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Patient Safety Learning

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  1. Patient Safety Learning
    The purpose of Care Quality Commission (CQC) ratings has been a hotly contested question since the creation of the four category classifications in the last decade.
    The original idea was to give the public a sense of how good their local hospital was, as well as providing commissioners, system managers and government with an idea of whether the local, regional or national health services they had responsibility for were getting better or worse.
    The practicality of the first aim was always questionable given the public’s inability and unwillingness, in most cases, to take their custom elsewhere. The second ran into the lack of desire and/or courage on behalf of most commissioners to challenge their local provider, but it did seem to have traction at the top of the shop.
    Jeremy Hunt, told HSJ, once they had been dished out across the sector, that their CQC classification now mattered much more then whether or not it had achieved foundation status or not.
    Another function, whether intended or not, was that by splashing “inadequate” and unsafe care on the front pages, in the wake of the Francis report, CQC ratings fuelled a drive to put more staff on the wards (forcing the Treasury to pay for the consequent agency bills and deficits, and curtailing Simon Stevens’ transformation funds).
    Whatever your take on their purpose, however, they only make sense if they accurately reflect the state of the service. And the latest data suggests that may not be the case.
    Read full story (paywalled)
    Source: HSJ, 17 March 2022
  2. Patient Safety Learning
    The NHS in London is planning to “fundamentally shift the way we deliver health and care” in the wake of coronavirus, according to documents obtained by HSJ.
    The plans from NHS England and Improvement’s London office say leaders should:
    Plan for elective waiting times to be measured at integrated care system level, rather than trust level. Accept “a different kind of risk appetite than the one we are used to”. Expect decisions from the centre on the location of cancer, paediatric, renal, cardiac, and neurosurgical services. Plan for a permanent increase in critical care capacity. Transform to a “provider system able to be commissioned and funded on a population health basis”. Work towards “a radical shift away from hospital care”. Expect “governance and regulatory landscape implications” plus “streamlined decision-making”. The document, titled Journey to a New Health and Care System, says there are three “likely” phases, with the final new system in place “from November 2021”.
    The preceding two phases are “action programmes” over the next 12 to 15 months which will be about reconfiguring services to deal with “immediate covid, non-covid and elective need”, and “transition” when the move to new configurations is evaluated and “public consent” sought.
    Read full story
    Source: HSJ, 11 May 2020
  3. Patient Safety Learning
    NHS staff are failing to follow guidelines for providing care to sickle cell patients - and some of the advice has been branded as “unfit for purpose”.
    The NHS Race and Health Observatory commissioned research, undertaken by Public Digital, to explore the lived experience of people undergoing emergency hospital admissions for sickle cell and managing crisis episodes at home.
    The Sickle cell digital discovery report: Designing better acute painful sickle cell care, found that the existence of service-wide information tailored by the National Institute for Health and Care Excellence has “arguably not been designed for an ambulance, A&E and emergency setting”, and states it has been proven that this guideline is “not being used and adhered to consistently”.
    Moreover, healthcare professionals have warned that the National Haemoglobinopathy Register (NHR) -  a database of patients with red cell disorders - is not being readily accessed, while patients reported being treated in a way that breached prescribed instructions.
    “We believe that sickle cell crisis guidelines could be improved in terms of their usability in a high-pressure emergency setting, and in terms of promoting access to them,” the report authors concluded, adding that current guidance should be adapted.
    Read full story
    Source: The Independent, 31 January 2023
  4. Patient Safety Learning
    Thousands more doctors and nurses will be trained in England every year as part of a government push to plug the huge workforce gaps that plague almost all NHS services.
    The number of places in medical schools will rise from 7,500 to 10,000 by 2028 and could reach 15,000 by 2031 as a result of the NHS’s first long-term workforce plan.
    There will also be a big expansion in training places for those who want to become nurses, with the number rising by a third to 40,000 by 2028 – matching the number of nurses the health service currently lacks.
    Amanda Pritchard, the chief executive of NHS England, hailed the long-awaited plan as “a once in a generation opportunity to put staffing on a sustainable footing for years to come”.
