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Patient Safety Learning

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  1. Patient Safety Learning
    Health and care sector workers in England who decline to be fully vaccinated could be moved to back-office roles, a UK government minister has suggested, as a consultation on plans to mandate COVID-19 and flu vaccinations was launched.
    The six-week consultation process will take views on whether vaccine requirements should apply for health and wider social care workers – those in contact with patients and people receiving care.
    It would mean only those who are fully vaccinated, unless medically exempt, could be deployed to deliver health and care services.
    Speaking on Times Radio, Helen Whately, the minister for care, said the government was working with care homes and other settings to see if workers who refused the vaccine could be redeployed.
    She said: “You can look at whether there are alternative ways somebody could be deployed, for instance, in a role that doesn’t involve frontline work, or doesn’t involve being physically in the same setting as the patient – whether it’s, for instance, working on 111, something like that."
    But she suggested that people who refused to get vaccinated against coronavirus should not work in social care.
    Speaking on Sky News, Whately said care homes had been hit particularly hard by Covid, and added: “The reality is that one of the best ways we can protect people living in care homes is through making sure that staff are vaccinated.”
    Read full story
    Source: The Guardian, 9 September 2021
  2. Patient Safety Learning
    A care home owner has said she was "forced" to ask two staff with Covid-19 to work because of a staff shortage.
    The Caledonia home in Holyhead, Anglesey, said 11 of its 12 residents had Covid and the two staff only cared for residents who were also positive.
    Ann Bedford said Anglesey council and an agency had both been unable to provide emergency cover for staff who were sick or isolating. After speaking to social services, it was agreed the staff could work.
    "I have never known a situation as bad as we faced over the last weekend. As a matter of course we have contingency plans in place to cope in emergencies but even these buckled under the strain," she said.
    "My heart sinks when I think about the weeks and months ahead. We felt abandoned and alone. I called on social services for help but they were facing their own emergencies."
    "The shortage of carers on Anglesey is at dangerous levels and is being intensified by the pandemic."
    Read full story
    Source: BBC News, 8 September 2021
  3. Patient Safety Learning
    Following a government announcement, a new body set to tackle health disparities in the UK will launch on Friday 1 October.
    The Office for Health Improvement and Disparities (OHID) aims to tackle health inequalities across the country and will be co-led by newly appointed Deputy Chief Medical Officer (DCMO), Dr Jeanelle de Gruchy.
    The OHID will play a vital role in the Department of Health and Social Care, driving the prevention agenda throughout the government to minimise health disparities, many of which have been exacerbated by the pandemic, and improve the public’s health.
    Unfortunately, health disparities around the UK are austere. For example, a woman living in Blackpool will on average live 16 fewer years in good health than a woman born in Brent, London.
    The government is also aware that ethnicity can impact health and health outcomes.
    Health disparities can consequently undermine a person’s ability to work and live a long, healthy and independent life, whilst putting pressure on the NHS, social care and other public services.
    Read full story
    Source: National Health Executive, 7 September 2021
  4. Patient Safety Learning
    The UK's vaccine advisory body has decided not to recommend vaccines for healthy 12-15-year-olds, but it will offer vaccines to thousands more children with underlying health problems.
    Ministers will now seek more advice on extending the rollout based on factors such as school disruption.
    There is general agreement that this was a really tricky call to make. Bur The Joint Committee on Vaccination and Immunisation (JCVI) has focused squarely on the health benefits of vaccination to children themselves - not on the impact to their schooling or other people.
    Children's risk from Covid isn't zero but the chances of them becoming seriously ill from Covid are incredibly small. Deaths among healthy children are extremely rare - most have life-limiting health conditions.
    That means there needs to be a clear and obvious advantage to giving them a jab. However, a very rare side-effect of the Pfizer and Moderna vaccines has made that calculation a lot more complicated.
    Paul Hunter, professor of medicine at University of East Anglia, says there's been intense pressure on the JCVI and he can understand why they are being cautious.
    "I don't know what the answer is - I'm very close to the fence on this. There's not enough data to be absolutely certain."
    Read full story
    Source: BBC News, 4 September 2021
  5. Patient Safety Learning
    Community doctors in Scotland have told the BBC they cannot imagine returning to normal face-to-face service with current levels of demand.
