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Patient Safety Learning

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  1. Patient Safety Learning
    A mental health hospital in Suffolk has been closed after inspectors found it was failing to protect patients from harm and abuse.
    St John's House in Palgrave, near Diss, was previously rated inadequate by the Care Quality Commission (CQC). A further inspection of the 49-bed hospital found the care was "unacceptable" and "insufficient progress had been made regarding patient safety".
    The company that runs the hospital, Partnerships in Care, part of the Priory Group, has now decided to close the site.
    Stuart Dunn, CQC head of inspection for mental health and community services, said: "Our latest inspection of St John's House found an unacceptable service where insufficient improvements had been made to protect patients from harm and abuse and the number of safety incidents remained high."
    "Staff weren't responding appropriately to patients who were self-harming, with one patient not being sent to hospital quickly enough after swallowing a foreign object, despite complaining of abdominal pain.
    "We reviewed CCTV footage and found staff were sometimes asleep when they should have been observing patients to make sure they were safe. This was all the more concerning as we identified this as a concern during the previous two inspections of this service, demonstrating a lack of improvement to keep patients safe.
    "Incidents of restraint remained high and not all staff had the right training to carry it out safely. In addition, staff were not following hospital policy when using soft handcuffs with patients during safety incidents."
    Read full story
    Source: ITV News, 17 September 2021
  2. Patient Safety Learning
    The entire Covid shielding programme has been “closed” for good in an announcement slipped out at night during a Cabinet reshuffle.
    Clinically extremely vulnerable people will “not be advised to shield again” in future despite fears of a huge winter wave, said the statement uploaded to the government website last week.
    Furious charities today raised fears disabled and immunosuppressed people will be “cast adrift” - while others will feel “yet again forgotten by the government”.
    Some 3.8million vulnerable people were advised to shield during England’s third lockdown, going outside only for exercise or health appointments. That guidance was paused on 1 April and on July 19 people were told they could follow the same rules as the rest of the population.
    But the ‘Shielded Patient List’ was retained for future use and ex-shielders were given special tips, such as only meeting vaccinated people.
    Last night, however, the government announced there will no longer be “centralised guidance” for clinically extremely vulnerable people.
    Read full story
    Source: Mirror, 16 September 2021
  3. Patient Safety Learning
    Negligent maternity care in the NHS has cost taxpayers an “eye-watering” £8.2bn over the past 15 years, The Independent reveals.
    Ministers face calls to urgently increase spending to ensure maternity units are safe for women and babies by providing adequate staffing levels, training and equipment.
    New data, obtained by The Independent from NHS Resolution, which handles clinical negligence costs for the service, reveals that total payments made following settled cases and legal costs rose from £271m in 2006-07 to an estimated £920m in 2020-21.
    The number of maternity claims being made by families has almost doubled in the past decade, rising from 391 in 2009-10 to 765 in 2019-20.
    Recent maternity scandals at the Shrewsbury and Telford Hospital Trust, East Kent Hospitals University Trust and at hospitals in Nottingham have all had common themes around poor culture, a lack of honesty and not enough staff or equipment.
    The Department of Health and Social Care is exploring how it can make changes to the UK clinical negligence system to reduce the costs to the taxpayer. Health minister Nadine Dorries told MPs on the Commons health committee in February that the reforms would look “across the NHS… not just maternity, at how issues of no-blame, no-fault compensation and clinical negligence are treated”.
    Read full story
    Source: The Independent, 20 September 2021
  4. Patient Safety Learning
    A trust’s maternity services were rated ‘good’ despite an independent report finding ‘weaknesses in the culture’ and ‘defensive and fractious’ behaviours, HSJ has learned.
    As previously reported, former staff at Sandwell and West Birmingham Hospital Trust had raised concerns with the Care Quality Commission (CQC) over what they described as a “toxic management culture” and “unsafe” staffing levels in the trusts maternity service. Particular concerns were raised around community midwifery services.
    This prompted an unannounced inspection by the CQC in May, which found “low morale and negative culture” in the services. However, the CQC ultimately concluded the trust was taking positive steps to address the problems and rated its maternity services “good” overall, as well as for leadership and safety.
    Some frontline staff in the service have questioned those findings, however, and pointed to an independent review which was conducted in the early months of 2021.
