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Patient Safety Learning

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  1. Patient Safety Learning
    Record levels of overheating and a sharp rise in flooding at England’s hospitals are putting vulnerable patients at risk, figures show.
    Analysis of NHS data by the Liberal Democrats found that the number of health trusts reporting overheating in clinical areas had doubled compared with six years ago, and floods had increased by nearly 60% from last year.
    An overheating incident is logged when an occupied ward or clinical area’s daily maximum temperature exceeds 26C, the temperature at which some patients become unable to cool themselves effectively.
    The latest government figures show that in the summer of 2022 there were an estimated 2,985 excess deaths due to heatwaves, the highest number on record. Heatwaves also forced a fifth of UK hospitals to cancel operations.
    The number of serious flooding incidents, where water caused disruption such as by breaching a building or flooding a road, rose from 176 to 279.
    The climate crisis is expected to increase these risks to hospitals and patients. Helen Buckingham, the director of strategy at the Nuffield Trust, said: “These figures are a cause for real concern about the resilience of the NHS’s estate to the growing threat from extreme weather in the UK. As temperatures have climbed, so too have the number of overheating incidents in NHS hospitals.”
    Read full story
    Source: The Guardian, 27 November 2023
  2. Patient Safety Learning
    Patients needing urgent treatment for life-threatening illness such as strokes or heart attacks waited more than 24 hours for an ambulance response, new figures show.
    New data shows the crisis facing NHS ambulance services resulted in every region missing vital NHS targets to respond to some of the most critically unwell patients last year.
    Despite improvements compared to 2022, figures obtained by the Liberal Democrat party show ambulance services continued to struggle with response times to category two patients, which may include those who have suffered a stroke or heart attack and should receive a response within 18 minutes.
    In two cases patients needing this level of response, in Warrington and Staffordshire, waited more than 25 hours for an ambulance.
    Sir Julian Hartley, chief executive at NHS Providers, which represents all NHS trusts, called for “urgent” investment and warned that “rising demand, limited resources and vast staff shortages are piling pressure on an already-stretched service, further driving up ambulance waiting times.”
    He said NHS hospital and ambulance leaders are working to reduce delays and responses at a time “when demand has never been higher.”
    Read full story
    Source: The Independent, 23 April 2024
  3. Patient Safety Learning
    A failure to share medical information between IT systems contributed to the death of a man in prison custody, a coroner has concluded.
    In a newly published report on the death of Finlay Finlayson at HMP Lewes in 2019, the coroner highlighted “information sharing” problems and “permissions issues” between the prison IT system and that of the man’s GP surgery. 
    Mr Finlayson died from blood clots in his lungs, having suffered from multiple long-term health conditions including cancer during his life. At the time of his death in 2019, health services at HMP Lewes were provided by Sussex Partnership Foundation Trust, though they are now provided by the Practice Plus Group.
    According to the Prevention of Future Deaths report issued last month, coroner Laura Bradford heard evidence that Mr Finlayson’s care was affected by “confusion and uncertainty about his medical conditions caused by information sharing and permissions issues with SystmOne”.
    It appears the GP practice had not enabled sharing of the data, which would have been required for it to be accessed in the prison.
    Read full story (paywalled)
    Source: HSJ, 22 April 2024
    Further reading on the hub:
    NHS England warns electronic patient record could pose ‘serious risks to patient safety’: what can we learn? The digitalising of patient records — why patients MUST be involved
  4. Patient Safety Learning
    Women working for the NHS will be entitled to two weeks’ leave if they have a miscarriage, in a move hailed as a major step to wider recognition of the trauma of baby loss.
    NHS England has announced that all staff who lose a baby before 24 weeks should receive up to 10 days’ paid leave to help them recover from the distress involved.
    “Baby loss is an extremely traumatic experience that hundreds of NHS staff experience each year and it is right that they are treated with the utmost care and compassion when going through such an upsetting experience,” said Dr Navina Evans, its chief officer for workforce, training and education.