    Allowing more patients to see their GP in person is a top priority for the government's NHS Recovery Plan. But as the country tries to emerge from the pandemic, surgeries are seeing unprecedented pressure to catch up with patients.
    The health secretary has confirmed that new guidance should allow practices to see more people in person. But greater use of telephone and video appointments, brought in when the pandemic hit, is going to continue.
    Dr Begg has been a GP for 25 years. He says they won't go back to business as usual, the way they worked before.
    "In person consultations are really important, to examine people, to give injections, to remove lesions, all of these. I think a flexible approach is what we need. It's what we were planning to do before the pandemic anyway; a flexible mix of phone call, video and in-person consulting where it is appropriate."
    Dr Begg says the new ways of working are essential to deal with the huge number of requests they get.
    "There is a demand, capacity gap and indeed there was before the pandemic. We are seeing at last more students come through medical school and more people finally coming to join general practice training, but this is going to take at least ten years to turn things around."
    Read full story
    Source: BBC News, 7 September 2021
  6. Patient Safety Learning
    More than 600,000 cancer patients in the UK are facing treatment delays or missing out on vital support because of a shortage of specialist nurses, a new report from Macmillan Cancer Support reveals.
    One in five of all those living with cancer (21%) are lacking dedicated support. The NHS is suffering from a “shocking” shortfall of 3,000 specialist nurses in England alone, according to the analysis by Macmillan Cancer Support.
    As a result, cancer patients are struggling with medication, having hospital appointments cancelled because there are not enough staff or experiencing devastating delays to chemotherapy. In some cases, patients are ending up in A&E.
    Patricia Marquis, England director of the Royal College of Nursing, warned the workforce crisis was having a “devastating impact” on people living with cancer. “Expertise built up over many years is lost very quickly and it is patients who pay the price, as this report shows,” she added.
    Read full story
    Source: The Guardian, 8 September 2021
  7. Patient Safety Learning
    "Bodies would have been piling up" if the Covid vaccine had not been available, the director of intensive care at Belfast City Hospital has said.
    Dr George Gardiner, a consultant, also said his biggest fear would be having to stop routine cancer surgery. He has called for an end to "tribal politics" in Northern Ireland to allow transformation of the health service, so that cancer and coronavirus can be tackled in tandem.
    He said the system was currently "one step from chaos" and warned hospitals will not cope with winter if Covid numbers continue to rise.
    "We need to get everyone who can take a vaccine to take it now before the winter pressures are on us," Dr Gardiner added.
    "The cancer surgery that we are doing at the minute is life saving. A few more Covid admissions, which could be prevented, will cause us to stop operating because we simply haven't got the capacity to do both."
    Read full story
    Source: BBC News, 7 September 2021
  8. Patient Safety Learning
    A new snapshot survey by the Royal College of Emergency Medicine has found that in August 2021 half of respondents stated that their Emergency Department had been forced to hold patients outside in ambulances every day, compared to just over a quarter in October 2020 and less than one-fifth in March 2020.
    The survey, sent out to Emergency Department Clinical Leads across the UK, also found that half of respondents described how their Emergency Department had been forced to provide care for patients in corridors every day, while nearly three-quarters said their department was unable to maintain social distancing every day.
    One-third said that the longest patient stay they had had in their Emergency Department was between 24 and 48 hours, with 7% reporting the longest stay to be more than 48 hours.
    Dr Ian Higginson, Vice President of the Royal College of Emergency Medicine, said: “It is shocking to see the extent of the challenges faced by Emergency Departments across the UK. Holding ambulances, corridor care, long stays – these are all unconscionable practices that cause harm to patients. But the scale of the pressures right now leaves doctors and nurses no options. We are doing all we can to maintain flow, maximise infection prevention control measures, and maintain social distancing. Our priority is to keep patients safe, and ensure we deliver effective care quickly and efficiently, but it is extremely difficult right now."
    Read full story
    Source: The Royal College of Emergency Medicine, 6 September 2021
  9. Patient Safety Learning
    Doctors at a hospital in Birmingham mistakenly terminated a healthy unborn baby in a procedure instead of its sickly twin.