    Medical groups, health experts and organisations representing NHS staff welcomed the plan as ambitious but overdue. Richard Murray, chief executive of the King’s Fund thinktank, said it could be a “landmark moment” for the health service by providing it with the staff it needs to provide proper care.
    Read full story
    Source: The Guardian, 29 June 2023
  5. Patient Safety Learning
    An NHS England review into the behaviour of high-profile senior leaders who took over a Midlands trust has concluded that the interim CEO “behaved poorly and inappropriately” while its chair was “complicit with” and failed to address problems.
    NHS England had commissioned an independent probe into allegations about the behaviour of new executives, who had recently been appointed to the board of Walsall Healthcare Trust.
    David Loughton and Professor Steve Field, who hold the same roles at the Royal Wolverhampton Trust, were brought in as interim chief executive and chair respectively in spring 2021.
    Walsall has faced care quality concerns for some years and it was hoped the pair from neighbouring Wolverhampton would bring improvements. 
    Dr McLean wrote in her review: “Leadership changes can, understandably, represent a period of anxiety for those affected but this can be minimised if changes are made in line with appropriate values and processes. 
    “Whilst I conclude that the joint chair and interim CEO were motivated to act in the best interests of patients, I was saddened by much of what I heard.
    ”In the narratives I heard, there was a consistent lack of compassion or respect for people.”
    She concluded: “The interim CEO, while motivated by the safety and care of patients, has behaved poorly and inappropriately … the joint chair has been complicit with and failed to address this behaviour.”
    Read full story (paywalled)
    Source: HSJ, 2 February 2022
  6. Patient Safety Learning
    A draft NHSE statement suggests mental trusts could be asked to eradicate features of the ‘serenity integrated mentoring’ (SIM) care model from clinical practice, following a whirlwind of concerns in 2021 and an investigation by national clinical director Tim Kendall.
    A core feature of SIM is to place a police officer within a healthcare team charged with supporting patients who frequently attend emergency services in crisis, and creating crisis plans.
    The draft position statement produced by NHSE, which the regulator said is not its final version and is subject to changes, says SIM should not be used.
    It also proposes the eradication of the following practices from any equivalent care model:
    Police involvement in delivery of therapeutic interventions in planned, non-emergency, community mental healthcare; The use of coercion, sanctions (criminal or otherwise), withholding care and otherwise punitive approaches; and Discriminatory practices and attitudes towards patients who express self-harm behaviours, suicidality and/or those who are deemed “high intensity users”. The statement, which is the first indication of NHSE’s position on the SIM model but not its final stance, also suggests Professor Kendall will be seeking assurance from trust medical directors that SIM or similar models, and the above three features of concern, are no longer used. A full policy and public statement on the model is expected by the spring.
    The StopSIM coalition, whose campaigning prompted the NHSE review, said: “Unless and until the full policy is freely available to service users and the public, service users are not equipped to protect themselves against the dangers of SIM and similar approaches".
    Further reading on the hub:
    The High Intensity Network (HIN) approach and SIM model for mental health care and 'high intensity users' – views and discussion
    StopSIM: Mental health is not a crime
     
  7. Patient Safety Learning
    Frontline NHS staff in England will have to be fully vaccinated against Covid, the health secretary has announced.
    A deadline is expected to be set for 1 April next year to give unvaccinated staff time to get both doses, Sajid Javid told the Commons.
    Between 80,000 and 100,000 NHS workers in England were unvaccinated, said Chris Hopson, head of NHS Providers.
    Thursday is the deadline for care home workers in England to get vaccinated.
    The government's decision follows a consultation which began in September and considered whether both the Covid and flu jabs should be compulsory for frontline NHS and care workers. Mr Javid said the flu vaccine would not be made mandatory.
    There will be exemptions for the Covid vaccine requirement for medical reasons, and for those who do not have face-to-face contact with patients in their work, he added.
    In a statement to MPs, Mr Javid said: "Having considered the consultation responses, the advice of my officials and NHS leaders including the chief executive of the NHS, I have concluded that all those working in the NHS and social care will have to be vaccinated."
