming death in very young babies are being reviewed amid concerns about a case in which a baby boy started to breathe after a diagnosis of brain stem death.
    Guy’s and St Thomas’ NHS Foundation Trust applied to the High Court in June for a declaration that A, who was born in April, was dead and for authorisation to withdraw his ventilation, ancillary care, and treatment. Aged 2 months, he had sustained a profound hypoxic ischaemic brain injury after a cardiac arrest that happened shortly after he was found limp in his cot with abnormal breathing.
    But before the case came to court a nurse observed him breathing spontaneously, and the trust rescinded the declaration of brain stem death. 
    Read full story (paywalled)
    Source: BMJ, 31 August 2022
  16. Patient Safety Learning
    The number of posts lying vacant across the NHS in England has reached a “staggering” record high of 132,139 – almost 10% of its planned workforce.
    The number at the end of June was up sharply from three months earlier when there were 105,855 vacancies, quarterly personnel figures show.
    NHS leaders said the huge number of empty posts showed why the health service is in a state of deepening crisis, with patients facing long waits for almost every type of care.
    The previous highest number of vacancies for full-time-equivalent staff was 111,864, recorded at the end of June 2019.
    The new number represents 9.7% of the NHS’s planned staffing levels – a new high. As recently as March 2021 there were 76,082 vacancies.
    Danny Mortimer, the chief executive of NHS Employers, said: “These figures paint a bleak picture. A jump in nearly 30,000 staff vacancies – equivalent to the entire staffing of a large NHS hospital – show an alarming trend across the NHS of rising levels of vacancies.”
    Read full story
    Source: The Guardian, 1 September 2022
  17. Patient Safety Learning
    Responding to the Ofgem announcement on the energy price cap, Jo Bibby, Director of Health at the Health Foundation said:  
    'Today’s announcement confirms the mounting financial pressures facing people this winter.  
    'Cold, damp homes make people ill. When people are having to make a choice between heating and eating, their health is going to suffer. Many will face the stress of managing debt and, in the long run, the price will be paid in poorer health, more pressure on the NHS, and fewer people in work. 
    'The cost-of-living crisis should be a spur for action for the new government – bringing forward the Health Disparities White Paper. In particular, it must deliver significant emergency support in the autumn, targeted at lower-income families who are most at risk of poorer health. Without the speed and scale of action we saw through the pandemic, there is a risk the cost-of-living crisis becomes another health crisis.'
    Read full story
    Source: The Health Foundation, 26 August 2022
  18. Patient Safety Learning
    Ongoing research underway at The University of Queensland in Australia is focusing on stopping children undergoing chemotherapy from feeling pain and other debilitating side effects.
    Dr Hana Starobova from UQ’s Institute for Molecular Bioscience has been awarded a Fellowship Grant from the Children’s Hospital Foundation to continue her research to relieve children from the side effects of cancer treatments.
    “Although children have a higher survival rate than adults following cancer treatments, they can still be suffering side-effects well into their adulthood,” Dr Starobova said.
    “A five-year-old cancer patient could be suffering severe pain, gastrointestinal problems or difficulty walking 20 years on from treatment.
    “There has been a lack of studies on children, which is an issue because they are not just small adults — they suffer from different cancers, their immune systems work differently and they have a faster metabolism, all of which affect how treatments work.
    “Our aim is to treat children before the damage happens so that the side-effects are dramatically reduced or don’t occur in the first place.”
    Dr Starobova is currently analysing how specific drugs could prevent a cascade of inflammation caused by chemotherapy drugs, which lead to tingling and numbness in hands and feet, and muscle pain and weakness that makes everyday tasks, like walking and doing up buttons, a challenge.
    She is focusing on Acute lymphoblastic leukaemia, one of the most frequently diagnosed cancers in children, with over 700 children diagnosed in Australia each year.