    The unidentified mother decided to abort one of the fetuses because it was suffering from restrictive growth, which increases the chances of stillbirth and puts the healthy baby at risk. During the procedure at Birmingham Women's and Children's NHS Foundation, surgeons accidentally terminated the wrong twin.
    The 2019 incident emerged in a Freedom of Information Act survey of hospital blunders.
    Dr Fiona Reynolds, chief medical officer at Birmingham Women's and Children's NHS Trust, said: "A full and comprehensive investigation was carried out swiftly after this tragic case and the findings were shared with the family, along with our sincere apologies and condolences."
    "The outcome of that thorough review has led to a new protocol being developed to decrease the likelihood of such an incident happening again."
    Read full story
    Source: The Independent, 6 September 2021
     
  10. Patient Safety Learning
    GP surgery staff are facing abuse from patients who are “angry and upset” that their blood test has been cancelled because of the NHS-wide chronic shortage of sample bottles.
    “Patients are angry when we ring them up and say, ‘Sorry we can’t do your blood test after all’. A lot of people are quite angry and concerned about their own health,” Dr David Wrigley, the deputy chair of council at the British Medical Association, said.
    “Patients are quite rightly upset and some get quite aggressive as well. They are worried because they don’t know what the implications of their cancelled test are for their health.”
    GP practices in England had begun cancelling appointments because the NHS’s main supplier could not deliver stocks as planned for one to two weeks because of “unforeseen road freight challenges”. 
    NHS England has responded to the shortage of blood sample bottles by telling GPs to cancel all but clinically urgent blood tests and hospitals to cut back the tests they do by at least 25%. 
    Read full story
    Source: The Guardian, 6 September 2021
  11. Patient Safety Learning
    A hospital has admitted liability for the death of a baby who was delivered stillborn three days after his mother’s complaints of fluid loss and severe pain were dismissed as wetting the bed.
    Jacob Jackson could have been born healthy, Shrewsbury and Telford hospital trust (Sath) has accepted, if it had arranged an earlier delivery in October 2018 as his mother, Charlotte, had suggested.
    The incident happened 18 months after an external review had been ordered into serious maternity failings at the trust, which are now known to be the biggest maternity scandal in the history of the NHS.
    Charlotte said: “It makes me feel sick to my stomach that they knew there were problems – this sort of thing had been going on for decades. We keep getting fed the same lines that ‘lessons have been learned’. If lessons had been learned parents and babies wouldn’t be going through this.”
    Read full story
    Source: The Guardian, 6 September 2021
  12. Patient Safety Learning
    Artificial intelligence (AI) tools and deep learning models are a powerful tool in cancer treatment. They can be used to analyse digital images of tumour biopsy samples, helping doctors quickly classify the type of cancer, predict prognosis and guide a course of treatment for the patient. However, unless these algorithms are properly calibrated, they can sometimes make inaccurate or biased predictions.
    A new study led by researchers from the University of Chicago shows that deep learning models trained on large sets of cancer genetic and tissue histology data can easily identify the institution that submitted the images. The models, which use machine learning methods to "teach" themselves how to recognise certain cancer signatures, end up using the submitting site as a shortcut to predicting outcomes for the patient, lumping them together with other patients from the same location instead of relying on the biology of individual patients. This in turn may lead to bias and missed opportunities for treatment in patients from racial or ethnic minority groups who may be more likely to be represented in certain medical centres and already struggle with access to care.
    "We identified a glaring hole in the in the current methodology for deep learning model development which makes certain regions and patient populations more susceptible to be included in inaccurate algorithmic predictions," said Alexander Pearson, one of the authors of the study.
    Read full story
    Source: Digital Health News, 22 July 2021
  13. Patient Safety Learning
    Dozens of acute trusts have operated at very high levels of bed occupancy in the past month, as they deal with a surge in non-covid patients with thousands fewer beds than normal.
    At one point in May, 49 general acute trusts out of 145 — the most since before covid — operated at occupancy of 95 per cent or more in adult acute beds. Up to eight trusts at a time were operating at 99 or 100% occupancy during May, according to analysis of published data. 
    NHS England, prior to covid, told trusts to keep occupancy below 92%, and others believe even this is dangerously high, although trusts do often exceed it during winter.
