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Patient Safety Learning

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  1. Patient Safety Learning
    Frontline staff are being ‘triggered’ by ministers playing down the ‘overwhelming’ pressures facing the health service with “a ‘move along, no story here’-type attitude”, a royal college president has warned.
    The Royal College of Emergency Medicine’s Katherine Henderson said the intentions of those making such comments may be “well meaning” but that it was important ministers and NHSE leaders were “humble and transparent about the scale of the problem [facing the NHS] at the moment”.
    Katherine Henderson said: “The scale of the problem feels quite overwhelming, and the kind of ‘move along, no story here’-type attitude I think is not great for the people working in healthcare. They need to feel heard.”
    Read full story (paywalled)
    Source: HSJ, 24 November 2021
  2. Patient Safety Learning
    It has been revealed that both NHS Digital and NHSX are to be incorporated into NHS England and Improvement.
    In a letter to staff, NHS England and Improvement’s chief executive, Amanda Pritchard said: “As a single organisation, we can further accelerate the digital transformation of the NHS and redouble our efforts to address health inequalities...”
    Pritchard praised NHSX and NHS Digital for their critical role throughout the pandemic delivering the NHS Covid Pass, Covid vaccine systems, virtual wards and many other innovations.
    Going forward she said: “Our Transformation Directorate will continue to lead the digital transformation agenda for the NHS and social care at national and ICS level, alongside colleagues from Improvement and Innovation, Research and Life Sciences.”
    In other major changes, Pritchard also announced that Health Education England is to merge with NHS England and Improvement.
    Secretary of state for health and social care, Sajid Javid, said:  “To ensure our record NHS investment makes a lasting impact, I am bringing workforce planning and digital transformation into the heart of the NHS."
    “These reforms will support our recovery from Covid-19 and help us tackle waiting lists to give patients excellent care in years to come.
    Read full story
    Source: Digital Health, 22 November 2021
  3. Patient Safety Learning
    ‘Unprofessional’ behaviours, a lack of compassion, and tension among staff and managers are all contributing to pockets of ‘poor culture’ at an acute trust.
    A Freedom to Speak Up report presented to the board of Buckinghamshire Healthcare Trust found there had been an increase in bullying and reports of staff members being “humiliated” during the last three months.
    The report, which covers the first two quarters of 2021-22, highlighted a “lack of compassion, kindness, and understanding” between colleagues and noted “increasing levels of frustration” that people are not being held to account for “unprofessional” poor behaviours.
    The report added the findings were not surprising due to the pressures of the pandemic experienced by staff.
    It found: “There appears to be an increase in the proportion of concerns around interpersonal behaviours and communication issues as well as levels of frustration and tension amongst staff and managers.”
    Read full story (paywalled)
    Source: HSJ, 24 November 2021
  4. Patient Safety Learning
    Lung transplant patients in Birmingham are facing significantly worse survival rates as a “sobering” report has revealed two-thirds of patients have died within five years, The Independent has learned.
    Survival rates for lung transplant patients at University Hospitals Birmingham Foundation Trust after five years are now almost 20 percentage points lower than the other main hospitals specialising in lung transplants.
    The latest figures from NHS Blood and Transplant (NHSBT) have revealed Birmingham’s five-year survival rates decreased from 79% in 2015-16 to 31% in 2020-21, and have consistently been the lowest compared to the other four other transplant hospitals in Newscastle, Cambridgeshire, London and Manchester.
    The latest NHSBT’s report showed of those patients who had a transplant in Birmingham between 2012 to 2016, 31 per cent survived. During the same period in Newcastle 47 per cent of patients survived, in Papworth and Manchester 51%, while London’s Royal Harefield recorded a 56 per cent survival rate.
    Birmingham recorded the lowest patient survival rates 90 days after surgery and for one year after surgery between 2016-17 to 2020-21. Although for these measures the hospital was within the national average, unlike its five-year survival rates.
    One transplant surgeon has raised concerns over the continued poor survival rates at Birmingham, claiming they showed the “staggering” failure for the programme in the city to improve.
    Read full story
    Source: The Independent, 23 November 2021
  5. Patient Safety Learning
    Patients are dying in the backs of ambulances or on trolleys in A&E while others languish in beds unable to be discharged due to the collapse in social care. Others waiting in pain are desperate to get a bed for much-needed surgery.