    Women will also be able to take further paid time off after a miscarriage for medical examinations, scans or other tests, or to receive mental health support, as well as the two-week grieving period.
    Rachel Hutchings, a fellow at the Nuffield Trust health thinktank, said its recent research into how parenting and caring responsibilities affect surgeons found that some staff who had a miscarriage did not feel well supported by the NHS.
    “Although some organisations had already introduced additional support for people who experienced baby loss, it is incredibly welcome that this policy recognises the experiences of these individuals and will ensure a more consistent approach”, said Hutchings.
    Read full story
    Source: The Guardian, 13 March 2024
  5. Patient Safety Learning
    Global supply problems have caused a “shock rise” in shortages of life-saving drugs like antibiotics and epilepsy medication, new research reveals. These shortages come at a cost to the patient and the taxpayer, and are happening despite the NHS spending hundreds of extra millions trying to mitigate the problem. The UK risks being left in the cold when it comes to co-ordinated EU attempts to tackle them. 
    That’s according to a new report by the Nuffield Trust think tank and a group of academics, funded by the Health Foundation, which examined key indicators on drug shortages in the UK in the context of global problems with supply chains and the availability of key ingredients. It finds that the past two years have seen constantly elevated medicines shortages, in a "new normal" of frequent disruption to crucial products.  
    Key findings on drugs shortages include: 
    Price concessions (where the government gives extra funding because there are no drugs left at the NHS price) have risen sharply in recent months: prior to 2016 there were rarely more than 20 per month but in late 2022 they peaked at 199 and have remained high ever since.   The excess cost for medicines in months when they were subject to price concessions was £220m across the year to September 2023. There are now over double the number of notifications by drugs companies warning of impending shortages than there were three years ago: in 2023 there were 1,634 such alerts issued, compared to 648 in 2020 (a spike in 2021 was caused by concerns over supply fears in Northern Ireland following Brexit).    The UK has been slower to approve drugs than the EU for new drugs that are authorised centrally. Of drugs authorised in the year to December 2023, 56 drugs authorised in Europe were approved later in the UK and eight have not been approved. Four were approved faster. The report shows that the EU Exit has not caused the recent spike in medicine shortages, but it is likely to significantly weaken the UK’s ability to respond to them by splitting it from European supply chains, authorisations and collective efforts to respond to shortages. In particular, the research highlights the risks posed to the UK from being left out of key initiatives like the Critical Medicines Alliance and Voluntary Solidarity Mechanism, led by EU member states to work together to insulate themselves from the impact of medicines shortages.  
    Read full story
    Source: The Nuffield Trust, 18 April 2024
  6. Patient Safety Learning
    The parents of a baby who died from sepsis said their son deserved a "fighting chance" after concerns were raised over his care in hospital.
    Ten-week-old Tommy Gillman was admitted to King's Mill hospital on 7 December 2022 but died the next day.
    Tommy Gillman, from Coddington, Nottinghamshire, was "extremely unwell" with what proved to be Salmonella Brandenburg meningitis when admitted to the Sutton-in-Ashfield hospital at 12:35 GMT.
    His assessment was delayed, and then the severity of his condition missed, meaning correct treatment with antibiotics and fluids did not start until 17:00.
    A coroner's report identified a lack of experienced paediatric nurses and confusion in handovers between staff.
    "I am not reassured that necessary actions to address these serious issues identified are in place," the coroner said.
    Sherwood Forest Hospitals NHS Foundation Trust said it welcomed the review and a "rapid" programme of improvements was being worked on.
    Tamzin Myers and Charlie Gillman said their son deserved "a fighting chance" by getting prompt treatment
    Read full story
    Source: BBC News, 17 April 2024
  7. Patient Safety Learning
    Two in three UK doctors are suffering “moral distress” caused by the enfeebled state of the NHS and the damage the cost of living crisis is inflicting on patients’ health, research has found.
    Large numbers are ending up psychologically damaged by feeling they cannot give patients the best possible care because of problems they cannot overcome, such as long waits for treatment or lack of drugs or the fact that poverty or bad housing is making them ill.