    Trusts are seeing the largest numbers of non-covid emergency patients since at least winter 2019-20; and are also trying to return as many planned operations as possible.
    They are doing so with thousands fewer beds than normal, due to measures to deal with ongoing covid patients without further outbreaks of the virus in hospital. 
    Read full story (paywalled)
    Source: HSJ, 8 June 2021
  14. Patient Safety Learning
    Mental health consultations among new mothers were 30% higher during the COVID-19 pandemic than before it, particularly during the first three months after birth, suggests Canadian research.
    Study authors noted that postpartum mental illness, including postnatal depression, usually affected as many as one in five mothers and could have long-term effects on children and families if it becomes chronic.
    They looked at mental health consultations by 137,609 people in Ontario during the postpartum period – from date of birth to 365 days later – from March to November 2020.
    They found mental health visits to both primary care and psychiatrists were higher than before the pandemic, especially among those with anxiety, depression, and alcohol or substance use disorders.
    Read full story
    Source: The Nursing Times, 7 June 2021
  15. Patient Safety Learning
    A group of patient activists has set up a new website using official NHS data to allow patients to check the waiting times for treatments at their local hospital.
    The new waiting times tool is thought to be the first automated and regularly updated website that shows hospital performance against key waiting time targets, by medical specialty such as cardiology or orthopaedics.
    The service, developed by volunteers from the not-for-profit Patient Experience Library, not only shows patients how many people are waiting to be treated overall but also shows data on the median waiting time as well as how well the hospital is performing against targets over time.
    Patients can also compare different hospitals and look at the performance of the NHS in England overall. Wait times for mental health services are treated separately and not included.
    Miles Sibley, co-founder of the Patient Experience Library, said the website was an attempt to bring transparency to NHS England’s “impenetrable spreadsheets” which not only affected patients but also other NHS staff who told Sibley they spend hours downloading data and working out their organisations performance.
    Read full story
    Source: The Independent, 7 June 2021
  16. Patient Safety Learning
    A trust’s gastroenterology service was ‘in a very poor state with significant risks to patient safety’ and had poor teamworking which “blighted” the service, an external review found.
    The problems in the service at Salisbury Foundation Trust, Wiltshire, were so severe that the Royal College of Physicians suggested it should consider transferring key services such as management of GI bleeds and the care of hepatology patients to other hospitals.
    The service was struggling with poor staffing which had led to increased reliance on a partnership with University Hospital Southampton Foundation Trust, outsourcing and the daily use of locum consultants, according to the report. The trust board had identified “inability to provide a full gastroenterology service due to lack of medical staff capacity” as an extreme risk.
    The report said: “This review was complex and necessary as the gastroenterology service is in a very poor state with significant risks to patient safety and the reputation of the trust. We found a wide range of problems which now need timely action to ensure patients are safe.”
    Read full story (paywalled)
    Source: HSJ, 7 June 2021
  17. Patient Safety Learning
    It is more than eight years since Averil Hart died after being found passed out in her university room, but the words left in her diary are etched in her father’s mind. “She said: ‘dear God please help me’ and that was four or five days before she collapsed,” says Nic Hart. “It sums up what many young people desperately need. They need help. Here we are eight-and-a-half years on and what has changed?”
    Averil, who was diagnosed with anorexia aged 15, was taken to Norfolk and Norwich University hospital at 19 in a “severely malnourished” state but received no nutritional or psychiatric support during her four-day admission, according to an inquest into her death. She was then urgently transferred to Addenbrooke’s hospital in Cambridge.
    The coroner found a litany of failings. She was treated by doctors who knew “practically nothing” about anorexia. There had been no follow-up from the local eating disorder team and a failure to provide life-saving treatment. The inquest was the last in a series of coroners’ examinations of five women who died from eating disorders while in the care of the NHS in the east of England.
    “I suppose listening to the NHS arguments on delivery … they would say it is an organisation of a million people and these things [real changes] take time,” her father says. “But you wonder what it takes to turn all these well-meaning policies that seem to come up from time to time into action.”
    Hart says we need to learn from how the UK has tackled potentially life-threatening conditions such as sepsis and think about how we can “train clinicians to turn this around quickly”.