    While there are many ingredients mixing together to create the current NHS crisis, a widespread shortage of nurses, doctors and other essential staff is one of the major contributory factors.
    Many in the NHS reacted with disbelief on Tuesday after 280 MPs voted with the government to reject a bid to force through better workforce planning for the NHS.
    Former health secretary Jeremy Hunt had pulled together a coalition of health organisations and charities who backed his proposal which demanded ministers draw up and publish workforce plans every two years.
    Mr Hunt’s amendment fell victim to the fear of the cost of actually training enough doctors and nurses to work in the NHS.
    The Treasury’s dead hand over NHS policy has and continues to be one of the biggest patient safety threats in the UK.
    As Mr Hunt told MPs, the costs are borne not only from huge bills for locum doctors and nurses who earn incredible pay working alongside exhausted full-time staff, but also in the safety failures caused by staff shortages.
    Exhausted nurses will make mistakes. One nurse cannot safely look after a ward of 16 elderly patients. A doctor can only see one patient at a time in A&E.
    Speaking to MPs, Mr Hunt pleaded with the Commons to offer some hope to the NHS workforce.
    He said NHS staff were “exhausted” but also “daunted” by the challenges they were seeing. He added: “All they ask is one simple request, that they can be confident we are training enough of them for the future.”
    Read full story
    Source: The Independent, 23 November 2021
  6. Patient Safety Learning
    On Monday 22 November, the UK under its G7 Presidency convened a meeting on ‘Patient safety: from vision to reality’, co-sponsored with the World Health Organization (WHO). Patient safety is a critical global public health issue and is essential if health systems are to advance and achieve universal health coverage (UHC). This event provided an important opportunity to demonstrate the continued importance of patient safety as an urgent global endeavour, facilitate international collaboration, and support strategic initiatives designed to eliminate avoidable harm in healthcare globally.
    Since 2016, the UK has worked closely with international partners, including in the G7, to raise the profile of patient safety issues and work together to drive solutions. This engagement led to the establishment of the annual Global Ministerial Summit on Patient Safety and adoption by the 72nd World Health Assembly (2019) of a UK co-led Resolution on ‘Global Action on Patient Safety’ (creating an annual World Patient Safety Day on 17 September) and WHO’s ‘Global Patient Safety Action Plan 2021 to 2030’ by the 74th World Health Assembly (2021).
    The event on 22 November brought together G7 countries, UK devolved administrations, system partners and patient advocates to share learning and reaffirm the importance of this critical issue. With the unprecedented coronavirus (COVID-19) pandemic, patient safety has become an even more crucial area for international cooperation, and the event underlined the importance of countries continuing to work together to maintain momentum on improving patient safety worldwide.
    The event was chaired by Dr Aidan Fowler, National Director of Patient Safety for NHS England and NHS Improvement, and was very well attended by global experts. The importance of continued international work to improve patient safety was underlined in the keynote speeches from Dr Tedros Adhanom Ghebreyesus, Director General of WHO, as well as Sajid Javid, Secretary of State for Health and Social Care, and Jeremy Hunt, Chair of the Health and Social Care Committee.
    The event also provided an important opportunity for sharing learning from around the world; and highlighted the need for and value of continued collaboration between countries on health issues. Interventions from G7 countries and UK devolved administrations provided important insights into how different countries are tackling this shared aim of eliminating avoidable harm in healthcare. It was clear that although health systems differ from country to country, many threats to patient safety have similar causes and similar solutions.
     
    Read full story
    Source: Department of Health and Social Care, 23 November 2021
  7. Patient Safety Learning
    Women who experience bleeding in early pregnancy and have had at least one miscarriage should be treated with the hormone progesterone.
    The new guidance, from the National Institute for Health and Care Excellence (NICE), is based on research suggesting the treatment could lead to 8,450 more births each year in the UK.
    The more miscarriages a woman had, the more effective progesterone was, the trial found. The naturally occurring hormone helps prepare the womb for the growing baby.
    About one in five women experience bleeding, or spotting as it is sometimes called, in the first 12 weeks of pregnancy. It often causes no problems but they are advised to have it checked out with their doctor or midwife to be sure.