    "We must avoid preventable harm and protect patients in the NHS, protect colleagues in the NHS and of course protect the NHS itself."
    Read full story
    Source: BBC News, 9 November 2021
  8. Patient Safety Learning
    More than half a million people have accessed online training that aims to prevent suicide in the last three weeks alone, a charity has said.
    The Zero Suicide Alliance said 503,000 users completed its online course during lockdown. It aims to help spot the signs that a person may need help.
    It comes as health leaders warned front-line workers tackling coronavirus could suffer from mental ill health.
    NHS England launched a mental health hotline to support staff last month.
    The alliance's Joe Rafferty said the true impact of the coronavirus on mental health will not be known until the pandemic ends, but he said "the stress and worry of the coronavirus is bound to have impacted people's mental health".
    Read full story
    Source: BBC News, 18 May 2020
  9. Patient Safety Learning
    Patient safety campaigners have said ‘too many women’ are still not being offered a general anaesthetic for a diagnostic test because of staff shortages, leaving them in severe pain.
    A survey by the Campaign Against Painful Hysteroscopies found around 240 women – which equates to 80 per cent of respondents – who had a hysteroscopy since the start of 2021 said they were not told they could have a general anaesthetic prior to the procedure.
    This suggests the situation has only improved marginally since 2019, when the campaign group first started collecting data. A spokeswoman from the campaign group called the pain being endured by women “barbaric” and said staffing shortages need to be addressed.
    Guidance from the Royal College of Obstetricians and Gynaecologists said all pain relief options, including general anaesthetic, should be discussed.
    Helen Hughes, chief executive of Patient Safety Learning, said: “We are hearing from too many women that they are not being given the full information about the procedure. It damages their trust and makes them worry about accessing future services.”
    She said: “It’s distressing that despite what we know, [the guidance] is not being implemented properly. Informed consent is essential for patient safety as well as a legal requirement.”
    Read full story (paywalled)
    Source: HSJ, 7 June 2022
    What is your experience of having a hysteroscopy? Share your experiences on the hub in our community forum.
    Further reading:
    House of Commons Debate - NHS Hysteroscopy Treatment Through the hysteroscope: Reflections of a gynaecologist Minister acknowledges patients’ concerns about painful hysteroscopies; but will action be taken? Improving hysteroscopy safety: Patient Safety Learning blog Outpatient hysteroscopy: RCOG patient leaflet
  10. Patient Safety Learning
    Academy-style hospitals will be set up to improve patchy NHS leadership under a shake-up planned by Sajid Javid to deal with post-pandemic waiting lists.
    The health secretary is formulating the reorganisation to give well-run hospitals more freedom as well as forcing failing trusts to improve. A new class of “reform trust” will be established as Javid signals an appetite for wide-ranging changes to deal with a “huge” variation in performance across the health service.
    Modelling reforms on the Blairite academies programme could lead to failing hospitals being forcibly turned into reform trusts, as happens with schools that are rated inadequate. It is possible that chains of hospitals will be run by leading NHS managers, or even outside sponsors, although this is yet to be decided.
    Boris Johnson is said to want to focus on cutting NHS waiting times as part of an “operation red meat” designed to shift the focus from rows over Downing Street parties. Allies of Javid say, however, that his desire for reform long predates the prime minister’s present problems and that as the Omicron wave recedes he believes he has a “six-month window” to introduce changes before planning for next winter takes over.
    His proposals raise the prospect of ministers embarking on another NHS reorganisation, even before the government’s Health and Care Bill — itself designed to reverse previous Tory reforms – becomes law.
    The plans are still at an early stage but are due to feature in a white paper that will set out Javid’s plans for dealing with weak leadership and slow adoption of best practice in parts of the NHS. A Whitehall source said: “Sajid’s reform agenda is all about driving up performance across the NHS. To achieve that we are going to apply some lessons from the academies programme.”