    This review, carried out by independent consultant Debbie Graham and seen by HSJ, concluded there was “evidence of weaknesses in the culture; evidenced in the behaviours of some staff which appears to go unaddressed; a lack of strong, visible leadership; a lack of a shared vision; the finding that some staff have a fear of ‘speaking up’; and poor communication systems.”
    Read full story (paywalled)
    Source: HSJ, 20 September 2021
  5. Patient Safety Learning
    Folic acid is to be added to UK flour to help prevent spinal birth defects in babies, the government will announce.
    Women are advised to take the B vitamin - which can guard against spina bifida in unborn babies - before and during pregnancy, but many do not. It is thought that adding folic acid to flour could prevent up to 200 birth defects a year.
    Mandatory fortification - which the government ran a public consultation on in 2019 - would see everybody who ate foods such as bread getting more folic acid in their diets.
    Neural tube defects, such as spina bifida (abnormal development of the spine) and anencephaly, a life-limiting condition which affects the brain, affect about 1,000 pregnancies per year in the UK. Many babies diagnosed with spina bifida survive into adulthood, but will experience life-long impairment.
    Kate Steele, chief executive of Shine, a charity providing specialist support for people affected by spina bifida and hydrocephalus and which has campaigned for mandatory fortification of flour for more than 30 years, said she was "delighted" by the decision.
    "In its simplest terms, the step will reduce the numbers of families who face the devastating news that their baby has anencephaly and will not survive," she said. "It will also prevent some babies being affected by spina bifida, which can result in complex physical impairments and poor health."
    Read full story
    Source: BBC News, 20 September 2021
  6. Patient Safety Learning
    A survey of almost 50,000 patients by the Care Quality Commission (CQC) found people’s experiences of emergency departments improved in 2020, compared to the last time the poll was conducted in 2018.
    On a scale of one to 10, the regulator found 33% of patients scored their overall experience as 10, compared to 29% in 2018. Eighty-eight per cent of patients scored their care at six or higher, compared to 85% three years ago.
    However, overall satisfaction levels declined at around 20 providers. 
    Ted Baker, CQC’s chief inspector of hospitals, said: “This year’s survey shows some encouraging improvements with trust and confidence in clinicians, perceptions of cleanliness and overall experience all performing better than in previous years…
    “However, the scope for further improvement remains. Access to emotional support, help with pain relief and information provided at discharge were all areas where some people surveyed were less positive.”
    Read full story (paywalled)
    Source: HSJ, 16 September 2021
  7. Patient Safety Learning
    At a certain point, it was no longer a matter of if the United States would reach the gruesome milestone of 1 in 500 people dying of COVID-19, but a matter of when. A year? Maybe 15 months? The answer: 19 months.
    The burden of death in the prime of life has been disproportionately borne by Black, Latino, and American Indian and Alaska Native people in their 30s, 40s and 50s.
    “So often when we think about the majority of the country who have lost people to covid-19, we think about the elders that have been lost, not necessarily younger people,” said Abigail Echo-Hawk, executive vice president at the Seattle Indian Health Board and director of the Urban Indian Health Institute. “Unfortunately, this is not my reality nor that of the Native community. I lost cousins and fathers and tribal leaders."
    The pandemic has brought into stark relief centuries of entwining social, environmental, economic and political factors that erode the health and shorten the lives of people of colour, putting them at higher risk of the chronic conditions that leave immune systems vulnerable to the coronavirus. Many of those same factors fuel the misinformation, mistrust and fear that leave too many unprotected.
    Many people don’t have a physician they see regularly due in part to significant provider shortages in communities of colour. If they do have a doctor, it can cost too much money for a visit even if insured. There are language barriers for those who don’t speak English fluently and fear of deportation among undocumented immigrants.
    “Some of the issues at hand are structural issues, things that are built into the fabric of society,” says Enrique W. Neblett Jr., a University of Michigan professor who studies racism and health.
    Read full story (paywalled)
    Source: The Washington Post, 15 September 2021
  8. Patient Safety Learning
    76 people were unintentionally exposed to ionising radiation in Irish hospitals in 2020, according to the Health and Information Quality Authority (HIQA). This figure represents an 11% increase on the total reported in 2019.
    HIQA today published an overview report on the 'increase in accidental and unintended exposure to ionising radiation events notified to HIQA in 2020.