    A new survey found that 65% of doctors overall, including nearly four in five (78%) GPs and more than half (56%) of hospital doctors, have experienced “moral distress” as a direct result of situations they have encountered working in the NHS.
    Seeing patients with malnutrition or hypothermia, or stuck on trolleys in A&E corridors asking for help or forced to choose between heating their home or getting a prescription dispensed are among the events triggering their distress, medics said.
    “There’s barely a doctor at work in the NHS today who doesn’t see or experience this distress on a daily basis,” said Prof Philip Banfield, the leader of the British Medical Association.
    The NHS is “impossibly overstretched”, has thousands of vacancies for doctors and has a quarter fewer doctors a head of population than Germany, he added.
    “In practice that means we can almost never give the standard of care we would want, only ever the care we can manage. That takes its toll, as we see here,” Banfield said.
    Read full story
    Source: The Guardian, 28 December 2023
  8. Patient Safety Learning
    The boss of the NHS has made a dramatic intervention in The Independent highlighting the shocking amount of sexual abuse against staff in the health service, arguing that a #MeToo moment is needed to safeguard staff.
    Amanda Pritchard hit out at the “unacceptable” levels of abuse faced by doctors and nurses, demanding that health trusts be judged on their progress in tackling sexual harassment.
    She has called for sexual harassment against NHS staff to be “stamped out” after it emerged that one in eight workers – 58,000 – had reported experiencing unwanted sexual behaviour last year.
    Writing exclusively for The Independent, Ms Pritchard said the abuse now levelled at doctors and nurses is unacceptable – with some staff being raped at work, groped, and shown pornography.
    “The #MeToo movement has powerfully called out this unacceptable behaviour and fuelled important discussions right across society, and the NHS must not be exempt,” Ms Pritchard wrote.
    Around 58,000 NHS workers reported being subjected to unwanted sexual behaviour last year (PA)
    “But we can’t just call out unacceptable behaviour and move on: we need to stamp it out across all parts of the NHS.”
    Read full story
    Source: The Independent, 13 April 2024
  9. Patient Safety Learning
    Medical device companies are paying millions of pounds to hospitals in the UK to fund staff places, as well as training and awareness campaigns, while pushing sales of their products, including implants, heart valves and diagnostic equipment, a new report reveals.
    An analysis of disclosures by medical device companies found that between 2017 and 2019 they reported €425m (£367m at today’s rates) in payments to healthcare organisations in Europe, according to the study in the journal Health Policy and Technology.
    The businesses reported paying more than €37m to hospitals and other healthcare bodies in the UK over the three-year period. The disclosures include payments to some of the biggest hospital trusts in England.
    James Larkin, one of the authors of the study and a postdoctoral researcher at the Royal College of Surgeons in Ireland, said the filings did not include consultancy fees for medical staff and many companies did not register their payments. “This is just the tip of the iceberg,” he said. “There is a huge number of payments that are not being disclosed. The descriptions for payments which are disclosed are very vague and it is not completely clear what they are for.”
    Read full story
    Source: The Guardian, 20 April 2024
  10. Patient Safety Learning
    Tens of thousands of doctors are hoping to quit the NHS and move abroad this year in search of better pay, the medical regulator has warned.
    Half of the doctors planning to leave said they wanted to move to Australia, which has been the most popular destination for emigrating UK doctors for the past five years.
    The General Medical Council surveyed 3,154 doctors about their attitudes towards leaving the UK, including 1,000 who had recently left to practise abroad. Some 13% of those working in the NHS said they were “very likely” to move in the next 12 months, while another 17% said they were “fairly likely” to move.
    The GMC said this would amount to 96,000 doctors quitting over the next year if applied to the total number of doctors on the medical register, although it acknowledged that the actual rate of departures was likely to be much lower.
    Read full story (paywalled)
    Source: The Times, 12 April 2024
  11. Patient Safety Learning
    Investigators have applied artificial intelligence (AI) techniques to gait analyses and medical records data to provide insights about individuals with leg fractures and aspects of their recovery.