    Read full story (paywalled)
    Source: The Times, 18 January 2022
  11. Patient Safety Learning
    People with learning disabilities have been given do not resuscitate orders during the second wave of the pandemic, in spite of widespread condemnation of the practice last year and an urgent investigation by the care watchdog.
    Mencap said it had received reports in January from people with learning disabilities that they had been told they would not be resuscitated if they were taken ill with COVID-19.
    The Care Quality Commission (CQC) said in December that inappropriate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices had caused potentially avoidable deaths last year.
    DNACPRs are usually made for people who are too frail to benefit from CPR, but Mencap said some seem to have been issued for people simply because they had a learning disability. The CQC is due to publish a report on the practice within weeks.
    The disclosure comes as campaigners put growing pressure on ministers to reconsider a decision not to give people with learning disabilities priority for vaccinations. There is growing evidence that even those with a mild disability are more likely to die if they contract the coronavirus.
    Read full story
    Source: The Guardian, 13 February 2021
  12. Patient Safety Learning
    The Health and Social Care Committee has launched a new inquiry to examine leadership, performance and patient safety in the NHS.
    Inquiry: NHS leadership, performance and patient safety
    MPs will consider the work of the Messenger review (2022) which examined the state of leadership and management in the NHS and social care, and the Kark review (2019) which assessed how effectively the fit and proper persons test prevents unsuitable staff from being redeployed or re-employed in health and social care settings.
    The Committee’s inquiry will also consider how effectively leadership supports whistleblowers and what is learnt from patient safety issues.
    An ongoing evaluation by the Committee’s Expert Panel on progress by government in meeting recommendations on patient safety will provide further information to the inquiry.
    Health and Social Care Committee Chair Steve Brine MP said:
    “The role of leadership within the NHS is crucial whether that be a driver of productivity that delivers efficient services for patients and in particular when it comes to patient safety.
    Five years ago, Tom Kark QC led a review to ensure that directors in the NHS responsible for quality and safety of care are ‘fit and proper’ to be in their roles. We’ll be questioning what impact that has made.
    We’ll also look at recommendations from the Messenger review to strengthen leadership and management and we will ask whether NHS leadership structures provide enough support to whistleblowers.
    Our Expert Panel has already begun its work to evaluate government progress on accepted recommendations to improve patient safety so this will build on that. We owe it to those who rely on the NHS – and the tax-payers who pay for it – to know whether the service is well led and those who have been failed on patient safety need to find out whether real change has resulted from promises made.”
    Terms of Reference
    The Committee invites written submissions addressing any, or all, of the following points, but please note that the Committee does not investigate individual cases and will not be pursuing matters on behalf of individuals.   Evidence should be submitted by Friday 8 March. Written evidence can be submitted here of no more than 3,000 words.   How effectively does NHS leadership encourage a culture in which staff feel confident raising patient safety concerns, and what more could be done to support this? What has been the impact of the 2019 Kark Review on leadership in the NHS as it relates to patient safety? What progress has been made to date on recommendations from the 2022 Messenger Review? How effectively have leadership recommendations from previous reviews of patient safety crises been implemented? How could better regulation of health service managers and application of agreed professional standards support improvements in patient safety? How effectively do NHS leadership structures provide a supportive and fair approach to whistleblowers, and how could this be improved? How could investigations into whistleblowing complaints be improved? How effectively does the NHS complaints system prevent patient safety incidents from escalating and what would be the impact of proposed measures to improve patient safety, such as Martha’s Rule? What can the NHS learn from the leadership culture in other safety-critical sectors e.g. aviation, nuclear? Read full story
    Source: UK Parliament, 25 January 2024
  13. Patient Safety Learning
    A miniature radar system that tracks a person as they walk around their home could be used to measure the effectiveness of treatments for Parkinson’s.
    The disease, which affects about 145,000 people in the UK, is linked to the death of nerve cells in the brain that help to control movement.
    With no quick diagnostic test available at present, doctors must usually review a patient’s medical history and look for symptoms that often develop only very slowly, such as muscle stiffness and tremors.
    The device, about the size of a wi-fi router, is designed to give a more precise picture of how the severity of symptoms changes, both over the long term and hourly.
