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  1. Patient Safety Learning
    Patients have come to avoidable harm after a large private provider failed to deliver thousands of medicine prescriptions, according to a report from the Care Quality Commission.
    Healthcare at Home, which is based in Staffordshire but provides NHS-funded care and medicine supplies to patients’ homes across the country, has been rated “inadequate” and placed in special measures.
    A report published today said inspectors found more than 10,000 patients missed a dose of their medicine between October and December 2020 due to problems caused by the introduction of a new information system. Reviews have found some suffered avoidable harm as a result.
    Read full story (paywalled)
    Source: HSJ, 13 May 2021
  2. Patient Safety Learning
    The chief medical officers of the four UK nations are set to warn about a surge in admissions of severely ill, very young children later this year, due to the resurgence of a respiratory virus which has been suppressed by anti-covid measures, HSJ can reveal.
    Public Health England modelling shows a possible sharp rise in cases of respiratory syncytial virus (RSV), which can cause bronchiolitis, this autumn and winter, several senior sources said. The modelling shows between 20 and 50% more cases needing hospitalisation than normal, HSJ understands.
    Official projections conclude that such a surge would require, at least, a doubling of paediatric intenstive care beds and a significant increase in other critlcal care resources for sick children. 
    Most of those expected to be affected by the rise in RSV are forecast to be three years old or younger.
    The UK’s four chief medical officers are considering the issue and planning to write to ministers to highlight it, the sources said, while NHS England is working on a response plan, and is expected to alert local NHS leaders. 
    Read full story (paywalled)
    Source: HSJ, 14 May 2021
  3. Patient Safety Learning
    The parents of a baby who died after medical errors are to push for a new inquest into his death, after they say a "cruel" inquest denied them justice.
    Hayden Nguyen died in 2016 after medics failed to treat an infection properly. However, despite the NHS trust admitting mistakes, coroner Shirley Radcliffe concluded the infant died of natural causes, after raising concerns about the hospital's initial investigation.
    Hayden was six days old when his parents took him to the Chelsea and Westminster hospital in west London in August 2016. He initially had a fever but rapidly deteriorated; he had a cardiac arrest and died within 12 hours of arriving there.
    An internal NHS investigation concluded eight errors were made in Hayden's care, and the root causes of his death were failure to identify the signs of shock and failure to act on abnormal test results.
    "When they had completed the investigation, they sat us down and took us through it line by line," says Alex Nguyen, Hayden's mother. "Although the content was incredibly disturbing, it was in a way healing and it helped a little bit with the grieving process."
    An inquest at Westminster Coroner's Court, conducted by Dr Radcliffe, followed. However, the coroner was not happy with the hospital's investigation.
    The hospital to issue a second report into Hayden's care, which halved the number of errors, and said the root cause of his death was the infection "which is known to have a high mortality".
    Armed with this second report, the coroner concluded that Hayden had died of natural causes.
    "What the coroner did was kill Hayden a second time," Hayden's father, Tum, told the BBC.
    Read full story
    Source: BBC News, 14 May 2021
  4. Patient Safety Learning
    Patients awaiting a diagnostic test are to be assessed according to risk of becoming disabled as the service tries to prioritise in the face of huge backlogs.
    NHS England guidance released yesterday said local teams should categorise diagnostic waits on a four-point scale so those in most urgent need are seen first. It said this would mean, “recognising that for less urgent or routine diagnostics, some patients may experience a delay”.
    The diagnostics data for February showed 1.15 million people waiting for a test, compared to 1.08m in February 2020 – however, the proportion of people waiting more than 13 weeks rose from 0.6% in 2020 to 28.5% this year. The number of people on the list waiting more than six weeks also increased five-fold over the year.
    No more than 1% of patients are supposed to wait longer than six weeks for a diagnostic test, under government waiting time standards.
    The NHS England guidance puts diagnostics on the same footing as elective treatment, which has been organised according to clinical priority – P1 being the most urgent P4 being the least — since shortly after the pandemic hit last year.
    Read full story (paywalled)
    Source: HSJ, 13 May 2021
  5. Patient Safety Learning
    The government is "fully committed to learning the lessons at every stage" of the pandemic, Prime Minister Boris Johnson has said.
    He told MPs an independent public inquiry into the handling of the pandemic would be held in spring 2022. The inquiry would place "the state's actions under the microscope", he added, and take evidence under oath.
    The inquiry's terms of reference have not yet been defined but would be published in "due course", he said, adding that the devolved administrations would be consulted.
    Mr Johnson acknowledged many bereaved families would want the inquiry to begin sooner, but said because of the threat of new variants and a possible winter surge in infections, spring next year would be the "right moment".