    Under the European Union (Basic Safety Standards for Protection against dangers arising from Medical Exposure to Ionising Radiation) Regulations 2018 and 2019, HIQA is the competent authority for patient protection in relation to medical exposure to ionising radiation in Ireland.
    In its 2019 report — its first such publication — HIQA expressed hope that the areas of improvement it identified "would help reduce the likelihood of such events and drive quality improvements in safety mechanisms for medical exposures in Ireland."
    Despite this, eight more accidental exposure incidents were recorded in 2020 than in the previous year.
    Human error was identified as the main cause of accidental exposure in 58% of the incidents, however, HIQA determined that other factors likely contributed to these.
    Some 34% of the incidents involved the wrong patient being exposed to ionising radiation. HIQA said these exposures occurred at varying points along the medical exposure pathway.
    It stressed that the number of unintended exposure to ionising radiation incidents last year was small compared with the total number of procedures carried out, estimated to be in the region of three million.
    Read full story
    Source: Irish Examiner, 15 September 2021
  9. Patient Safety Learning
    Changes to periods and unexpected vaginal bleeding after having a Covid vaccine should be investigated to reassure women, says a leading immunologist specialising in fertility.
    Writing in the BMJ, Dr Victoria Male, from Imperial College London, said the body's immune response was the likely cause, not something in the vaccines. There is no evidence they have any impact on pregnancy or fertility.
    The UK's regulator has received more than 30,000 reports of period problems. These include heavier than usual periods, delayed periods and unexpected bleeding after all three Covid vaccines, out of more than 47 million doses given to women in the UK to date.
    After reviewing the reports, the Medicines and Healthcare products Regulatory Agency (MHRA) says it "does not support a link" between Covid vaccines and the symptoms.
    However, writing in an opinion piece in the BMJ, Dr Male says "robust research" into reports of period problems would help to counter misinformation around the vaccines.
    "Vaccine hesitancy among young women is largely driven by false claims that COVID-19 vaccines could harm their chances of future pregnancy. Failing to thoroughly investigate reports of menstrual changes after vaccination is likely to fuel these fears."
    "If a link between vaccination and menstrual changes is confirmed, this information will allow people to plan for potentially altered cycles," she said.
    Read full story
    Source: BBC News, 16 September 2021
  10. Patient Safety Learning
    Changes to maternity services during the pandemic, including the mandatory redeployment of midwives and doctors to care for infected patients, may have affected the care given to women who had stillborn babies, a Healthcare Safety Investigation Branch (HSIB) investigation has found.
    The safety watchdog launched an investigation after the number of stillbirths after the onset of labour increased between April and June 2020. During the three months there were 45 stillbirths compared to 24 in the same period in 2019.
    The HSIB launched a probe examining the care of 37 cases. Among its findings the watchdog said staffing levels were affected because of the NHS response to the pandemic.
    In its report it said this “influenced normal work patterns and the consistency and availability of clinicians.”
    As an example, in one maternity unit the staffing numbers were short by three midwives due to sickness and redeployment. In another consultant presence was reduced overnight.
    During the pandemic both the Royal College of Midwives and the Royal College of Obstetricians criticised NHS trusts for redeploying maternity staff when mothers continued to need services regardless of the pandemic.
    HSIB said none of the women in its report were recorded as having the virus, but it found the pressures and changes as a result of the pandemic may have affected the care they received.
    The study stressed that the proportion of consultations undertaken remotely was not known and "the impact of remote consultations is not clear from this review".
    Read full story
    Source: The Independent, 16 September 2021
  11. Patient Safety Learning
    A new coalition with members from Royal Colleges, health charities (including Patient Safety Learning) and patient groups has come together to ensure the interests of patients are at the heart of the development of policy in digital health technology.
    The Patient Coalition for AI, Data and Digital Tech in Health is the first coalition to unite such a diverse range of stakeholders from across the health policy landscape in order to champion the patient perspective in this field.
    Currently, not enough is being done to ensure that patients are included in the evolving policy discussions surrounding the development, implementation or evaluation of digital health technologies in the UK. In fact, there is limited understanding of what patients actually want from digital health. The danger is that these technologies end up as something done ‘to’ patients rather than ‘with’ and ‘for’ them. 
