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Patient Safety Learning

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  1. Patient Safety Learning
    Opt-out blood tests for HIV, Hepatitis B and Hepatitis C will be rolled out to a further 46 hospitals across England, the government has announced.
    Health Secretary Victoria Atkins said the new £20m programme would lead to earlier diagnoses and treatment.
    Under the scheme, anyone having a blood test in selected hospital A&E units has also been tested for HIV, Hepatitis B and Hepatitis C, unless they opted out.
    The trials have been taking place for the last 18 months in 33 hospitals in London, Greater Manchester, Sussex and Blackpool, where prevalence is classed by the NHS as "very high".
    Figures released by the NHS earlier show those pilots have identified more than 3,500 cases of the three bloodborne infections since April 2022, including more than 580 HIV cases.
    Ms Atkins said: "The more people we can diagnose, the more chance we have of ending new transmissions of the virus and the stigma wrongly attached to it."
    She added that rolling out the tests to more hospitals would help ensure early diagnoses so people "can be given the support and the medical treatment they need to live not just longer lives but also higher quality lives".
    Read full story
    Source: BBC News, 29 November 2023
  2. Patient Safety Learning
    Deaths from cancer in the UK are set to rise by more than 50% in the next 26 years, stark new estimates suggest.
    Experts from the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO) have found there were 454,954 new cases of cancer in the UK in 2022 and warned this is expected to rise to 624,582 by 2050.
    In 2022, 181,807 people died in Britain from cancer, but researchers warned this is expected to rise to 279,004 by 2050 – a 53% increase.
    The estimates suggest the rising rates of cancer will be driven by the UK’s growing and ageing population. However, researchers have also called for new policies to tackle levels of smoking, unhealthy diets, obesity and alcohol to help lower the expected surge in cases.
    The study examined cancer data from 115 different countries and estimated global cases would rise by 77 per cent, from 20 million in 2022 to 35 million in 2050.
    The organisations estimate that cancer deaths around the world will almost double from 9.7 million to 18.5 million in that time.
    Dr Panagiota Mitrou, director of research, policy and innovation at the World Cancer Research Fund, said the new estimates “show the increased burden that cancer will have in the years to come”.
    “UK governments’ failure to prioritise prevention and address key cancer risk factors like smoking, unhealthy diets, obesity, alcohol and physical inactivity has in part widened health inequalities,” she added.
    Read full story
    Source: The Independent, 1 February 2024
  3. Patient Safety Learning
    Italy will carry out an inquiry into its handling of the coronavirus pandemic in a move hailed as “a great victory” by the relatives of people killed by the virus but criticised by those who were in power at the time.
    Italy was the first western country to report an outbreak and has the second highest Covid-related death toll to date in Europe, at more than 196,000. Only the UK’s death toll is higher.
    The creation of a commission to examine “the government’s actions and the measures adopted by it to prevent and address the Covid-19 epidemiological emergency” was approved by the lower house of parliament after passing in the senate.
    Consuelo Locati, a lawyer representing hundreds of families who brought legal proceedings against former leaders, said: “The families were the first to ask for a commission and so for us this is a great victory. The commission is important because it has the task, at least on paper, to analyse what went wrong and the errors committed so as not to repeat the massacre we all suffered.”
    Read full story
    Source: The Guardian, 15 February 2024
  4. Patient Safety Learning
    Climate change presents one of the most significant global health challenges and is already negatively affecting communities worldwide. Communicating the health risks of climate change and the health benefits of climate solutions is both necessary and helpful. To support this, the World Health Organization (WHO) in collaboration with partners has developed a new toolkit designed to equip health and care workers with the knowledge and confidence to effectively communicate about climate change and health.
    The toolkit aims to fill the gaps in knowledge and action among health and care workers – all those who are engaged in actions with the primary intent of enhancing health, as well as those occupations in academic, management and scientific roles. Despite their recognized trustworthiness and efficacy as health communicators, many health and care workers might not be fully equipped to discuss climate change and its health implications. This toolkit seeks to change that narrative.