    Read full story
    Source: BBC News, 12 May 2021
  6. Patient Safety Learning
    Covid has left a toxic legacy for the NHS, with hospitals facing a huge backlog, putting lives at risk, patient groups and staff are warning.
    And in-depth analysis by BBC News has found:
    waiting lists have ballooned at some hospitals in England, with more than one out of every 10 of patients in a quarter of trusts left at least a year without treatment major disruption to cancer services, with some hospitals struggling to treat half of their patients within the target time of two months concern growing for 45,000 "missing cancer patients", after drops in GP referrals and screening services across the UK. Elaine Walsh was diagnosed with womb cancer in January. She should have been operated on within weeks, but her operation was cancelled because of the pandemic and the backlog it had caused.
    Elaine's story is not unique. Analysis by BBC News shows the numbers starting treatment within the target time have fallen during the pandemic.
    And some trusts are struggling to start treatment for even half of patients in the recommended timeframe - two months following an urgent referral from their GP.
    About one in every four of the patients waiting the longest has postponed treatment themselves - and nurses at the trust have been phoning and pleading with them to have treatment.
    This reluctance to come forward coupled with problems accessing GP and screening services at points in the pandemic is the reason why the number of patients coming forward for checks and being diagnosed has dropped.
    Analysis by Macmillan Cancer Support suggests across the UK there are 45,000 "missing" cancer patients.
    Read full story
    Source: BBC News, 13 May 2021
  7. Patient Safety Learning
    A major trial to detect one of the most elusive and deadly cancers - ovarian - has failed to save lives, after two decades of work.
    The researchers, at University College London, said the results were a disappointment - and thanked the 200,000 people who participated.
    The trial had looked promising, with annual blood tests detecting cases of ovarian cancer earlier. But routine screening for the cancer is now a distant prospect.
    Ovarian cancer is tricky to diagnose because the symptoms are easily mistaken for less serious health problems.
    "Some women are diagnosed so late they are too sick to start treatment," the trial's lead investigator, Prof Usha Menon, said.
    The UK Collaborative Trial of Ovarian Cancer Screening - the largest in the world - tracked levels of CA125, a chemical released by ovarian tumours, in the blood and sent participants in whom they were rising for an ultrasound scan.
    Unfortunately the final results, published in the Lancet medical journal, showed the screening had failed to save lives.
    Read full story
    Source: BBC News, 12 May 2021
  8. Patient Safety Learning
    Every adult who has tested positive for COVID-19 in Scotland is to be invited to take part in a major new study into the effects of long Covid.
    Researchers hope to identify how many people in Scotland continue to be unwell after having the virus.
    The Covid in Scotland Study (CISS) will ask people what their symptoms are and how it affects their lives. Those taking part will be asked to use a phone app to answer questions about their health before and after Covid.
    Early estimates suggest as many as 6,000 people in Scotland were experiencing long term symptoms after the first wave of the pandemic but it is not known what that tally is now.
    Read full story
    Source: BBC News, 12 May 2021
  9. Patient Safety Learning
    New research examining the effect of minimum nurse-to-patient ratios has found it reduces the risks of those in care dying by up to 11%. 
    The study, published in The Lancet, also said fewer patients were readmitted and they had shorter stays in hospital.
    It compared 400,000 patients and 17,000 nurses working in 27 hospitals in Queensland, Australia to 28 other hospitals. The state has a policy of just one nurse to every four patients during the day and one to seven at night, in a bid to improve safety and standards of care.
    The research said savings made from patients having a shorter length of stay, which fell 9%, and less readmissions were double the cost of hiring the extra nurses needed to achieve the ratios.
    NHS England has resisted moves towards minimum nurse to patient ratios, suspended work by the National Institute for Health and Care Excellence (NICE) on safe nurse staffing in 2015. This came as the watchdog was preparing to call for minimum ratios in accident and emergency departments. It has advised that eight or more patients to one nurse is the point at which harm can start to occur.
    Read full story
    Source: The Independent, 12 May 2021
  10. Patient Safety Learning
    The government has confirmed its commitment to bring in new health legislation during this Parliament, but social care reform has again been ‘kicked into the long grass’.
    Today’s Queen’s Speech confirmed that planned, radical changes to the Health and Social Care Bill 2012 will be laid before Parliament this year.
    The changes, first outlined in the government’s proposals this February, will put integrated care systems on a statutory footing, dissolve clinical commissioning groups, water down the internal market within the NHS and increase the powers the health secretary has over NHS England and the service. 