    In addition to providing a forum for discussion, this Coalition will act as an independent campaigning coalition, taking forward joint pieces of work and engaging actively to help influence Government and NHS policy on the use of digital technology in healthcare. The goal will be to ensure patient interests are at the forefront of ongoing media and policy discussions surrounding digital health tech, and being incorporated into the policymaking process. The goal is to cultivate the necessary policy conditions to enable the UK to capitalise on new digital health technologies to the benefit of patients and the NHS.
    Issues Coalition members have committed to tackling include:
    Examining health inequalities and calling for the prioritisation of access to digital health. Sharing best patient-centric practice in digital health. Ensuring the patient perspective is embedded in policy and government strategies.    The Coalition’s objectives for the next year are to:
    Promote understanding of the patient experience of digital health Ensure patients receive the support needed to access digital health tech Inform policymakers on what good practice looks like. The Coalition will continue to engage proactively with policymakers, health agencies and others to help inform digital health policy. It will campaign for policies such as:
    Ensuring all patients have access to digital health technology, regardless of where they are in the country Providing patients with the choice of how they receive care, and empowering them to make that decision for themselves Prioritising digital assurance so that patients feel confident when engaging with digital health technologies that they are using products that have been approved by the NHS Ensuring there are clear regulations for the collection, sharing and use of patient data. Read the full press release on the Patients Association website. 
    Read the Coalition's first report: Digital Health during the Covid-19 Pandemic: Learning Lessons to Maintain Momentum.
    Source: Patients Association, 15 September 2021 
  12. Patient Safety Learning
    Young people cared for by an NHS mental health service "came to harm" because of its failings, inspectors said.
    The care provided by Essex Partnership University NHS Foundation Trust (EPUT) has been rated "inadequate" by the Care Quality Commission (CQC). It has now been stopped from admitting new patients after inspectors found "serious concerns" in the children and adolescent mental health services.
    EPUT said it had increased staffing levels and had been coaching staff.
    The inspection was prompted by a serious incident and concerning information received about safety and quality, the CQC said.
    Inspectors visited, unannounced, in May and June and looked at the Larkwood and Longview wards at the St Aubyn Centre in Colchester and the Poplar Adolescent Unit at Rochford Hospital.
    The CQC found observations were not always carried out safely and patients "had been harmed as a result of the poor practices", which included patients self-harming.
    It said these incidents were not always reported or dealt with appropriately.
    Read full story
    Source: BBC News, 15 September 2021
  13. Patient Safety Learning
    A retiring chief executive was “astonished” how many junior doctors had never met the senior directors of their hospitals — and stressed how being visible on the wards is “critical” to good leadership.
    Karen Partington, who has this month stepped down after 10 years leading Lancashire Teaching Hospitals Foundation Trust, said she had made it her mission to understand the feelings and motivations of frontline staff.
    In an interview with HSJ, she was asked if being visible and spending significant time talking to frontline staff is the most important bit of advice she would give a first-time chief executive.
    She said: “In my personal opinion, it’s critical. How can CEOs be compassionate leaders without understanding the daily pressures faced by the whole team?"
    “My executive team and I [would] meet regularly with our junior doctors and do a ‘you said, we did’ session, which really helped us to change their experiences for the better. But it was also an opportunity to ensure our frontline colleagues understood the environment they were working in as well. I have always found that when people understand ‘why’, [then] they will come up with the solutions."
    Read full story (paywalled)
    Source: HSJ, 14 September 2021
  14. Patient Safety Learning
    The use of opioids for pain relief soared during the pandemic as some patients waited longer for surgery, according to new research.
    The University of Aberdeen team focused on more than 450 patients due to have hip or knee replacement surgery.
    They said waiting times for these procedures increased by an average of 90 days and that the numbers of patients using opioids while waiting for surgery increased by 40% compared to pre-pandemic levels.
    The research, published in the BMJ Quality and Safety, looked at data collected from 452 NHS patients from the north east of Scotland.
    The university's Luke Farrow, who led the research, said alternative ways of managing severe arthritis pain needed to be found "urgently" for those waiting for this kind of surgery.
    Read full story
    Source: BBC News, 15 November 2021
  15. Patient Safety Learning
    A culture of bullying and racial discrimination has been found at a hospital trust, according to an inspection report.
    The Care Quality Commission (CQC) said there was a bullying culture across Nottingham University Hospitals (NUH) Trust, with many staff too frightened to speak up. The trust has been told it requires improvement as a result of the report.
    NUH said it was working to address the concerns.
    The report said a number of the bullying cases were directly attributable to racial discrimination.