    It sits in one room and emits radio signals that bounce off the body of a patient. Using artificial intelligence it is able to recognise and lock on to one individual. Over several months it will notice if their walking speed is becoming slower in a way that indicates that the disease is becoming worse. During a single day it can also recognise periods where a person’s strides quicken, which means that it could be used to monitor the effectiveness of new and existing drugs, even where the effects last a relatively short time.
    “This really gives us the possibility to objectively measure how your mobility responds to your medication. Previously, this was nearly impossible to do because this medication effect could only be measured by having the patient keep a journal,” said Yingcheng Liu, a graduate student at the Massachusetts Institute of Technology (MIT) who is part of the team behind the device. 
    Read full story (paywalled)
    Source: The Times, 22 September 2022
  14. Patient Safety Learning
    Only 15% of healthcare apps meet minimum safety standards, highlighting a “desperate need” for a proper review process, new research has concluded.
    Health app evaluation organisation ORCHA evaluated more than 5,000 apps against 260 performance and compliance factors and found that majority do not meet the minimum safety requirements.
    Liz Ashall-Payne, ORCHA’s Chief Executive, said: “We believe that digital health apps are one of the most important tools available to help tackle health issues in an ageing population that’s facing more complex, long-term problems. The fact that only 15% of apps that we review meet the minimum standards show there is a desperate need to regularly and properly assess the apps available to ensure that people are protected against the serious risks associated with downloading ineffective or even harmful apps.”
    Helen Hughes, Chief Executive of Patient Safety Learning, which is working with ORCHA to improve the safety of apps, said the research reiterated the need for consistent regulatory standards and accreditation frameworks to be applied to healthcare apps.
    “One of the areas we are beginning to explore with ORCHA is whether or not we can consider what patient safety would be in part of the review process,” she said. “Essentially what we want is patient safety embedded in all of the review processes so that we can inform and guide clinicians and inform and guide patients."
    “And that there is appropriate research on their use and their impact so that information can feed the improvement of standards.”
    Read full story
    Source: Digital Health. 9 October 2019
     
  15. Patient Safety Learning
    On January 2020, Patient Safety will be on the G20 agenda (among other five health key priorities), but Abdulelah M. Alhawsawi, Saudi Patient Safety Center, asks "what is patient safety doing on an economic forum like the G20?"
    Patient harm is estimated to be the 14th leading cause of the global disease burden. This is comparable to medical conditions such as tuberculosis and malaria. In both US and Canada, patient safety adverse events represent the 3rd leading cause of death, preceded only by cancer and heart disease. In the US alone, 440,000 patients die annually from healthcare associated infections. In Canada, there are more than 28,000 deaths a year due to patient safety adverse events. In low-middle income countries,  134 million adverse events take place every year, resulting in 2.6 million deaths annually. 
    In addition to lives lost and harm inflicted, unsafe medical practice results in money loss. Nearly, 15 % of the health expenditure across Organization of Economic Cooperative Development countries is attributed to patient safety failures each year, but if we add the indirect and opportunity cost (economic and social), the cost of harm could amount to trillions of dollars globally.
    When a patient is harmed, the country loses twice. The individual will be lost as a revenue generating source for society and the individual will become a burden on the healthcare system because he or she will require more treatment. Unless we do something different about patient safety, we would risk the sustainability of healthcare systems and the overall economies. 
    Alhawsaw proposed establishing a G20 Patient Safety Network (Group) that will combine Safety experts from healthcare and other leading industries (like aviation, nuclear, oil and gas, other), and economy and fFinancial experts
    This will function as a platform to prioritise and come up with innovative patient safety solutions to solve global challenges while highlighting the return on investment (ROI) aspects. 
    This multidisciplinary group of experts can work with each state that adopts the addressed global challenge to ensure correct implementation of proposed solution.
    Read full story
    Source: The G20 Health & Development Partnersip, 10 February 2020
  16. Patient Safety Learning
    Every day Sharon Smith has to take a strong morphine tablet to dull the excruciating pain she has lived with for more than a decade. 