    Today’s Queen’s Speech said these changes meant “patients will receive more tailored and preventative care, closer to home [and will] empower the NHS to innovate and embrace technology”.
    However, it did not add any further information to the government’s already stated plans to “bring forward proposals in 2021” for social care reform. The 2019 Queen’s Speech, the first delivered during Boris Johnson’s tenure as prime minister, promised to bring in ”legislation for long-term social care reform in England”. To date, the government has failed to act on this promise.
    Read full story
    Source: HSJ, 11 May 2021
  11. Patient Safety Learning
    The Department of Health and Social Care (DHSC) is facing being taken to court over an inquiry it launched into the deaths of dozens of mental health patients in Essex.
    Last year, the government said it would commission an independent inquiry into at least 36 inpatient deaths in Essex, which had taken place over the last two decades.
    However, more than 70 families are calling for a full statutory public inquiry, which can compel witnesses to give evidence. They have lodged judicial review proceedings at the High Court against the government to that effect.
    The DHSC said it could not comment on ongoing legal proceedings.
    The current inquiry was launched in response to a highly critical report from the Parliamentary Health Service Ombudsman, published in June 2019, into the deaths of two patients at North Essex Partnership University Foundation Trust, which has since merged to form Essex Partnership University FT.
    There has also been an investigation by Essex Police into 25 of the deaths. This concluded in 2018, when the force said there had been “clear and basic” care failings, but there was not enough evidence to prosecute the trust for corporate manslaughter.
    Read full story (paywalled)
    Source: HSJ, 11 May 2021
  12. Patient Safety Learning
    Major change is required if Northern Ireland's emergency departments are to avoid another "exceptionally difficult" winter, a senior consultant has warned.
    Dr Brendan Lavery, who works for the Western Health Trust, said "standing still is not an option". He described the system as currently operating on a "knife edge".
    The Department of Health said it was "a very challenging time" for staff "with COVID-19 restrictions impacting on an already fragile system".
    Speaking to BBC News NI, Dr Lavery likened the situation to "Groundhog Day" with decade-long problems like capacity and staffing exacerbated by the lingering effect of the COVID-19 pandemic on other healthcare services.
    The department responded: "Well before COVID-19, there was clear evidence that our urgent and emergency care services were under increasing pressure. This is an unsustainable position that requires sustained investment and reform, including, of course, long-term investment in staffing. There is no quick or easy solution to these problems."
    Read full story
    Source: BBC News, 12 May 2021
  13. Patient Safety Learning
    There are many reasons why mental wellbeing is important. Not only is it protective against physical illnesses and linked to greater productivity, but the mental wellbeing of a population is essential for a country’s sustainability, long-term growth and development.
    But despite the clear benefits, governments tend to focus public spending on treating and preventing disease, and providing care for those who are ill. While this is important and should continue to be prioritised, such strategies alone won’t increase levels of mental wellbeing overall.
    Not only would enhancing mental wellbeing across all segments of the population lead to better health on average, it would also be beneficial from an economic perspective.
    In a new study, the link between mental wellbeing and government expenditure was explored. It was found that each increase in mental wellbeing in a population was associated with lower social and health care costs the following year. In other words, the greatest savings could be made by maximising everyone’s mental wellbeing.
    Read full story
    Source: The Independent, 11 May 2021
  14. Patient Safety Learning
    Thousands of doctors feel under pressure from their employers to work extra shifts, often unpaid, to help tackle the backlog of care caused by the covid pandemic, the BMA has warned.
    The warning came after results from the BMA’s latest tracker survey showed that more than half its respondents (58%, 2834 of 4876) had worked extra hours in the previous month as part of the response to the pandemic. Almost a third (29%, 1387) said they were not paid for the additional time they worked.
    More than two fifths (44%) of respondents (2086 of 4719) said they felt under pressure from their employer to do extra hours in the last month. And more than a third (36%, 1759) had either skipped taking full breaks altogether or taken them on rare occasions in the past fortnight.
    Nearly six in 10 doctors who responded (57%, 2889 of 5059) reported a higher than normal level of fatigue or exhaustion because of working or studying during the pandemic.
    Chaand Nagpaul, the BMA’s chair of council, said, “To learn that an already depleted and now exhausted workforce feels forced into doing more and more hours, with many reporting higher levels of fatigue than ever, is extremely worrying. It is putting them and their patients at risk. Working ‘flat out’ without a change to rest and recuperate is simply unsustainable and unsafe."
    Read full story
    Source: BMJ, 10 May 2021
  15. Patient Safety Learning
    Just 10% of money allocated to help treat young people with eating disorders reached the NHS frontline, a new analysis has revealed.