    The study, published in the Journal of Orthopaedic Research, uncovered a significant association between the rates of hospital readmission after fracture surgery and the presence of underlying medical conditions. Correlations were also found between underlying medical conditions and orthopedic complications, although these links were not significant.
    It was also apparent that gait analyses in the early postinjury phase offer valuable insights into the injury’s impact on locomotion and recovery. For clinical professionals, these patterns were key to optimizing rehabilitation strategies.
    "Our findings demonstrate the profound impact that integrating machine learning and gait analysis into orthopaedic practice can have, not only in improving the accuracy of post-injury complication predictions but also in tailoring rehabilitation strategies to individual patient needs," said corresponding author Mostafa Rezapour, PhD, of Wake Forest University School of Medicine. "This approach represents a pivotal shift towards more personalised, predictive, and ultimately more effective orthopaedic care."
    Read full story
    Source: Digital Health News, 12 April 2024
  12. Patient Safety Learning
    A record 3.7 million workers in England will have a major illness by 2040, according to research.
    On current trends, 700,000 more working-age adults will be living with high healthcare needs or substantial risk of mortality by 2040 – up nearly 25% from 2019 levels, according to a report by the Health Foundation charity.
    But the authors predicted no improvement in health inequalities for working-age adults by 2040, with 80% of the increase in major illness in more deprived areas.
    Researchers at the Health Foundation’s research arm and the University of Liverpool examined 1.7m GP and hospital records, alongside mortality data, which was then linked to geographical data to estimate the difference in diagnosed illness by level of deprivation in England in 2019, the last year of health data before the pandemic.
    They then projected how levels of ill health are predicted to change in England between 2019 and 2040 based on trends in risk factors such as smoking, alcohol use, obesity, diet and physical activity, as well as rates of illness, life expectancy and population changes.
    Without action, the authors warn, people in the most deprived areas of England are likely to develop a major illness 10 years earlier than those in the least deprived areas and are also three times more likely to die by the age of 70.
    Read full story
    Source: The Guardian, 17 April 2024
  13. Patient Safety Learning
    Lucy Letby is to apply for permission to appeal against her convictions for the murder and attempted murder of babies in her care.
    A panel of three judges at the Court of Appeal in London is due to consider the former nurse’s case later.
    The 34-year-old was handed 14 whole life terms last year.
    She was found guilty of murdering seven babies and attempting to murder a further six at the Countess of Chester Hospital between 2015 and 2016.
    Second stage
    Shortly after her trial ended in August, Letby applied for leave to appeal against her convictions.
    She lost the first stage of the process, in which a single judge reviewed her arguments as a paper exercise.
    Letby, originally of Hereford, now has the right to a second stage, which involves renewing her application before a panel of judges at a hearing at the Court of Appeal.
    Separately to the appeal, Letby is due to be re-tried on one charge of attempted murder, which the jury at her trial was unable to decide on.
    Read full story
    Source: BBC News, 2 April 2024
  14. Patient Safety Learning
    Millions of patients are being put at risk in crumbling hospitals that are unfit for purpose, MPs have said, as figures reveal more than 2,000 NHS buildings are older than the health service itself.
    Health bosses have repeatedly warned ministers of the urgent need to plough cash into replacing rundown buildings in order to protect the safety of patients and staff. The maintenance backlog has risen to £11.6bn in England.
    Now analysis of NHS Digital data has found that at 34 out of 211 NHS trusts in England at least one in four buildings have been standing since before 1948, the year the NHS was founded.
    Sewage leaking from sinks on to wards are among the issues affecting more than 2,000 buildings that predate the health service. Last month it was reported that the ceiling of an intensive care ward collapsed on to a patient on life support and a falling lift broke a doctor’s leg. One hospital is said to have been using its intensive care unit as a storeroom because it deemed it unsafe for patients.