    “Health and care workers play a key role in addressing climate change as a health crisis. Their unique position enables them to raise awareness, advocate for policy changes, and empower communities to mitigate and adapt to climate change,” said  Dr Maria Neira, Director, Department of Environment, Climate Change and Health. “By engaging in dialogue and action, health and care workers can catalyse efforts to safeguard human health as well as ensuring a resilient and sustainable future for all.”
    Read full story
    Source: WHO, 22 March 2024
  5. Patient Safety Learning
    NHS England has been accused of bowing to political pressure and trying to “undermine” the junior doctors strike.
    British Medical Association council chair Philip Banfield tonight wrote to NHSE chief executive Amanda Pritchard accusing her organisation of the “weaponisation” of the process used to agree minimum services level during the strike.
    Junior doctors walked out yesterday to begin a six day strike, the latest in their 10 month campaign and the longest in NHS history.
    Professor Banfield’s letter claims that NHSE is not respecting the terms of the voluntary agreement to provide “derogations”. These, says the letter, “allow for junior doctors to return to work in the event of safety concerns arising from ‘unexpected and extreme circumstances’ unrelated to industrial action”.
    The BMA accuses trusts of not providing the information the union needs to determine if the requests for derogations are justified. It said that the lack of information provided by trusts had led to it turning down 20 requests for derogations.
    The letter states: “We are increasingly drawing the conclusion that NHS England’s change in attitude towards the process is not due to concerns around patient safety but due to political pressure to maintain a higher level of service, undermine our strike action and push the BMA into refusing an increasing number of requests; requests, we believe, would not have been put to us during previous rounds of strike action.
    “The change in approach also appears to be politicisation and weaponisation of a safety critical process to justify the Minimum Service Level regulations.”
    Read full story (paywalled)
    Source: HSJ, 3 January 2024
  6. Patient Safety Learning
    Hundreds of rheumatology patients have stopped receiving drugs they did not need or had their diagnosis changed after a damning review of the service found the standard of care was “well below” what would be considered acceptable.
    Jersey’s Health and Community services department has said it will be contacting some of the affected patients “over the coming weeks” and would also be seeking legal advice on “an appropriate approach to compensation”.
    The independent review by the Royal College of Physicians also noted there was “no evidence” of standard operating procedures for most aspects of routine rheumatological care and, in some cases, “no evidence of clinical examinations”.
    It also found that there had been incorrect diagnosis and wrongly prescribed drugs, describing the standard of care as “well below what the review team would consider acceptable” for a contemporary rheumatological service.
    The review was commissioned by HCS medical director Patrick Armstrong, following concerns raised by a junior doctor in January 2022.
    Read full story
    Source: Jersey Evening Post, 22 January 2024
  7. Patient Safety Learning
    An inquiry into birth trauma has received more than 1,300 submissions from families.
    It is estimated that 30,000 women a year in the UK have suffered negative experiences during the delivery of their babies, while 1 in 20 develop post-traumatic stress disorder.
    The investigation is a cross-party initiative, led by MPs Theo Clarke and Rosie Duffield, in collaboration with the Birth Trauma Association.
    Ms Clarke the Conservative MP for Stafford, triggered the first ever parliamentary debate on the issue in October.
    In an emotional exchange in the House of Commons, she described her own experience following her daughter's birth at the Royal Stoke University Hospital in 2022.
    She bled heavily after suffering a tear and had to undergo two-hour surgery without general anaesthetic, due to an earlier epidural.
    The Birth Trauma Association, which is administering the inquiry, invited the public to submit written accounts of their own experiences.
    Dr Kim Thomas, from the association, said she had received an "overwhelming" number of personal accounts. Some cases date back as far as the 1960s.
    Read full story
    Source: BBC News, 25 February 2024
  8. Patient Safety Learning
    The government has been accused of “deprioritising women’s health” as analysis shows that almost 600,000 women in England are waiting for gynaecological treatment, an increase of a third over two years.
    There are 33,000 women waiting more than a year for such treatment, an increase of 43%, according to Labour analysis of data from the House of Commons library.
    It found that there is no region in England that meets the government’s target for cervical cancer screening of 80% coverage, with just over two-thirds of women (68.7%) having been screened in the past five and a half years.
    Also, one in four women (26%) with suspected breast cancer waited more than a fortnight to see a specialist in the year to September 2023.