    Read full story
    Source: The Guardian, 6 June 2021
  18. Patient Safety Learning
    An NHS trust has become the first in the country to individually contact every family of patients who caught coronavirus while they were in hospital in a large-scale bid to be transparent over the scale of infections.
    Bosses at the Queen Elizabeth Hospital Kings Lynn NHS Trust have set up a team to work through hundreds of cases where patients caught coronavirus in hospital.
    At least 99 patients are known to have died after becoming infected with more cases still to review.
    In a unique approach to transparency the trust is sending a letter by recorded delivery to every affected patient or family where it is thought the patient picked up the virus within the hospital.
    The letter offers an apology for what happened and is followed by a phone call with a nurse and a meeting with officials if families have more concerns. Some families have asked to meet the nurses who cared for their loved ones.
    Read full story
    Source: The Independent, 6 June 2021
  19. Patient Safety Learning
    Labour has urged the NHS and Matt Hancock to pause their plan to share medical records from GPs to allow time for greater consultation on how the idea would work, saying that maintaining patients’ trust must be paramount.
    In a letter to the head of NHS Digital and the health secretary, the shadow public health minister, Alex Norris, said Labour backed the principle of improved data collaboration but shared the concerns of some doctors’ groups.
    The Royal College of General Practitioners warned NHS Digital a week ago that plans to pool medical pseudonymised records on to a database and share them with academic and commercial third parties risked affecting the doctor-patient relationship.
    NHS Digital needed to explain the plans better to the public, the group said, as well as outlining how people could opt out.
    The British Medical Association (BMA) has also called for a pause to the General Practice Data for Planning and Research scheme. Another group, the Doctors’ Association, said it was worried it would “erode the doctor/patient relationship, leaving patients reluctant to share their problems due to fears of where their data will be shared”.
    Read full story
    Source: The Guardian, 6 June 2021
  20. Patient Safety Learning
    Most people who are reluctant to be vaccinated against Covid are worried about side-effects and whether the vaccines have been adequately tested, a survey in 15 countries has shown.
    Other reasons cited in the survey of 68,000 people, led by Imperial College London’s Institute of Global Health Innovation in collaboration with YouGov, were the uncertainty that people would not get the vaccine they preferred and worries about efficacy.
    The survey was carried out in Australia, Canada, Denmark, France, Germany, Israel, Italy, Japan, Norway, Singapore, South Korea, Spain, Sweden, the United Kingdom and the United States.
    Excluding eligibility, the top reasons for not having the vaccine across all 15 countries surveyed were “concerns about side effects” and/or “concerns that there has not been enough testing of vaccines”.
    Trust in vaccines was highest in the UK, at 87%, and lowest in Japan, at 47%. The UK respondents also had the highest level of confidence in their health authorities (70%), while South Korea had the lowest (42%).
    Among those who had not yet been vaccinated, confidence was highest in the Pfizer/BioNTech vaccine in nine out of the 15 countries, and in three others – Canada, Singapore and Sweden – among those under 65.
    Read full story
    Source: The Guardian, 4 June 2021
  21. Patient Safety Learning
    A hospital trust has decided to prioritise people with learning disabilities for elective treatment, after analysis showed they were disproportionately affected by lengthy waits for care, along with some people who have a minority ethnic background.
    The decision forms part of wider analysis at Calderdale and Huddersfield Foundation Trust of how the impact of covid, and work to recover from it, can exacerbate health inequalities and how this can be addressed.
    The FT said in a board paper it would “initially prioritise [people with a learning disability] for treatment after cancer and urgent patients”.
    Papers said it wanted to prioritise patients “around health inequalities and need based” rather than chronologically, as part of its covid elective recovery work.
    It made the decision about people with a learning disability as they have a shorter average life expectancy “and therefore the impact of waiting for treatment can both further reduce this as well as disproportionately impact on their quality of life whilst waiting,” according to trust board papers.
    Read full story (paywalled)
    Source: HSJ, 4 June 2021
  22. Patient Safety Learning
    The number of people suffering from symptoms of long covid more than a year after their initial Coronavirus infection has jumped to almost 400,000.
    New data from the Office for National Statistics based on a survey of patients found the numbers of patients with persistent symptoms after 12 months jumped from 70,000 in March to 376,000 in May.