    “We are studying the most commonly used chemotherapy treatment for children, which is a mix of drugs that are very toxic, but have to be used to treat cancer fast and stop it becoming resistant to the drugs,” Dr Starobova said.
    “It’s a fine balance — too little chemotherapy and cancer won’t be killed but sometimes the side effects are so bad, patients have to stop the therapy.
    “I hope that by having a treatment to reduce side-effects, it will be one less thing for these kids and their families to worry about.”
    Read full story
    Source: The Print, 15 August 2022
  19. Patient Safety Learning
    Covid vaccination advice in pregnancy has not changed, contrary to false social media posts, UK health agencies have clarified.
    Inaccurate messages shared by thousands claimed that pregnant or breastfeeding women were now recommended not to take the vaccine.
    In fact, the NHS says the vaccine is both safe and strongly recommended for this group.
    The misleading claim came from a now out-of-date document from 2020. The document went viral after a Twitter user - whose account has since been suspended - shared a post stating incorrectly that the UK government had, "quietly remove[d] approval for use of Covid vax in pregnant and breastfeeding women".
    She linked to a report from December 2020 which said, "reassurance of safe use of the vaccine in pregnant women cannot be provided at the present time", because of an absence of data and that, "women who are breastfeeding should also not be vaccinated".
    This was true at the time, but since then data has been gathered finding no link between the vaccine and problems in pregnancy or birth. In fact, the Covid vaccine seems to reduce the risk of still-birth and pre-term delivery.
    And unvaccinated pregnant women are more likely to need hospital treatment if they catch Covid, especially in the third trimester.
    This evidence led to the recommendation being changed - so the statement found in this report no longer stands.
    Read full story
    Source: BBC News, 1 September 2022
  20. Patient Safety Learning
    Hospital trusts in England face “eye-watering” rises in energy bills of £2m a month each due to the fuel price surge, with NHS leaders saying patients may face longer waiting times or even see their care “cut back” as a result.
    NHS trusts are concerned they will have to make critical choices on staff levels and the services they provide in order to keep operating, with energy costs predicted to be as much as three times higher than a year ago.
    The BMJ surveyed NHS trusts in England for details of their recent and predicted future energy bills and how they expected to operate this coming winter when taking into account the additional energy charges on the way. Most said they expected their energy bills to double at least.
    Rory Deighton, senior acute lead at the NHS Confederation, which represents the whole healthcare system in England, Wales and Northern Ireland, said: “This isn’t an abstract problem, as the gap in funding from rising inflation will either have to be made up by fewer staff being employed, longer waiting times for care, or other areas of patient care being cut back."
    Read full story
    Source: The Guardian, 1 September 2022
  21. Patient Safety Learning
    Cold homes will damage children’s lungs and brain development and lead to deaths as part of a “significant humanitarian crisis” this winter, health experts have warned.
    Unless the next prime minister curbs soaring fuel bills, children face a wave of respiratory illness with long-term consequences, according to a review by Sir Michael Marmot, the director of University College London’s Institute of Health Equity, and Prof Ian Sinha, a respiratory consultant at Liverpool’s Alder Hey children’s hospital.
    Sinha said he had “no doubt” that cold homes would cost children’s lives this winter, although they could not predict how many, with damage done to young lungs leading to chronic obstructive pulmonary disease (COPD), emphysema and bronchitis for others in adulthood.
    Huge numbers of cash-strapped households are preparing to turn heating systems down or off when the energy price cap increases to £3,549 from 1 October, and the president of the British Paediatric Respiratory Society, also told the Guardian that child deaths were likely.
    “There will be excess deaths among some children where families are forced into not being able to heat their homes,” said Dr Simon Langton-Hewer. “It will be dangerous, I’m afraid.”
    Read full story
    Source: The Guardian, 1 September 2022
  22. Patient Safety Learning
    A troubled acute trust has been sent a further warning notice after inspectors found severe shortages of midwives were causing dangerous delays to labour inductions.