    Under two-thirds (66.4%) of eligible women have been screened for breast cancer in the last three years, with just two English regions meeting the 70% coverage target.
    The NHS target in England is that 92% of patients have a referral-to-treatment time of less than 18 weeks.
    The figures come after the government pledged to end decades of gender-based health inequalities through a new women’s health strategy for England.
    Read full story
    Source: The Guardian, 22 April 2024
  9. Patient Safety Learning
    Ambulance chiefs have warned that patients are coming to harm, paramedics are being assaulted and control room staff reporting a “high stakes game of chicken” with police during the implementation of a controversial new national care model.
    The Association of Ambulance Chief Executives say in a newly published letter they believe the “spirit” of national agreement on how to implement the Right Care, Right Person model is not being followed by police, raising “significant safety concerns”.
    The membership body set out multiple concerns about the rollout of the model, under which the police refuse to attend mental health calls unless there is a risk to life or of serious harm.
    In the letter to Commons health and social care committee chair Steve Brine, AACE chair Daren Mochrie says timescales for introducing it were often “set by the police rather than “agreed” following meaningful engagement with partners”, meaning demand was shifting before health systems had built capacity. They also flag a lack of NHS funding to meet the new asks. 
    Mr Mochrie, also CEO of North West Ambulance Service Trust, described a “grey area” relating to what he called “concern for welfare” calls, which meet neither the police nor attendance services’ threshold for attendance.
    “To date this is the single biggest feedback theme we have heard from ambulance services, with some control room staff describing feeling like they’re in a ‘high-stakes game of chicken’ where the police have refused to attend and told the caller to hang up, redial 999 and ask for an ambulance,” he wrote.
    Read full story (paywalled)
    Source: HSJ, 20 February 2024
  10. Patient Safety Learning
    Black children in the UK are four times more likely to experience complications after appendicitis surgery than their white counterparts, a study has found.
    The study, funded by the Association of Paediatric Anaesthetists of Great Britain and Ireland, looked at 2,799 children from 80 hospitals across the UK aged under 16 who had surgery for suspected appendicitis between November 2019 and January 2022.
    Of these, 185 children (7%) developed postoperative complications within 30 days of the surgery. Three-quarters of these complications were related to the wound, while a quarter were respiratory, urinary or catheter-related or of unknown origin.
    The study found that black children had a four times greater risk of experiencing complications after the operation, and that this risk was independent of the child’s socioeconomic status and health history.
    Appendicitis is one of the most common paediatric surgical emergency with 10,000 performed every year. The authors said that this was the first study to look at the demographic differences of postoperative complication rates in regards to appendicitis.
    The researchers said they could not draw firm conclusions regarding why black children had worse outcomes after this type of emergency surgery, and that this apparent health inequality “requires urgent further investigation and development of interventions aimed at resolution”.
    Read full story
    Source: The Guardian, 22 February 2024
  11. Patient Safety Learning
    Mothers of babies who died or suffered brain damage from a Group B Strep (GBS) infection say routine screening is needed.
    Oliver Plumb, from the charity Group B Strep Support, said it was a "small number of babies" exposed to the bacteria that developed a serious and potentially fatal infection.
    He said around 800 babies a year developed the infection - which is about two babies a day - and about one a week will die, while another a week will be left with a lifelong disability.
    "It's a heart-breaking start to life for families and that often the first they hear of Group B Strep is when their baby is sick or in intensive care".
    The charity has called for GBS to be a notifiable disease to make it a legal responsibility for infections to be reported. It added that current figures could be "missing around one fifth of the infections".
    There was a "postcode lottery" in terms of how many families will hear about GBS, he said. The charity also backed calls for screening.
    "In the UK we don't sadly have a routine testing programme, that's at odds with much of the rest of the high-income world. "
    A DHSC spokesperson said a public consultation on the notifiable diseases list was carried out last year.
    "DHSC and UKHSA are considering the responses and confirmation of any changes will be published in due course," they said.
    Several reasons for not recommending routine screening have been given by the committee, including that results can change in the last few weeks of labour, and that GBS does not cause infection in every baby.