    Some may experience a "threatened miscarriage", where bleeding continues along with the pregnancy. Most are told to go home and wait and see what happens next.
    The new (NICE) guidance recommends inserting progesterone pessaries into the vagina twice a day.
    A trial carried out by researchers at the Tommy's National Centre for Miscarriage Research which the new guidance is based on, found that progesterone didn't make much of a difference for women who just had bleeding and no previous miscarriages. But the more miscarriages a woman had suffered, the more effective progesterone was.
    One of those behind the Tommy's National Centre for Miscarriage Research research, Prof Arri Coomarasamy, from the University of Birmingham, said: "This is a very significant moment.
    "We have an intervention that works that can stop a miscarriage. This gives hope to thousands of couples throughout UK."
    "But it's really important to appreciate that only some miscarriages can be prevented by progesterone."
    "There are other causes for miscarriages."
    "We still need to study them. We need to find other effective treatment."
    Read full story
    Source: BBC News, 24 November 2021
  8. Patient Safety Learning
    Millions of people with mild depression in England should be offered therapy, exercise, mindfulness or meditation before antidepressants, according to the first new NHS guidelines in more than a decade.
    Under draft guidance, the National Institute for Health and Care Excellence (NICE) recommends the “menu of treatment options” be offered to patients by health professionals before medication is considered.
    Currently, those with mild depression are offered antidepressants or a high-intensity psychological intervention, such as cognitive behavioural therapy (CBT). The shake-up forms part of the first new recommendations to identify, treat and manage depression in adults since 2009.
    According to the Office for National Statistics (ONS), about one in six (17%) adults experienced some form of depression this summer. The rate is higher than before the pandemic, when 10% of adults experienced it. Younger adults and women are more likely to be affected, the ONS found.
    A 2019 review showed 17% of the adult population in England (7.3 million people) had been prescribed antidepressants in the year 2017-18.
    Dr Paul Chrisp, director of the centre for guidelines at NICE, said: “The Covid-19 pandemic has shown us the impact depression has had on the nation’s mental health. People with depression need these evidence-based guideline recommendations available to the NHS, without delay.”
    Nav Kapur, professor of psychiatry and population health at the University of Manchester and chair of the guideline committee, said: “As a committee we have drawn up recommendations that we hope will have a real impact on people who are suffering from depression and their carers. In particular we’ve emphasised the role of patient choice – suggesting that practitioners should offer people a choice of evidence-based treatments and understanding that not every treatment will suit every person.”
    Read full story
    Source: The Guardian, 23 November 2021
  9. Patient Safety Learning
    Press release: 23 November 2021
    We are pleased to announce that Patient Safety Learning is now a member of National Voices, the leading coalition of health and social care charities in England. Members of National Voices work together to strengthen the voice of patients, service users, carers, their families and the voluntary organisations that work for them.
    Commenting on today’s announcement, Patient Safety Learning’s Chief Executive Helen Hughes said:
    “We are delighted to have joined National Voices. To reduce avoidable harm in health and social care we all need to work in partnership to identify patient safety concerns, highlight where changes are needed and share good practice, to help deliver the systemic change required to create a patient-safe future. We look forward to working closely with partners in National Voices going forward to help improve patient safety.”
    Notes to editors:
    Patient Safety Learning is a charity and independent voice for improving patient safety. We harness the knowledge, insights, enthusiasm and commitment of health and social care organisations, professionals and patients for system-wide change and the reduction of avoidable harm. National Voices is the leading coalition of health and social care charities in England. We have more than 180 members covering a diverse range of health conditions and communities, connecting us with the experiences of millions of people. We work together to strengthen the voice of patients, service users, carers, their families and the voluntary organisations that work for them.
  10. Patient Safety Learning
    Midwives across England are still not receiving enough essential safety training with the pandemic leaving hospitals delivering less training than three years ago.
    A new report from the charity Baby Lifeline, based on an investigation of 124 NHS trusts in England, found 9 in 10 units had training affected by the pandemic with staff shortages named as a major factor in preventing workers from taking time out for learning. This was cited by 72%  of units as a problem.
    The average spend on maternity training was significantly lower in 2020-21 at £34,290 compared to £59,873 in 2017-18, with NHS trusts delivering less training to staff than they did in 2017-18.