    Overall, the ONS said an estimated one million people had self-reported signs of long Covid which last for more than four weeks.
    The effects of long Covid were reported to be affected the day-to-day activities of 650,000 people, with 192,000 of those saying their ability to undertake day-to-day activities had been limited a lot.
    Fatigue was the most common symptom reported, with 547,000 people affected. A total of 405,000 people reported a shortness of breath, while 313,000 had muscle aches. More than a quarter of a million patients, 285,000 people, said they had difficulty concentrating.
    According to the ONS the prevalence of long Covid was higher among those aged between 35 and 69-year-old and women were more likely to be affected than men along with those living in the most deprived areas as well as staff working in health and social care.
    Read full story
    Source: The Independent, 3 June 2021
  23. Patient Safety Learning
    Patients who had longer consultations with their GP were less likely to subsequently self-refer themselves to hospital due to a worsening of their condition, a study has found.
    The study, which looked at factors associated with potentially missed acute deterioration, said this might be because GPs with more time to assess patients ‘are more likely to recognise deterioration and refer the patient for secondary care’.
    A longer consultation might also allow GPs more time to provide advice, such as telling the patient to contact the practice again if their condition worsens, the British Journal of General Practice study found.
    The researchers defined a potentially missed acute deterioration as a patient having a self-referred admission to hospital after being seen by a GP in the three days beforehand.
    They found that 116,097 patients had contacted a GP three days before an emergency admission, with patients with sepsis or urinary tract infections more likely to self-refer.
    GP appointment duration was associated with self-referral, with a five-minute increase in appointment time resulting in a 10% decrease on average in the odds of self-referred admissions.
    Patients having a telephone consultation compared with face-to-face, previous health service use, and the presence of comorbidities were all also associated with self-referred admission, according to the research.
    Read full story
    Source: Management in Practice, 2 June 2021
  24. Patient Safety Learning
    A group set-up following the Winterbourne View scandal is urging more people with learning disabilities to attend their annual health check-up.
    Healthwatch South Gloucestershire said regular health checks could prevent people from dying unnecessarily.
    It formed after BBC Panorama exposed abuse of patients at Winterbourne View hospital 10 years ago. Only about 36% of people with learning difficulties are believed to have an annual GP health check-up.
    The Local Democracy Reporting Service (LDRS). said the lack of regular, medical observations contributed to them having a life expectancy of 20 years lower than in the wider population.
    Healthwatch South Gloucestershire, a regional, independent health and social care champion, has created a checklist to encourage more people to attend appointments to help them improve their life expectancy.
    Vicky Marriott from the group said: "It is our unrelenting mission to listen and share people's lived experience so that the information informs how health and social care services improve.
    "We recently listened to people with learning disabilities and their families and developed with them an accessible info-sheet packed full of easy-to-read explanations about the lifesaving benefits of annual health checks."
    Read full story
    Source: BBC News, 1 June 2021
  25. Patient Safety Learning
    The prospect of care home workers being required to get vaccinated against COVID-19 has moved a step closer, with a crucial endorsement from the UK’s human rights watchdog.
    Ministers are considering changing the law to make vaccination a condition of deployment for people in some professions that come into regular close contact with elderly and vulnerable people at high risk from the coronavirus.
    In a report to the government seen by the Guardian, the Equality and Human Rights Commission (EHRC) admitted that making vaccines compulsory for care home staff would be a “significant departure from current public health policy”.
    But they judged that ministers were “right to prioritise protection of the right to life for residents and staff” and said it would be reasonable for care home workers to need a jab “in order to work directly with older and disabled people, subject to some important safeguards”.
    The EHRC is also likely to make a similar recommendation about healthcare workers, after the vaccines minister, Nadhim Zahawi, suggested over the weekend that NHS staff could face mandatory jabs, too, as some patients were “being infected in hospital”.
    Zahawi said no decisions had been made yet, and stressed there was a precedent: surgeons were required to be vaccinated against hepatitis B. He added: “It would be incumbent on any responsible government to have the debate, to do the thinking about how we go about protecting the most vulnerable by making sure that those who look after them are vaccinated.”
    Read full story
    Source: The Guardian, 2 June 2021

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