    Read full story
    Source: BBC News, 26 February 2024
    Further reading on the hub:
    Leading for safety: A conversation with Jane Plumb, Founder of Group B Strep Support  
  12. Patient Safety Learning
    Gripping a bag of morphine handed to him by hospital staff, Antonio sheltered at a bus stop, cold and shivering, as he tried to work out what to do.
    It was three days after undergoing gruelling surgery to remove his testicular cancer and the 36-year-old had been discharged from NHS care with nowhere to go.
    He was clutching a referral letter for the council’s housing team, given to him by hospital staff. When he arrived at the council office, he explained he had been homeless for the past few months – but was told they could not house him.
    “They asked me: ‘If you are in so much pain and trouble, why did they send you here?’ and I didn’t know what to say,” Antonio, whose name has been changed, tells The Independent. He was given a piece of paper with a phone number on it and told to call the next day.
    It was now late in the afternoon and the Salvation Army’s homeless day centre, where he would usually go for help, was closed. He had no option but to turn around and ready himself for a night on the streets.
    Antonio’s story is, tragically, not unique. He is one of thousands of people across England who have been discharged from NHS hospitals into homelessness in recent years, many while still battling serious health conditions.
    Data obtained by The Independent, in collaboration with the Salvation Army, shows at least 4,200 people were discharged from wards to “no fixed abode” in 2022/23.
    Read full story
    Source: The Independent, 17 March 2024
  13. Patient Safety Learning
    Trusts could be exposed to increased negligence claims as a result of new NHS England guidance for a rare spinal condition, a royal college has claimed.
    The Royal College of Emergency Medicine (RCEM) has said updated national guidance on treating cauda equina syndrome could also lead to greater “inequity of access” due to issues accessing timely MRI scans at many accident and emergency departments.
    An NHS Resolution report in 2022 found delayed MRI scans were a significant factor in high-value clinical negligence claims, particularly those relating to management of spinal conditions. 
    The guidance issued by NHSE’s Getting It Right First Time programme national pathway guidance says emergency MRIs for suspected CES should be taken within four hours of requests to radiology, and where this is not possible, “standard operating procedures” involving local spinal and radiology services should be in place for urgent out-of-hours scanning. Local provision for this “must be in place by June 2024,” the guidance says.
    NHSE said the GIRFT guidance has been endorsed by 11 clinical and patient bodies, including the Royal College of Radiologists and the Spinal Injuries Association.
    But RCEM, understood to be the only clinical body not to endorse the guidance, has issued a position statement last month stating that “few EDs, outside of tertiary centres, have access to 24/7 MRI scanning”.
    Read full story (paywalled)
    Source: HSJ, 3 April 2024
  14. Patient Safety Learning
    The number of patients waiting more than 12 hours for a bed on a ward after being seen in A&E in England was 19 times higher this winter than it was before the pandemic, figures show.
    There were nearly 100,000 12-hour waits in December and January - compared with slightly more than 5,000 in 2019-20.
    A decade ago these waits were virtually unheard of - in the four winters up to 2013-14 there were fewer than 100.
    The King's Fund said long delays were at risk of becoming normalised.
    It said the pressures this winter had received little attention compared with last winter, despite no significant improvement in performance.
    During December 2023 and January 2024, 98,300 patients waited more than 12 hours for a bed on a ward after A&E doctors took the decision to admit them.
    The Northern Ireland branch of the Royal College of Emergency Medicine (RCEM) said the pressures were "unsurmountable" and it was having a detrimental impact on patients.
    Read full story
    Source: BBC News, 15 February 2024
  15. Patient Safety Learning
    Health services for Londoners with eating disorders are struggling to cope with demand, a new report warns.
    Data from London's mental health trusts shows adult referrals have increased by 56% - from 3,000 to nearly 8,000 - in the last six years
    Child and adolescent referrals increased by 158%, from 1,400 to 4,000, in the same time period.
    The report has been compiled by the London Assembly's health committee.
    It has made 12 recommendations to London Mayor Sadiq Khan and City Hall officers, which include assessing other physical and mental health indicators as well as just patients' bodyweight as per their BMI.