    “I am in chronic pain every day. It’s affected our whole family and I’ve lost all my independence,” said Smith, from Leigh, Greater Manchester.
    Over four years from 2009, she endured three operations on her spine at Salford Royal Hospital, which as an NHS trust was once fêted as England’s safest.
    But the hospital had a dark secret: an incompetent leading surgeon who, an independent review would later find, had already “contributed” to the death of a girl in 2007.
    Now a wider investigation has confirmed that dozens of other patients who went under John Bradley Williamson’s knife were harmed or received poor care.
    Read full story (paywalled)
    Source: The Times, 30 July 2023
  17. Patient Safety Learning
    The number of people under 40 in the UK being diagnosed with type 2 diabetes is rising at a faster pace than the over-40s, according to “shocking” and “incredibly troubling” data that experts say exposes the impact of soaring obesity levels.
    The UK ranks among the worst in Europe with the most overweight and obese adults, according to the World Health Organization. On obesity rates alone, the UK is third after Turkey and Malta.
    The growing numbers of overweight and obese children and young adults across the UK is now translating into an “alarming acceleration” in type 2 diabetes cases among those aged 18 to 39, analysis by Diabetes UK suggests.
    There is a close association between obesity and type 2 diabetes. There is a seven times greater risk of type 2 diabetes in obese people compared with those of healthy weight, and a threefold increase in risk for those just overweight.
    “This analysis confirms an incredibly troubling growing trend, underlining how serious health conditions related to obesity are becoming more and more prevalent in a younger demographic,” Chris Askew, the chief executive of Diabetes UK, said.
    He added: “While it’s important to remember that type 2 diabetes is a complex condition with multiple other risk factors, such as genetics, family history and ethnicity, these statistics should serve as a serious warning to policymakers and our NHS.
    “They mark a shift from what we’ve seen historically with type 2 diabetes and underline why we’ve been calling on the government to press ahead with evidence-based policies aimed at improving the health of our nation and addressing the stark health inequalities that exist in parts of the UK.”
    Read full story
    Source: The Guardian, 1 November 2022
  18. Patient Safety Learning
    GPs are breaching medical guidelines by prescribing antidepressants for children as young as 11 who cannot get other help for their mental health problems, NHS-funded research reveals.
    Official guidance says that under-18s should only be given the drugs in conjunction with talking therapies and after being assessed by a psychiatrist.
    But family doctors in England are “often” writing prescriptions for antidepressants for that age group even though such youngsters have not yet seen a psychiatrist, according to a report by the National Institute for Health and Care Research (NIHR), the NHS research body.
    The report linked the prescriptions to the long wait many young people, some self-harming or suicidal, face before starting treatment with NHS child and adolescent mental health services (CAMHS). Under-18s are prescribed the drugs for anxiety, depression, pain and bedwetting.
    The guidance on antidepressants has been issued by the National Institute for Health and Care Excellence (NICE), which advises the NHS on which treatments are effective.
    Referencing NICE’s recommendation of a two-step approval process, the NIHR study said “this often” did not happen. “No antidepressants are licensed in the UK for anxiety in children and teenagers under 18 years, except for obsessive compulsive disorder. Yet both specialists [psychiatrists] and GPs prescribe them. Thousands of children and teenagers in the UK are taking antidepressants for depression and anxiety. The numbers continue to rise and many have not seen a specialist.”
    Read full story
    Source: The Guardian, 4 November 2022
  19. Patient Safety Learning
    Insulin rights activists and those who live with diabetes are calling for meaningful action to address the high costs of insulin in the United States as a new study shows the widespread habit of rationing the life-saving medicine.
    A study published on 18 October in the Annals of Internal Medicine by researchers at Harvard Medical School, the City University of New York’s Hunter College and Public Citizen, found that 1.3 million Americans rationed insulin due to the high costs of insulin in 2021. The staggering number represents an estimated 16.5% of the US population with diabetes.