    Despite concerns over the poor quality of safety investigations in the NHS, fewer than a third of NHS units trained staff in how to carry out investigations.
    Judy Ledger, chief executive and founder of Baby Lifeline, said: “Today’s report highlights how gaps and variation in the delivery of maternity training across the NHS continues to impact on the safety and care women and babies receive. Time and again evidence shows that training investment can save lives, and the pandemic has widened existing, detrimental gaps that years of chronic under-funding and staff shortages have created.
    Read full story
    Source: The Independent, 23 November 2021
  11. Patient Safety Learning
    Eight highly skilled intensive care (ICU) nurses have resigned from one trust in the past two weeks and more could follow, a leading nurse has warned.
    More resignations expected as working conditions remain unsustainable
    Belfast Health and Social Care Trust in Northern Ireland has confirmed it is redeploying non-specialist nursing staff to fill the gaps in staffing on ICU wards, with experienced ICU nurses expected to provide supervision.
    RCN Northern Ireland director Rita Devlin said the college has heard others at the trust are ‘considering their position’.
    "These are highly skilled nurses who are difficult to replace and this is a very worrying situation," she said.
    "Nursing staff are doing everything they can to keep services going, but it is not sustainable to work under such pressure for long periods of time without a break."
    The resignations come just months after it was revealed that 182 nurses and 50 healthcare assistants had quit their jobs at the trust between January and July.
    Read full story
    Source: Nursing Standard, 23 November 2021
  12. Patient Safety Learning
    The family of a woman who died after being repeatedly overdosed with paracetamol in an NHS hospital have demanded action over her death amid allegations of an NHS cover up.
    Laura Higginson, a trainee solicitor and mum of two, died after seeking medical help for sickness and pneumonia. She died two weeks later from multi-organ failure and sepsis.
    Whiston Hospital, in Merseyside, has admitted to the overdose but denied it caused her death and rejects any suggestion of wrong doing.
    But expert reports, seen by The Independent, including from a liver specialist, questions the trust’s account of what happened, the quality of its post-mortem and concludes the mother-of-two – who only weighed 36kg – suffered liver failure after too much paracetamol in April 2017.
    The overdose mistake was recognised by staff on the third day but Laura’s family were never told.
    The trust did not record the error as an incident and only started an investigation 14 months later when concerns were raised by Laura’s family. Her husband Antony Higginson says the subsequent investigation report is “littered with inaccuracies.”
    He told The Independent: “We just want justice; we don’t care about money. Laura died needlessly and all these institutions charged with ensuring safe care and accountability have point blank failed and have rendered Laura’s life as essentially worthless and that she didn’t matter, when she did matter.”
    Read full story
    Source: The Independent, 21 November 2021
  13. Patient Safety Learning
    The Royal College of Midwives is calling for members to be given the same support as doctors when they struggle with drug and alcohol problems.
    Research shared with the Guardian – the first of its kind into substance abuse among midwives – has revealed that significant numbers of midwives have problems with drugs or alcohol. It found that 28% said they had problems and 16% said they worked while under the influence of various substances.
    Dr Sally Pezaro, the author of the research, found that along with alcohol, midwives used cannabis, cocaine, heroin and sedatives. She said reasons given include work-related stress and anxiety, bullying, traumatic clinical incidents and to maintain overall functioning.
    Pezaro, a midwife and fellow of the Royal College of Midwives, said there was no dedicated support programme available for midwives, while doctors struggling with substance abuse can get support from the NHS practitioner health programme. The incidence of substance abuse among midwives, based on the survey of 623 people, appears higher than among doctors – 8%-15% of whom have been found to have substance abuse problems.
    Pezaro is calling for more support for midwives. “If midwives seek help they lose their licence to practise. Doctors are treated less harshly by their regulator, the General Medical Council, than we are by ours – the Nursing and Midwifery Council,” she said. Between 2014 and 2016 26% of 1,298 fitness to practise cases that came before the Nursing and Midwifery Council (NMC) involved drugs or alcohol.
    A Royal College of Midwives spokesperson said: “It is a brave decision to step forward and say you have a problem and are grappling with substance misuse, which blights the lives of people and their families. For anyone who does this, including healthcare professionals, there should be a compassionate approach.