    Read full story
    Source: The Guardian, 15 April 2024
  15. Patient Safety Learning
    Ethnic minorities and young people require more visits than other people to the GP before being diagnosed with cancer, according to new analysis.
    On average, one in five people across England require three or more GP interactions before being diagnosed with cancer. But for people from ethnic minority backgrounds, the figure rises to one in three, according to analysis of the NHS cancer patient experience 2022 survey by QualityWatch, a joint programme from the Nuffield Trust and the Health Foundation.
    For young people aged between 16 and 24, about half needed at least three GP visits before being diagnosed, with 20% needing at least five visits. Despite this, young people were still more likely to be diagnosed at an early stage in their cancer.
    Prof Kamila Hawthorne, the chair of the Royal College of GPs, said that identifying cancer symptoms in young people could be challenging as the risk for the group was generally much smaller.
    Hawthorne said: “Ensuring patients receive timely and appropriate referrals for suspected cancers is a priority for GPs – and to this end, they are doing a good job, making more urgent referrals and ensuring more cancers are being diagnosed at an early stage than ever.
    “Whilst GPs are highly trained to identify cancers, this remains challenging in primary care, not least and particularly with some cancers, because the symptoms are often vague and typical of other, more common conditions.”
    Dr Liz Fisher, senior fellow at the Nuffield Trust, said: “Delays to a cancer diagnosis pose real risks for people and an early diagnosis plays a pivotal role in determining the treatments available to people and determining outcomes.
    “The NHS has set an ambitious goal to dramatically increase early detection of cancer, but performance in this area has stubbornly stalled in recent years. Everyone’s experience of cancer diagnosis is different but the risks to delays aren’t felt equally, with younger people and those from minority ethnic groups requiring more visits to health professionals to secure a diagnosis.”
    Read full story
    Source: The Guardian, 24 April 2024
  16. Patient Safety Learning
    Children are being forgotten by the government as they face “disgraceful” waiting times for NHS treatment, Britain’s top paediatric doctor has warned.
    Dr Camilla Kingdon said children are being failed because their care is not being treated as a priority, despite considerable progress having been made in reducing waiting times for adults.
    In her final interview as president of the Royal College of Paediatrics and Child Health, she also issued a stark warning over the impact of poverty on young people’s health, lamenting the rise in the number of children being treated for severe lung disease due to damp and poor ventilation in inadequate housing.
    Many parents cannot afford to be at their dying or sick child’s bedside because of financial pressures – an issue that has grown significantly worse in the past five years, she said.
    She told The Independent: “Children simply need to be made a priority. We cannot afford to be ignoring this problem.”
    The latest NHS figures show that the backlog for children’s hospital care has risen again, increasing from 387,000 in August to 412,000 in January, despite the adult waiting list having fallen since October.
    Read full story
    Source: The Independent, 31 March 2024
  17. Patient Safety Learning
    Maternity departments are raising thousands of safety reports every year about delayed inductions of labour, HSJ can reveal.
    Induction of labour may be used when women are overdue, because their waters have broken, or for other medical reasons to speed up the birth, such as poor growth of the baby.
    Delaying induction therefore may increase risks for both mothers and babies and the National Institute for Health and Care Excellence says trusts should raise a “red flag event” if it is delayed for more than two hours after admission.
    Information collected by HSJ from 50 trusts show 4,945 red flags related to delays in induction of labour in 2022-23. HSJ also found 3,109 reports in 2021-22 and 1,807 in 2020-21 across 47 trusts. 
    Meanwhile, there were 1,997 Datix reports mentioning induction of labour in 2022-23 across 59 trusts able to give HSJ figures, in response to Freedom of Information Act requests, compared with 1,690 in 2021-22 and 1,368 in 2020-21. 
    The Care Quality Commission has also raised concerns in inspections that incidents which should have been treated as “red flags” have not always been reported as such. The watchdog has also raised concerns about a lack of board-level oversight of maternity safety incidents and a need for clearer guidance for staff on reporting processes. 
    Read full story (paywalled)
    Source: HSJ, 2 April 2024
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