    The study found insulin rationing was most commonly reported by those without health insurance coverage and individuals under the age of 65 not eligible for Medicare. Black insulin users were more likely to report rationing insulin, at 23.2%.
    The impact of the practice can be terrible.
    Janelle Lutgen of Dubuque county, Iowa, lost her 32-year-old son Jesse, a type 1 diabetic, after he started rationing his insulin because he lost his job and with it his health insurance and died in early 2018 from diabetic ketoacidosis.
    Without health insurance, Lutgen said over-the-counter insulin costs more than $1,000 (£865) a month, and that her son couldn’t afford the high cost of healthcare coverage in the marketplace without a job and wasn’t eligible for Medicaid coverage because his income from when he was working was too high.
    “It would probably be impossible to really know exactly all the harm that’s been done with high insulin prices,” said Lutgen, who explained that individuals who ration insulin because of the cost, if they do survive, can still experience other health impacts such as neuropathy, or losing toes or feet. “It seems like we can’t get it through legislators’ heads that we have to make sure everyone who needs insulin can get it, not just people who have insurance or people on Medicare – everybody. The only way to do that is to go to the root of the problem, big pharma.”
    Read full story
    Source: The Guardian, 1 November 2022
  20. Patient Safety Learning
    The largest expansion of medical training posts has been announced the day after Scotland’s health secretary warned that the NHS was facing up to its most challenging winter.
    Humza Yousaf yesterday confirmed that 152 more places for trainee doctors would be created next year.
    He hailed it as the “most significant increase in medical training places to date” and an increase on the 139 places created last year. The announcement comes after ministers were urged to fund the creation of additional training places in key specialities including general practice, core psychiatry, oncology, emergency medicine, intensive care medicine and anaesthetics.
    “These additional training places highlight the Scottish government’s continued commitment to ensure that our health service is resilient and can continue delivering high quality care to those who need it,” Yousaf said. “This record expansion will support a wide range of medical specialties, many of which are under increased pressure as a result of growing demand.
    “We will continue to monitor the number of available training places in collaboration with NHS Education for Scotland to help make sure the NHS is equipped to meet the country’s current and future needs.”
    Read full story (paywalled)
    Source: The Times, 1 November 2022
  21. Patient Safety Learning
    The Covid public inquiry has asked to see Boris Johnson's WhatsApp messages during his time as prime minister as part of its probe into decision-making.
    Counsel for the inquiry, Hugo Keith KC, said the messages had been requested alongside thousands of other documents.
    He said a major focus of this part of the inquiry was understanding how the "momentous" decisions to impose lockdowns and restrictions were taken.
    The revelations came as he set out the details of how this module will work. The inquiry is being broken down into different sections - or modules as they are being called.
    The preliminary hearing for module one, looking at how well prepared the UK was, took place last month.
    Monday marked the start of the preliminary hearing for module two, which is looking at the political decision-making.
    Mr Keith said this allowed the inquiry to take a "targeted approach". He said it would look at whether lives could have been saved by introducing an earlier lockdown at the start of 2020.
    Read full story
    Source: BBC News, 31 October 2022
  22. Patient Safety Learning
    One in 10 patients undergoing fertility treatment experience suicidal thoughts “all the time”, a survey suggests.
    Fertility Network UK, which carried out the poll, said the findings reveal the “far-reaching trauma” of experiencing infertility and undergoing IVF in the UK.
    Four in 10 respondents - 98% of whom were women - said they had experienced suicidal feelings.
    Gwenda Burns, chief executive of Fertility Network UK, said: “Fertility patients encounter a perfect storm: not being able to have the child you long for is emotionally devastating.
    "But then many fertility patients face a series of other hurdles, including potentially paying financially crippling amounts of money for their necessary medical treatment, having their career damaged, not getting information from their GP, experiencing their relationships deteriorate, and being unable to access the mental support they need."
    “This is unacceptable. Infertility is a disease and is as deserving of medical help and support as any other clinical condition.”
    Three in four patients said their GP did not provide sufficient information about fertility problems and treatment.