    Read full story
    Source: The Guardian, 22 November 2021
  14. Patient Safety Learning
    More than 20 different health organisations have joined forces to call for a complete overhaul of the National Health Service in Wales.
    It comes after the worst ever performance figures for hospital emergency departments and the ambulance service were published, as well as warnings from doctors across the country that patients are dying in ambulances and waiting rooms due to overcrowding.
    The group of 22 organisations working across health and social care say Wales needs a single national body with a strategic oversight of the Welsh NHS in order to drive improvements in patient care and hold health boards to account.
    They have launched the 'Ending the postcode lottery' campaign which calls for "an end to fragmented health services".
    Those involved include the the Royal College of Physicians Wales, the British Heart Foundation, Parkinson's UK and Cancer Research UK. They claim that a single, independent national NHS Wales executive would be better placed to improve patient care and deliver on the aims of a healthier Wales.
    The organisations are calling for an independent body with the right powers would have the authority to:
    Support system transformation across health board boundaries Play a national leadership role in service improvement Collect and analyse data to improve performance Improve patient outcomes across clinical specialties, public health and inequalities Provide strong governance and accountability to ensure that the NHS in Wales gets the best value from its combined resources. Dr Abrie Theron, chair of Academy of Medical Royal Colleges in Wales, said: "I cannot see how the Welsh NHS is going to implement the changes needed for a Covid recovery without a NHS Executive team facilitating health boards working together as one for the patients of Wales."
    Read full story
    Source: The National, 22 November 2021
  15. Patient Safety Learning
    The system for assessing who should be asked to pay for NHS services “incentivises racial profiling”, an investigation has found.
    A study by the Institute for Public Policy Research found that overstretched NHS staff sometimes racially profile patients in order to determine who is not “ordinarily resident” in the UK, and therefore must pay for their care.
    The report is critical of the more stringent charging regime introduced by NHS England over the past decade as part of a series of measures devised to create a hostile environment for people living in the UK without the correct immigration status. Overseas visitors officers have been appointed by NHS trusts, responsible for identifying chargeable patients, as part of a cost recovery programme launched in 2014.
    One of the officers told the IPPR study they had felt forced to discriminate between patients based on their name. “If you’ve got a, I don’t know, Mohammed Khan and a Fred Cooper, you’re obviously going to go for [investigating] the Mohammed Khan … Even for someone who’s, you know, well I’d like to think hopefully open-minded, like myself, you’re just trying to save yourself time because there’s not enough hours in the day,” the officer said.
    A hospital employee also reported that discrimination on the basis of ethnicity was used to determine who should be billed for treatment. “It’s a system that is designed to benefit [white] people like me, not people like … the patient on intensive care who is black and British and was unconscious and sent a bill. So why did someone think he was not eligible for care? Given he was unconscious most of the admission, significantly unwell, probably not his accent, more likely his skin colour,” the health worker said.
    Under the rules, anyone “not ordinarily resident” in the UK should be charged 150% of the NHS national tariff for most secondary (non-urgent) healthcare, but the report found that processes varied across the country, with a lack of consistent training and widespread confusion over the 130-page rules for the charging system.
    Some healthcare staff told IPPR researchers that they disliked the extra burden of having to consider whether to refer a patient for charging, which they felt distracted them from their core medical responsibilities.
    Read full story
    Source: The Guardian, 23 November 2021
  16. Patient Safety Learning
    Only 5,000 people a month are being referred to specialist long Covid clinics each month despite more than a million people having the condition – and a third of those are having to wait at least 15 weeks for their first appointment, NHS figures reveal.
    Over the last year the NHS has set up dozens of specialist long Covid clinics in England to assess and diagnose people who visit their GPs with symptoms of the condition.
    The Office for National Statistics estimates there are 1.2 million people in the UK – about a million of them in England – with long Covid, meaning they have had symptoms for 12 weeks or more. However, only 4,846 to 5,182 patients a month were referred to the clinics from July to September this year, the first period for which figures are available.
    Of those patients who are referred, 33% are having to wait at least 15 weeks to be seen for their first assessment – with another 15% waiting for 10 to 14 weeks, the figures show.
    Sarah Woolnough, chief executive of Asthma UK and the British Lung Foundation, said she was extremely concerned by the NHS figures – which tally with anecdotal evidence and her foundation’s own research.