    It said the trust's latest staff survey showed the organisation was above average for black, Asian and minority ethnic staff experiencing bullying.
    Sarah Dunnett, the CQC's head of hospital inspection, said they were told of bullying incidents that had not been addressed.
    "We were concerned about the culture of bullying across the trust with many staff being too frightened to speak up," she said.
    She said the CQC would "monitor the service closely" to ensure changes were made.
    Read full story
    Source: BBC News, 15 September 2021
  16. Patient Safety Learning
    A new volunteering programme is aiming to bring trained volunteers into the homes of older patients to provide one-to-one support.
    The Falls Prevention Community Exercise Volunteers programme is being run by the volunteering service at Kingston Hospital NHS FT, which is funded by the volunteering organisation Helpforce and the Kingston Hospital Charity.
    It hopes that this will improve the strength, balance, and mobility of elderly patients, as well as improve their overall health and well-being. This is then expected to reduce the strain on the NHS caused by falls among older patients.
    Research from NICE in 2018 showed that the risk of falls in elderly patients can be reduced by as much as 54%, when they take part in exercises focused on improving strength and balance.
    Bianca Larch, Community Outreach Manager at the trust, said: “We are delighted to launch this much needed volunteering service to support our patients at home.
    “With volunteers supporting patients to undertake a physiotherapy prescribed exercise programme, we hope to see improved strength, mobility and balance in our patients and in turn reduce their risk of falls significantly.
    “This programme can really improve the quality of life of our patients by restoring well-being and independence, especially for those waiting to access various community interventions.”
    Read full story
    Source: National Health Executive, 9 September 2021
  17. Patient Safety Learning
    The NHS may be unable to cope this winter because of a “frightening” shortfall of more than 50,000 doctors, the head of the British Medical Association has warned.
    The number of medics in England has fallen further behind comparable European countries over the summer, ahead of what is predicted to be one of the worst winters in the 73-year history of the health service, Dr Chaand Nagpaul said.
    “Winter is an incredibly difficult time for the health service,” he said. “With flu season on the horizon and even fewer staff this time round, it’s a total unknown as to how well our services will cope – if they even cope at all.”
    With more GPs and hospital doctors quitting over the summer, the shortage has risen to 50,191, according to the BMA. This reflects a loss of 919 doctors in primary care and 110 in secondary care over the last two months.
    Yet more doctors are actively considering quitting in the coming months due to burnout and excessive workloads. “Alarm bells” should be ringing, Dr Nagpaul said.
    The workforce crisis means staff are working longer hours to keep up with patient demand. Some feel they have no choice but to hand in their notice to get the respite they need. This piles pressure on those that remain, Dr Nagpaul said.
    Last week, Prof Martin Marshall, the chair of the Royal College of General Practitioners, told the Guardian that GPs in England are “finding it increasingly hard to guarantee safe care” for millions of patients, because the shortage of medics means they are unable to cope with soaring demand."
    Read full story
    Source: The Guardian, 13 September 2021
  18. Patient Safety Learning
    In recent months, long Covid has received a great deal of media and public attention. Research has found that as many as one in four of those infected with Covid suffer from chronic long-term symptoms, including headaches, dizziness, abdominal pain, heart problems, fatigue, anxiety, depression, cognitive impairment and other conditions.
    It is a difficult and complex illness, and we must do much more to help those who are struggling with it. At the same time, it is important to realise that rather than being a strange special case, long Covid is probably part of a broader phenomenon that affects many more people. In recent years, doctors and researchers have increasingly realised that many of those who survive an illness of any kind, or who go through serious physical trauma, are at high risk for a range of debilitating and chronic physical, cognitive and mental health symptoms – problems that closely resemble long Covid.
    As medicine has advanced, clinicians have learned how to save hundreds of thousands of severely ill or injured patients who would have previously died. Although this is a remarkable accomplishment, however, in many cases, survival does not mean complete recovery: some patients find that their bodies, brains and psyches continue to bear the scars of what they have gone through.
    One non-Covid study found that a year after hospitalisation, a third of patients with severe respiratory failure or shock had significant cognitive impairment. Another found that between a quarter and a third of patients who were treated in the ICU had significant and long-lasting symptoms of anxiety, depression or PTSD. Researchers have found similar results for survivors of other medical conditions, including cancer, multiple sclerosis and ALS.