    One consultant clinical psychologist told the committee that "almost all of the eating disorder services in London do not have the staffing levels available to safely provide the care required".
    Read full story
    Source: BBC News, 7 March 2024
  16. Patient Safety Learning
    Patients are being exposed to radiation doses at the “upper limit of safe” because a hospital is relying on a radiology machine three years after its “end of life” with a substandard second-hand part.
    The risk was revealed in board papers from Medway Foundation Trust, in Kent, among several other serious problems linked to outdated equipment.
    Recent board papers said the machine was necessary for maintaining the trust’s interventional radiology service which includes being on-call 24/7.
    It said: “Owing to the age of the machine we are experiencing a growing number of faults and breakdowns and due to its age no new parts are available.
    “At present a second hand tube has been installed to replace the existing faulty equipment.”
    But the papers went on to say the second-hand part has a defect “causing serious issues with the imaging [which] has the potential to increase imaging acquisitions required which will increase patient radiation dose and lengthen the procedure time”. 
    A business case for a new machine described current radiation doses as “within the upper limit of safe”.
    The trust indicated “mitigations” are in place, including additional reviews of patients who use it.
    Read full story (paywalled)
    Source: HSJ, 11 March 2024
  17. Patient Safety Learning
    Doctors made do-not-resuscitate orders for elderly and disabled patients during the pandemic without the knowledge of their families, breaching their human rights, a parliamentary watchdog has said.
    In a new report on breaches of the orders during the pandemic, the Parliamentary Health Service Ombudsman (PHSO) found failings from at least 13 patient complaints.
    The research, carried out with the charity Dignity in Dying, found “unacceptable” failures in how end-of-life care conversations are held, and in particular with elderly and disabled patients.
    Following a review of complaints in 2019 and 2020 the PHSO found evidence in some cases that doctors did not even inform the patient or their family that a notice had been made and so breached their human rights.
    The report calls for health services in Britain to improve the approach by medics in talking about death and end-of-life care.
    In examples of cases reviewed, the PHSO revealed the story of 58-year-old Sonia Deleon who had schizophrenia and learning disabilities and a notice which was wrongly applied during the pandemic.
    In 2020, she was admitted to Southend University Hospital after contracting Covid-19 at age 58. On three occasions a notice was made but her family were never informed.
    Following Sonia’s death her family found out the reasons given by doctors for the DNAR which “included frailty, having a learning disability, poor physiological reserve, schizophrenia and being dependent for daily activities.”
    Sonia’s sister Sally-Rose Cyrille said: “I was devastated, shocked and angry. The fact that multiple notices had been placed in Sone’s file without consultation with us, without our knowledge, it was like being hit with a sledgehammer.
    Read full story
    Source: The Independent, 14 March 2024
  18. Patient Safety Learning
    Hospitals are cynically burying evidence about poor care in a “cover-up culture” that leads to avoidable deaths, and families being denied the truth about their loved ones, the NHS ombudsman has warned.
    Ministers, NHS leaders and hospital boards are doing too little to end the health service’s deeply ingrained “cover-up culture” and victimisation of staff who turn whistleblower, he added.
    In an interview with the Guardian as he prepares to step down after seven years in the post, Rob Behrens claimed many parts of the NHS still put “reputation management” ahead of being open with relatives who have lost a loved one due to medical negligence.
    The ombudsman for England said that although the NHS was staffed by “brilliant people” working under intense pressures, too often his investigations into patients’ complaints had revealed cover-ups, “including the altering of care plans and the disappearance of crucial documents after patients have died and robust denial in the face of documentary evidence”.
    Read full story
    Source: The Guardian, 17 March 2024
  19. Patient Safety Learning
    A dedicated mental health and addiction support service for secondary care staff is shutting to new patients, as NHS England is set to cut its funding.
    The NHS Practitioner Health programme, which was rolled out nationally in October 2019, is halting new registrations for secondary care staff from 15 April.
    NHS England has informed the provider its funding will be cut for secondary care staff, subject to a review it is carrying out of wider services. The Practitioner Health programme for GPs and dentists is expected to continue for another year, although its future beyond that is also unclear, HSJ was told.