    “We’ve heard first-hand from thousands of people whose lives have been turned upside down by long Covid, who have had to quit their jobs and most-loved hobbies as they battle wide-ranging and disabling symptoms like persistent breathlessness,” she said.
    “If that wasn’t tough enough, many people are then forced to deal with the debilitating effects of long Covid on their own, because of a lack of support and huge wait times for specialist care,” she added.
    “The Government needs to train and recruit more specialist NHS staff, so that people with long Covid can access the specialist care they so desperately need.”
    Read full story
    Source: iNews, 20 November 2021
  17. Patient Safety Learning
    A review into whether medical devices are equally effective regardless of the patient's ethnicity has been ordered by Health Secretary Sajid Javid.
    Research suggests oximeters, which are clipped to a person's finger, can overstate the level of oxygen in the blood of people from ethnic minorities.
    Ministers want to know whether bias could have prevented patients receiving appropriate Covid treatment.
    Mr Javid said any bias was "totally unacceptable".
    But the doctors' union the British Medical Association (BMA) said the review should not simply look at equipment, but also "structural issues" within healthcare that affect ethnic minorities.
    Mr Javid announced the review in the Sunday Times, saying he was determined to "close the chasms that the pandemic has exposed".
    Asked later on the BBC's Andrew Marr show whether he thought people had died of Covid because of pulse oximeters, Mr Javid said: "I think possibly yes, yes. I don't have the full facts."
    He said there was racial bias in some medical instruments, adding: "It's unintentional but it exists."
    "And the reason is that a lot of these medical devices, even some of the drugs, some of the procedures, some of the textbooks, most of them are put together in majority white countries and I think this is a systemic issue around this," he said.
    Read full story
    Source: BBC News, 21 November 2021
  18. Patient Safety Learning
    An acute trust has been fined £2.5m after pleading guilty to charges of failing to provide safe care after the deaths of two patients.
    The Care Quality Commission brought charges against The Dudley Group Foundation Trust earlier this year over care failings in two separate cases which the regulator said exposed two patients to “significant risk of avoidable harm”.
    The trust pleaded guilty to the charges in July and was fined during a sentencing hearing today.
    The cases, involving 33-year-old mother of six Natalie Billingham, and 14-year-old Kaysie-Jane Bland [also known as Kaysie-Jayne Robinson], were both in 2018 and  related to care at the trust’s Russells Hall Hospital in Dudley.
    Ms Billingham was admitted to Dudley’s Russells Hall Hospital with numbness in her right foot on 28 February 2018 and died on 2 March of organ failure caused by a “time critical” infection.
    The court was told she was initially thought to have a deep vein thrombosis after a three-minute triage that failed to identify "disordered" observations. The hospital then had multiple reasons to reconsider the initial diagnosis, but opportunities for review were "missed or ignored".
    In the case of Kaysie-Jane, who had cerebral palsy, an "early warning score" was inaccurate, meaning a sepsis screening tool was not triggered.
    The CQC said the care both patients received at Russells Hall Hospital was undermined by the Dudley Group’s failure to address known safety failings which the regulator repeatedly raised with the trust in the months before their deaths. The CQC said the trust did not take all reasonable steps to make improvements, despite its intervention. The trust has denied it did not react to the concerns raised. 
    Failings included errors in the hospital’s initial assessments and monitoring of both patients, which hindered the timely escalation of concerns.
    A lawyer acting on behalf of the Dudley Group NHS Foundation Trust had admitted the trust failed to provide treatment in a safe way, resulting in harm, in February and March 2018.
    Read full story (paywalled)
    Source: HSJ, 19 November 2021
  19. Patient Safety Learning
    System leaders are pushing for their new bundle of urgent and emergency standards to replace the four-hour target from April, HSJ has learned
    Well-placed senior sources said the NHS is seeking to persuade the government that a new package of measures can be introduced from the start of 2022-23.
    The new package of targets, which include ambulance response and handover times, as well as arrival to admission times, have some traction among ministers but have not yet got the green light from the top of government.