    Unfortunately, people with long Covid, as well as other chronic post-illness symptoms, often find that the medical establishment doesn’t understand their experience, and so minimises or questions it. This is not surprising: clinicians tend to pay less attention to how patients with severe illness do once they are out of mortal danger, or once symptoms extend beyond an arbitrary time frame.
    Read full story
    Source: The Guardian, 12 September 2021
  19. Patient Safety Learning
    Fully vaccinated people are much less likely to die with COVID-19 than those who aren't, or have had only one dose, figures from the Office for National Statistics (ONS) show.
    Out of more than 51,000 Covid deaths in England between January and July 2021, only 256 occurred after two doses.
    They were mostly people at very high risk from illness from COVID-19.
    The figures show the high degree of protection from the vaccines against illness and death, the ONS said.
    Some deaths after vaccination were always expected because vaccines are not 100% effective, and it takes a couple of weeks after your second dose to build the fullest protection.
    Breakthrough" deaths - occurring at least two weeks after the second jab along with a first positive PCR Covid test - tend to happen in the most vulnerable, men and those with weakened immune systems, with the average age being 84.
    But overall numbers were very small - they accounted for only 0.5% of all deaths from COVID-19 over the first six months of the year.
    Read full story
    Source: BBC News, 14 September 2021
  20. Patient Safety Learning
    Cancer operations at one of England’s largest hospital trusts are being delayed as bosses admit patient care on wards is being compromised.
    Nottingham University Hospitals Trust has been forced to convert one of its few remaining wards for cancer surgery patients into an emergency medical ward to cope with an influx of patients.
    The Independent understands the trust’s A&E department is regularly overcrowded with 40 or more patients waiting for a bed at the start of most days.
    In a leaked message to staff sent on Friday and shared with The Independent, bosses at the hospital said the trust was facing an “exceptionally difficult time” which was “probably the most challenging position we have been in since the pandemic began”.
    It added: “There is no doubt that we are having to compromise the quality of care we are providing to some patients to ensure that we are able to maintain a service for the whole population.”
    “Our emergency department is over capacity continuously, which means that patients are waiting for extended periods on trolleys with little privacy and dignity because they do not have a bed to go to. We are having to make difficult decisions every day as to whether we can proceed with cancer and urgent operations and we are not able to tell some patients when they will get their operation."
    Read full story
    Source: The Independent, 13 September 2021
  21. Patient Safety Learning
    Screening smokers and ex-smokers could dramatically reduce deaths from lung cancer – Britain’s biggest cancer killer – a major new study has found.
    Low-dose computerised tomography (CT) scans can detect tumours in people’s lungs early and cut deaths by 16%, according to the UK Lung Cancer Screening Trial (UKLS).
    The findings have prompted renewed calls from lung cancer experts for the government to bring in routine screening across the UK of all those who are at risk because of their smoking history. They say that early detection means patients can have potentially curative surgery or radiotherapy.
    “Lung cancer early detection and surgical intervention saves lives,” said Professor John Field of Liverpool University, an author of the trial. 
    Read full story
    Source: The Guardian, 12 September 2021
  22. Patient Safety Learning
    Dr Kelly Fearnley caught COVID-19 in November 2020, after being redeployed to work on a coronavirus ward. Ten months on, she’s still living with debilitating symptoms of the condition known as long Covid.
    The latest estimates, published in June, suggest more than two million people in the UK have had long Covid since the pandemic began, while figures released by the Office for National Statistics in April show that more than 120,000 of those are NHS staff.
    Dr Fearnley discusses with iNews her experience of being taken to hospital after becoming seriously unwell. Dr Fearnley had a high resting heart rate and wasn’t able to get out of bed. She had pins and needles and was experiencing attacks of breathlessness, as well as violent shaking of her entire body. Yet, after running tests, she says the senior doctor she saw made it clear they believed Dr Fearnley was suffering from anxiety.
    “I was [treated as] an anxious little girl. My concerns weren’t taken seriously. Despite being a doctor myself, I felt let down by my colleagues at a time when I needed help but help wasn’t there,” Dr Fearnley said. “Sadly, I know my experience isn’t uncommon. I know a lot of long haulers have had their symptoms dismissed as anxiety.”