    An announcement published on X, formerly known as Twitter, said: “New secondary care patients will be signposted to alternative sources of support, including your GP, occupational health departments and organisational employee assistance programmes.”
    Its axing comes amid severe pressure on NHS budgets nationally and locally, with overall funding barely keeping up with anticipated inflation in 2024-25, and many integrated care systems forecasting large deficits.
    Medical unions and senior doctors have criticised the axing of the service.
    Read full story (paywalled)
    Source: HSJ, 12 April 2024
  20. Patient Safety Learning
    The NHS Race and Health Observatory, in partnership with the Institute for Healthcare Improvement and supported by the Health Foundation, has established an innovative 15-month, peer-to-peer Learning and Action Network to address the gaps seen in severe maternal morbidity, perinatal mortality and neonatal morbidity between women of different ethnic groups.
    Across England, nine NHS Trusts and Integrated Care Systems will participate in this action oriented, fast-paced Learning and Action Network to improve outcomes in maternal and neonatal health. Through the Network, the nine sites will aim to address the gaps seen in severe maternal morbidity, perinatal mortality and neonatal morbidity between women of different ethnic groups. Haemorrhage, preterm birth, post-partum depression and gestational diabetes have been identified as some of the priority areas for the programme.
    The sites will generate tailored action plans with the aim of identifying interventions and approaches that reduce health inequalities and enhance anti-racism practices and learning from the programme. These will be evaluated and shared across and between healthcare systems.
    The Network, the first of its kind for the NHS, will combine Quality Improvement methods with explicit anti-racism principles to drive clinical transformation, and aims to enable system-wide change.  Over a series of action, learning and coaching sessions, participants will review policies, processes and workforce metrics; share insights and case studies; and engage with mothers, parents, pregnant women and people.
    The programme will run until June 2025, supported by an advisory group from the NHS Race and Health Observatory, Institute for Healthcare Improvement, and experts in midwifery, maternal and neonatal medicine.
    Read full story
    Source: NHS Race and Health Observatory, 24 January 2024
  21. Patient Safety Learning
    More than 100 patients who had eggs and embryos frozen at a leading clinic have been told they may have been damaged due to a fault in the freezing process.
    The clinic, at Guy's Hospital in London, said it may have unwittingly used some bottles of a faulty freezing solution in September and October 2022.
    But it said it did not know the liquid was defective at the time.
    One patient at a second clinic, Jessop Fertility in Sheffield, has also been affected, the BBC has learned.
    The fertility industry regulator, the Human Fertilisation and Embryology Authority (HFEA), said it believes the faulty batch was only distributed to those two clinics.
    It is believed that many of the patients affected have subsequently had cancer treatment since having their eggs or embryos frozen, which may have left them infertile. This means they now may not be able to conceive with their own eggs.
    Guy's Hospital's Assisted Conception Unit is now being investigated by the HFEA, because of a delay in informing people affected.
    Read full story
    Source: BBC News, 14 February 2024
  22. Patient Safety Learning
    Ambulance trusts have often prioritised capacity and response times over dealing with cases of misconduct, a review of culture in the sector for NHS England has found.
    The review says ambulance trusts need to “establish clear standards and procedures to address misconduct”.
    The work was carried out by Siobhan Melia, who is Sussex Community Healthcare Trust CEO, and was seconded to be South East Coast Ambulance Service Foundation Trust interim chief from summer 2022 to spring last year.
    Her report says bullying and harassment – including sexual harassment – are “deeply rooted” in ambulance trusts, and made worse by organisational and psychological barriers, with inconsistencies in holding offenders to account and a failure to tackle repeat offenders.
    She says “cultural assessments” of three trusts by NHSE had found “competing pressures often lead to poor behaviours, with capacity prioritisation overshadowing misconduct management”, adding: “Staff shortages and limited opportunities for development mean that any work beyond direct clinical care is seen as a luxury or is rushed.
    “Despite this, there is a clear link between positive organisational culture and improved patient outcomes. However, trusts often focus on meeting response time standards for urgent calls, whilst sidelining training, professional development, and research.”
    Read full story (paywalled)
    Source: HSJ, 15 February 2024
  23. Patient Safety Learning
    Patients in parts of England are facing an uphill struggle to see a GP, experts say, after an analysis showed wide regional variation in doctor numbers.