    The new ‘bundle of ten standards’:
    Pre-hospital
    Response times for ambulances. Reducing avoidable trips (conveyance rates) to emergency departments by 999 ambulances. Proportion of contacts via NHS 111 that receive clinical input. A&E
    Percentage of ambulance handovers (from ambulance to A&E) within 15 minutes. Time to initial assessment — percentage within 15 minutes. Average (mean) time in department — for non-admitted patients. Hospital
    Average (mean) time in department — for admitted patients. Clinically ready to proceed (time from when decision is made to admit or discharge, and patient is admitted or discharged). Whole system
    Patients spending more than 12 hours in A&E. Critical time standards — aimed at ensuring the highest priority patients get care within a set timeframe such as an hour. Read full story (paywalled)
    Source: HSJ, 18 November 2021
  20. Patient Safety Learning
    The increased risk of black and minority ethnic women dying during pregnancy needs to be seen as a whole system problem and not limited to just maternity departments, according to experts on an exclusive panel hosted by The Independent.
    Professor Marian Knight, from Oxford University told the virtual event on Wednesday night that the health service needed to change its approach to caring for ethnic minority women in a wider context.
    Campaigners Tinuke Awe and Clotilde Rebecca Abe, from the Fivexmore campaign, called for changes to the way midwives were trained and demanded it was time to “decolonise the curriculum” so it recognised the physiological differences between some ethnic minority women and white women.
    Dr Mary Ross-Davie, from the Royal College of Midwives, said work was underway to ensure the voices of black women and other minorities were represented in its work and it was examining how it could deliver better training to midwives.
    The data on maternity deaths in the UK show black women are four times more likely to die during pregnancy in the UK than white women. For Asian women, they are twice as likely to die.
    Read full story and watch video of event
    Source: The Independent, 18 November 2021
  21. Patient Safety Learning
    Becoming a father can be the happiest time in a man's life, but for some it can bring unexpected feelings of anxiety, stress and guilt. Until recently, mental health concerns for new dads were little understood and, often, went unaired. But some men who have experienced postnatal depression hope telling their stories will encourage others to open up.
    When Stephen's daughter was born five years ago he knew he was meant to feel happy but instead began to think his wife and newborn child might be better off without him.
    "You don't get a chance to sit back, take it in, relax and enjoy it," he said. "I'd come home on a weekend after a long week, tired out, and my wife was back at work, working weekends."
    "It just affects you, you don't see each other, you don't have the chance to enjoy it, and all the stress and anxiety builds up. I got to such a low point I considered my family were better off without me."
    An international study in 2010 suggested that as many as one in 10 men struggle with postnatal depression (PND). More recently, in 2015, a survey by the National Childbirth Trust (NCT) found one in three new fathers had concerns about their mental health.
    The NCT has called for more recognition around mental health issues affecting new dads. It has set up Parents in Mind: Partners Project, which offers support to everyone who has an active role raising a child under two.
    "Becoming a parent is an emotional rollercoaster," said Catherine Briars, who runs the project in St Helens.
    "Fathers sometimes feel uncomfortable opening up about their feelings but we encourage them to do so if they're struggling. It's often the first step to recovering and regaining good mental health."
    She said they encourage men to talk to someone they trust or their GP.
    Read full story
    Source: BBC News, 19 November 2021
  22. Patient Safety Learning
    The UK government was not properly prepared for a pandemic like COVID-19, a new report has found.
    The report by the National Audit Office (NAO) said the government lacked detailed plans on shielding, job support schemes and school disruption.
    The spending watchdog added that lessons needed to be learned.
    In response, the government said the unprecedented pandemic had challenged health systems around the world - not just the UK.
    The NAO said preparations for a flu pandemic or highly infectious diseases like Ebola were prioritised over diseases with similar characteristics to Covid.
    The watchdog said the UK government did not have specific plans to tackle a disease like COVID-19, which has a lower mortality rate than Ebola but has the ability to spread in communities with asymptomatic infected people.
    The report suggests the government had some mitigations in place for a pandemic, like a stockpile of personal protective equipment, but it lacked preparation for "wide-ranging impacts" coronavirus and other pandemic-inducing viruses can have on society and the economy.
    A government spokesperson said: "We have always said there are lessons to be learned from the pandemic and have committed to a full public inquiry in spring.
    "We prepare for a range of scenarios and while there were extensive arrangements in place, this is an unprecedented pandemic that has challenged health systems around the world."