    During one day in June, the Care Quality Commission found eight high-risk women at Blackpool Victoria Hospital had waited prolonged time periods for their labour to be induced.
    They said one woman had waited five days, while another who was forced to wait more than two days despite her waters having broken on the ward. Delays to labour induction can lead to serious safety risks for mothers and babies.
    The hospital’s maternity services, previously rated “good” for safety, have now been rated “inadequate” in this domain. The overall rating for maternity has dropped to “requires improvement”.
    The problems were caused by severe shortages of midwives at the hospital, which had struggled to bring in agency staff due to a lack of availability in the area. However, inspectors also said there was a lack of any discussion or attention to the issues within the trust, despite the Healthcare Safety Investigation Branch previously highlighting concerns.
    Read full story (paywalled)
    Source: HSJ, 1 September 2022
  23. Patient Safety Learning
    Doctors say it could take months to process mounting piles of medical paperwork caused by a continuing cyber-attack on an NHS supplier.
    One out-of-hours GP says patient care is being badly affected as staff enter a fourth week of taking care notes with pen and paper.
    The ransomware attack against software and services provider Advanced was first spotted on 4 August.
    The company says it may take another 12 weeks to get some services back online.
    Dr Fay Wilson, who manages an urgent-care centre in the West Midlands, says the main choke point for her team is with patient records.
    She said it could affect patient care "because we can't send notifications to GP practices, except by methods that don't work because they require a lot of manual handling, and we haven't got the staff to actually do the manual handling".
    Read full story
    Source: BBC News, 31 August 2022
  24. Patient Safety Learning
    Medically fit patients are waiting up to nine months to be discharged from some NHS hospitals as increasing numbers of working age people develop more complex conditions amid ongoing social care shortages, HSJ can reveal.
    Trust data obtained by HSJ suggests patients at the hospitals which have struggled most with delayed discharges can face delays of many months after a decision has been made that they are fit to leave hospital.
    HSJ obtained data from seven trusts which have consistently reported high numbers of delayed discharges through a freedom of information request.
    At North Bristol Trust, one patient waited more than nine months to be discharged, while another waited around eight months.
    David Maguire, a senior analyst at The King’s Fund think tank, said lengthy delayed discharges often involve patients with highly complex needs, elderly and frail patients, or people with mental health conditions or learning difficulties. But he said there is also a growing number of working age people with chronic and more complex conditions.
    He added: “There has always been a large number of older people who will access health care and hospital services. But over the last few years we have seen a growing number of working age people requiring hospital care and social care services. That’s a growing part of the demand which will flow through into who needs discharge from hospital settings.
    Read full story (paywalled)
    Source: HSJ, 31 August 2022
  25. Patient Safety Learning
    More than two-thirds of trusts have been forced to suspend or pause a high-profile service improvement aimed at reducing neonatal and maternal deaths, because of widespread staffing shortages.
    HSJ research revealed a majority of trusts have been unable to implement the continuity of carer maternity model, after they were told to look again at whether it could be safely implemented.
    The model intends to give women “dedicated support” from the same midwifery team throughout their pregnancy, with a 2016 review saying it would reduce infant and maternal mortality rates and improve care more generally.
    It is particularly aimed at improving care for patients from minority ethnic groups and those with other risk factors, and has been championed by Jacqueline Dunkley-Bent, NHS England’s chief midwifery officer. Key targets around the model were included in the 2019 NHS long-term plan.
    However, there is consensus nationally that it can only be rolled out safely where there are adequate numbers of staff to do so – otherwise the risks outweigh the benefits.
    Earlier this year, the final Ockenden report into maternity care failings at Shrewsbury and Telford Hospital Trust was critical of the model, and said it should be suspended until trusts have enough staff to meet “safe minimum requirements on all shifts”.
    Read full story (paywalled)
    Source: HSJ, 30 August 2022
    Read more about the continuity of care maternity model on the hub

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