    The Nuffield Trust think tank found Kent and Medway had the fewest GPs per person, followed by Bedfordshire, Luton and Milton Keynes.
    It comes as ministers have struggled to hit the pledge to boost the GP workforce by 6,000 this Parliament.
    But the government said it had plans in place to tackle shortages.
    However, Dr Billy Palmer, of the Nuffield Trust, said: "Solely boosting the number of staff nationally in the NHS is not enough alone - the next government should set a clear aim of reducing the uneven distribution of key staffing groups and shortfalls to tackle unfairness in access for patients."
    The think-tank report found while the government had met its target to increase the number of nurses by 50,000 this Parliament, the rises had not been felt evenly, with some specialist nurse posts, such as health visitors and learning-disability nurses, seeing numbers shrink.
    Dr Palmer said minimum numbers of GPs may have to be set for local areas - and better incentives to attract them to those with the fewest.
    Read full story
    Source: BBC News, 8 March 2024
  24. Patient Safety Learning
    A controversial unproven medical condition which is rooted in pseudoscience and disputed by doctors is routinely being used in Britain to explain deaths after police restraint, the Observer has found.
    “Acute behavioural disturbance” (ABD) and “excited delirium” are used to describe people who are agitated or acting bizarrely, usually due to mental illness, drug use or both. Symptoms are said to include insensitivity to pain, aggression, “superhuman” strength and elevated heart rate.
    Police and other emergency services say the labels, often used interchangeably, are a helpful shorthand used to identify when a person who might need medical help and restraint may be dangerous. But the terms are not recognised by the World Health Organization and have been condemned as “spurious” by campaigners who say they are used to “explain away” the police role in deaths.
    The American Medical Association rejected “excited delirium” after it was used by police lawyers in the case of George Floyd. California lawmakers banned it as a diagnosis or cause of death in October, saying it had been “used for decades to explain away mysterious deaths of mostly black and brown people in police custody”.
    The Royal College of Psychiatrists has also warned that the current definition of ABD, as it is now more commonly known in the UK, could be leading to people “being subjected to avoidable and potentially harmful interventions”. In 2017, a Home Office-commissioned review into deaths in police custody said the terms were “strongly disputed amongst medical professionals”.
    The Royal College of Psychiatrists has also warned that the current definition of ABD, as it is now more commonly known in the UK, could be leading to people “being subjected to avoidable and potentially harmful interventions”. In 2017, a Home Office-commissioned review into deaths in police custody said the terms were “strongly disputed amongst medical professionals”.
    Read full story
    Source: The Guardian, 17 March 2024
  25. Patient Safety Learning
    Harold Chugg spent much of early 2023 in a hospital bed because of worsening heart failure. During his most recent admission in June, the 75-year-old received several blood transfusions, which led to fluid accumulating in his lungs and tissues.
    Ordinarily, he would have remained in hospital for further days or weeks while the medical team got his fluid retention under control. But Harold was offered an alternative: admission to a virtual ward where he would be closely monitored in the comfort of his own home.
    Armed with a computer tablet, a Bluetooth-enabled blood pressure cuff and weighing scales, Harold returned to his farm near Chulmleigh in north Devon and logged his own symptoms and measurements daily, which were reviewed by a specialist nurse in another part of the county.
    Virtual wards provide hospital-level care in people’s homes through the use of apps, wearables and daily “virtual ward rounds” by medical staff, who review patient data and follow up with telephone calls or home visits where necessary.
    More than 10,000 such beds are already available across England and at least a further 15,000 are planned. Scotland, Wales and Northern Ireland are also funding their expansion.
    But while proponents claim patients in virtual wards recover at the same rate or faster than those treated in hospital, and that the wards’ provision can help cut waiting lists and costs, some worry that their rapid expansion could place additional strain on patients and caregivers while distracting from the need to invest in emergency care.
    “Virtual wards, if they deliver hospital-level processes of care, are just one part of the solution, not a panacea,” said Dr Tim Cooksley, a recent ex-president of the Society for Acute Medicine.
    Read full story
    Source: The Guardian, 7 February 2024
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