    Labour's shadow Cabinet Office minister Fleur Anderson, said the report showed "Conservative ministers failed to prepare and they failed the public".
    Read full story
    Source: BBC News, 19 November 2021
  23. Patient Safety Learning
    The NHS is to introduce a revolutionary new treatment to tackle the leading genetic cause of death among babies and young children.
    About 1,500 patients in England with certain types of spinal muscular atrophy (SMA) are expected to benefit from risdiplam, after a recommendation from the health watchdog. The drug, also called Evrysdi and made by Roche, is a syrup that can be taken at home and is the first non-injectable treatment for the condition.
    SMA is a progressive neuromuscular condition affecting the nerves in the spinal cord controlling movement and can cause paralysis, muscle weakness and progressive loss of mobility.
    The NHS England chief executive, Amanda Pritchard, said: “In the last three years the NHS has revolutionised care for people with SMA, by securing access to a trio of innovative treatments – Spinraza, Zolgensma and now risdiplam – where three years ago clinicians had no effective medicines at all.
    “Spinal muscular atrophy is a cruel disease and the leading genetic cause of death among babies and young children, which is why NHS England has been determined to make these treatments available to people as soon as possible to help transform the lives of patients and their families.”
    Meindert Boysen, the deputy chief executive of NICE, said the watchdog was pleased to recommend a “convenient oral treatment for people with SMA that can be administered at home”.
    He said: “This will not only be less burdensome, and therefore have a positive impact on the lives of both people with SMA and their caregivers, but it will also reduce the treatment administration requirements for the NHS.
    “In practical terms, the availability of an oral drug should lead to greater adherence to treatment, along with giving access to a treatment to those who aren’t able to have other currently recommended options.”
    Read full story
    Source: The Guardian, 19 November 2021
  24. Patient Safety Learning
    A third of women who have suffered symptoms of the menopause say they hid them at work, and many think there remains a stigma around talking about the subject, according to a survey of workers in five countries.
    More than 5,000 women in the UK, Germany, Spain, Italy and South Africa were interviewed about their experiences of the menopause and work in research for the mobile phone provider Vodafone.
    In all of the countries except Italy, about a third said they had hidden symptoms, while in Spain more than half felt a stigma around the subject in the workplace.
    South African women seemed most comfortable discussing the subject with colleagues, with 37% saying they thought there was a stigma, while in Italy the proportion who said they had hidden symptoms was lowest at 28%.
    The survey found those who experienced symptoms before they were 45 were most likely to say that they were too embarrassed to ask for support in the workplace. Of those in the UK, 63% of adults under the age of 44 said they had shied away from asking for help, while across all ages the figure was 43%. The figures were similar in the four other countries.
    In recent years, businesses have begun to introduce policies to help women who are suffering from menopausal symptoms such as hot flushes, anxiety and fatigue. However, there are concerns that many women are still leaving the workforce because they struggle with some of the effects, and feel they are not supported by their employers. 
    Read full story
    Source: The Guardian, 8 March 2021
  25. Patient Safety Learning
    The shortage of hormone replacement therapy (HRT) in Northern Ireland is distressing for women and challenging for pharmacies trying to access it, according to a community pharmacist.
    Loretto McManus advised women to leave plenty of time for ordering their prescriptions.
    The Health and Social Care Board said there were "some treatments which are currently experiencing supply issues".
    HRT helps many women control their often difficult menopausal symptoms. There is a national shortage of HRT with officials citing several reasons including manufacturing delays, an increase in demand and possibly Brexit.
    Ms McManus said certain products were out of stock in pharmacies across Northern Ireland and that this was "distressing" for women who have become used to particular treatments.
    "As a community pharmacist the utmost care of our patients is premium to us," she said. "Trying to source the prescribed product in a timely manner for the patient can be challenging."
    Several women have told BBC News NI that they were being offered substitutes or had to source the medication themselves.
    Kathryn Schreuder, part of a Northern Ireland menopause support group, said: "For a lot of women, their concern is, if their medication isn't available and they have just maybe spent six months to a year getting the right level of what they need, for that suddenly to be changed because of the limitation of what is available is very distressing."
    Read full story
    Source: BBC News, 7 November 2021

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