    But Dr Fearnley’s experience is also not unique to long Covid patients. “There’s a long history in medicine of dismissing hard-to-diagnose and hard-to-treat patients as having psychological or behavioural problems,” says Brian Hughes, Professor of Psychology at the National University of Ireland, Galway.
    “Historically, these problems have also been far more likely to emerge where illnesses primarily affect women,” he added.
    There are countless examples of this, but the condition that’s been most closely linked to long Covid is myalgic encephalomyelitis (ME) – also known as chronic fatigue syndrome or ME/CFS. 2020 research into GPs’ knowledge and understanding of the condition found that between a third and half of GPs did not accept ME as a “genuine clinical entity“. As a result, patients have continued to have their symptoms disbelieved or dismissed as psychological for decades. 
    Read full story
    Source: iNews, 9 September 2021
  23. Patient Safety Learning
    GPs in England are finding it "increasingly hard to guarantee safe care" as the number of doctors falls and demand surges, a senior medic said.
    Prof Martin Marshall, chair of the Royal College of GPs, told the Guardian GP numbers had fallen by 4.5% despite an ageing population with an increased need for care. GPs feared making serious mistakes due to excessive workloads, he said.
    Prof Marshall also defended the continued use of remote consultations.
    Prof Marshall said the demand for services from GPs, including more complex consultations and the vaccination programme, on top of this decline in numbers was putting family doctors under strain.
    "The fact that general practice is under such enormous pressure means it can't deliver the patient-centred services that it wants to. Many GPs are even finding it challenging to maintain a safe service," he said.
    He said family doctors were more likely to make a mistake if they were working 11- or 12-hour days, seeing 50 or 60 patients.
    "GPs are finding it increasingly hard to guarantee safe care to their patients," he said. "The chances of making a mistake in a diagnosis or a mistake in a referral decision or a mistake in prescribing are all greater when you're under stress."
    Read full story
    Source: BBC News, 11 September 2021
  24. Patient Safety Learning
    A third of all children’s acute hospital beds in parts of England are being occupied by vulnerable children who do not need acute medical care but have nowhere else to go, safeguarding experts have warned.
    Doctors say they feel like very expensive “babysitters” for vulnerable children, many of whom are in care but whose placements have broken down because of their violent and self-harming behaviour. Others have severe neurodevelopmental or eating disorders and need specialist treatment not available on ordinary children’s wards, where they get “stuck”, sometimes for months at a time.
    Paediatricians told the Guardian they have had to deal with vulnerable children who were not physically ill but displayed such challenging behaviour that they could not be looked after in children’s homes.
    “It is estimated that roughly a third of acute hospital beds at the moment are full of these vulnerable young people, many who are subject to child protection plans, or they are already children in care, living in a residential placement that’s falling apart,” said Dr Emilia Wawrzkowicz, a paediatric consultant who is the assistant officer for child protection at the Royal College of Paediatrics and Child Health (RCPCH).
    Though many of these children are in extreme distress, they often have no diagnosable mental illness and do not qualify for a psychiatric “tier four” bed. 
    “Some children have such extreme emotional and behavioural issues or are at risk of exploitation that they can’t get back to their residential placements or their foster parents. They can’t obviously go back to their homes, and we’ve got to keep them safe. So they sit in the hospital because there’s nowhere else to go. There are children sitting on our wards for months,” said Wawrzkowicz.
    Charlotte Ramsden, president of the Association of Director of Children’s Services, warned that a failure to increase the suitable provision for traumatised children would lead to more child suicides and more children ending up in custody after harming others.
    Read full story
    Source: The Guardian, 13 September 2021
  25. Patient Safety Learning
    A trust facing serious questions about its working culture has had a dramatic rise in the number of concerns raised about issues such as harassment and bullying. 
    In the first quarter of 2021-22, staff raised 84 incidents to East of England Ambulance Service Trust’s Freedom to Speak Up guardian, compared with only eight in the first quarter of 2020-21. 
    Half of the cases raised to the guardian this year involved issues of harassment, bullying or concerns about behaviours or relationships, according to a report to the trust board.
    However, the biggest single area of concern — with 35 cases — was “the inconsistent applications of processes in policies” and only one out of 84 cases involved patient safety or quality.
    The report said: “Staff across the organisation are exhausted and express concern at continuing under this pressure… staff continue to report that the slow pace of change leaves them with little confidence of lasting change.”
    Read full story (paywalled)
    Source: HSJ, 8 September 2021

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