    Read full story (paywalled)
    Source: The Telegraph, 31 October 2022
  23. Patient Safety Learning
    Further funding cuts to the NHS will unavoidably endanger patient safety, an NHS leader warned last week after the chancellor’s promise of spending cuts of “eye-watering difficulty”.
    Matthew Taylor, the chief executive of the NHS Confederation, said his members were issuing the “starkest warning” about “the huge and growing gulf between what the NHS is being asked to deliver and the funding and capacity it has available”.
    The warning came as figures showed that paramedics in England had been unavailable to attend almost one in six incidents in September due to being stuck outside hospitals with patients. Service leaders say wait times for A&E and other care are being exacerbated by an acute lack of nurses, with a record 46,828 nursing roles – more than one in 10 – unfilled across the NHS.
    "Patients are presenting more unwell," says a GP from South Wales,
    "Wait times in A&E have become unmanageable, so we’re seeing patients who have waited so long to be seen they’re bouncing back to us. Things we can’t deal with, like injuries and chest pain. We tell them they have to go back to A&E.
    "Abuse of surgery reception and admin staff began last year and it’s just scaled up from there. We’ve had staff members who have been verbally and physically threatened and we’re struggling to recruit and retain staff – people are hired and quit in a couple days. A lot of people are going off sick with stress."
    Five healthcare workers describe the pressures they are facing, including ambulance stacking, rising A&E wait times and difficulties discharging patients.
    Read full story
    Source: The Guardian, 1 November 2022
  24. Patient Safety Learning
    Three teenage girls died after major failings in the care they received from NHS mental health services in the north-east of England, an independent investigation has found.
    “Multifaceted and systemic” failures by the Tees, Esk and Wear Valleys (TEWV) NHS trust contributed to the young women’s self-inflicted deaths within eight months of each other, it concluded.
    Christie Harnett died aged 17 on 27 June 2019 at the trust’s West Lane hospital in Middlesbrough. Nadia Sharif, also 17, died there six weeks later, on 5 August. Emily Moore, who had been treated there, died on 15 February 2020 at a different hospital in Durham. All three had complex mental health problems and had been receiving NHS care for several years.
    The investigation into their deaths, commissioned by the NHS, found that 119 “care and service delivery problems” by NHS services, especially TEWV, had occurred.
    Charlotte and Michael Harnett, Christie’s parents, said their daughter had “lost her life whilst in a hospital run by TEWV trust where there was little or no care or compassion”. Emily’s parents, David and Susan Moore, said she received “horrific care” while at West Lane. Services at the hospital were understaffed, “unstable and overstretched”, the investigation’s final report found.
    Both families, and also Nadia’s parents, Hakeel and Arshad Sharif, said the dangerous inadequacy of the care provided by TEWV, and the likelihood that other patients with fragile mental health had died as a result, showed that ministers should order a full public inquiry. “This mental health trust is a danger to the public,” the Moores said.
    The report said TEWV failed to properly monitor the girls, given their known risk of self-harm; to take seriously concerns about their care and suicide risk raised by their families; and to remove all potential ligature points.
    Read full story
    Source: The Guardian, 2 November 2022
  25. Patient Safety Learning
    Just 10 trusts account for more than half of patients ‘inappropriately’ sent out of their area for a mental health bed – with dozens having to travel up to 300km, according to HSJ analysis.
    Official NHS data for adults shows these 10 mental health providers accounted for 9,485 “inappropriate” out of area placement bed days during July, out of 18,705 across the 44 trusts reported nationally. 
    At one trust, Sussex Partnership FT, 40 placements were recorded as being between 200km and 300km away in that single month. The trust has revealed in board papers that four were sent to Glasgow. It has cited a shortage of capacity in the Kent and Sussex adult eating disorder service having led to 25 OAPs, and also said “quality concerns” had caused a temporary lack of acute beds in the county.
    Nationally, levels of “inappropriate” out of area placement – where people with acute mental health needs are sent up to hundreds of miles for a bed – are rising again, driven by quality failures, bed closures and staffing shortages.
    Read full story (paywalled)
    Source: HSJ, 3 November 2022
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