    The latest data on NHS mental health spending comes amid concern the pandemic has exacerbated eating disorders in young people, sparking a rise in demand.
    A report commissioned by MPs compiled by the eating disorder charity Beat, using NHS data, shows local clinical commissioning groups (CCGs), who purchase NHS services on behalf of NHS England, spent just £1.1m of the £11m they were given for community eating disorder services in 2019-20.
    The money was set aside by NHS England to try and tackle increasing referrals and to ensure young people could get treatment. 
    Wera Hobhouse MP, chair of the All-Party Parliamentary Group on Eating Disorders, and which commissioned the work said: “Eating disorders are serious mental illnesses, and we know that early intervention and access to specialist treatment saves lives."
    “NHS England has continued to allocate extra funding to clinical commissioning groups for children and young people’s community eating disorder services, but this report shows that much more needs to be done to ensure this money reaches the frontline services, particularly now as they face unprecedented numbers of referrals.”
    Read full story
    Source: The Independent, 11 May 2021
  16. Patient Safety Learning
    A nurse accused of murdering eight babies in an alleged year-long killing spree at an NHS hospital has appeared in court.
    Lucy Letby, aged 31, appeared at Manchester Crown Court via videolink from HMP Peterborough on Monday morning.
    She has been charged the murder of five boys and three girls at the neonatal unit at the Countess of Chester Hospital.
    The babies all died between June 2015 and June 2016.
    Read full story
    Source: The Independent, 10 May 2021
  17. Patient Safety Learning
    A world-leading treatment that halves the risk of lung cancer patients suffering a return of the disease after undergoing treatment, is to be rolled out by NHS England.
    In a trial of the drug – the first of its kind – around nine out of ten patients treated, remained alive and disease-free after two years – compared to more than four in ten who hadn’t received the new therapy.
    Lung cancer is the most common cause of cancer death in the UK, accounting for one in five of all cancer deaths.
    Around 100 patients in England with a rare form of cancer will initially have access to the drug, called Osimertinib, with many more expected to benefit this year.
    Read full story
    Source: NHS England, 7 May 2021
  18. Patient Safety Learning
    A perfect storm of pandemic pressures, changes to the medical curriculum and inadequate Health Education England funding threatens to leave 700 anaesthetists without a job this summer, HSJ has learned.
    The news comes as the NHS prepares to tackle the huge backlog of elective care work that has built up during the pandemic. Anaesthetists will play a critical role in the recovery effort. 
    Each year around 300 higher training, or ST3, places for anaesthetists are offered by the NHS. However, this year there are over 1,000 applicants for these posts. The oversupply has been created by the inability of trainees to seek work overseas because of the pandemic and a change in the curriculum overseen by the Royal College of Anaesthetists.  
    Royal College of Anaesthetists’ council member Helgi Johannsson told HSJ  he was concerned trainees could become “so demoralised” after failing to secure a a job that they might switch to another specialty.
    “We need those trainees to come through,” he said. “There is a shortage of anaesthetists with around 10 per cent of consultant jobs unfilled and we need to protect our supply line and get on top of our elective backlog.”
    Read full story (paywalled)
    Source: HSJ, 7 May 2021
  19. Patient Safety Learning
    New standards for the safe working of nurses across hospital wards, care homes and in the community have been set out by the Royal College of Nursing, for the first time in its 100 year history.
    In a bid to underline the safety-critical nature of expert nurses in healthcare, the RCN hopes the minimum standards will be used to force improvements in safe staffing levels and the treatment of nurses across the country by NHS trusts and other employers.
    It comes as a new poll finds a majority of adults believe there are not enough nurses to provide safe care. There are 50,000 nursing vacancies across the NHS and research has repeatedly shown having degree-educated nurses leads to better patient safety.
    A major study across 500 hospitals in 12 European countries found for every extra patient a nurse was expected to look after, the chances of the patient dying increased 7%. Other studies have shown replacing degree-educated nurses with less educated staff led to an increase in mortality of 21%.
    Despite the research, the UK government and NHS England has consistently opposed tougher ratios of nurses to patients and has invested in new non-degree roles to fill gaps in staffing.
    Read full story
    Source: The Independent, 9 May 2021
  20. Patient Safety Learning
    Blood cancer patients are one of the most vulnerable groups of people at risk of COVID-19, according to research, being 57% more likely to suffer severe disease compared to other cancer patients. 
    Despite the high risk these patients face, charities such as Anthony Nolan, which assist blood cancer patients with finding a stem cell match, were left out of the allocated government budget that was announced in March.
    The cancellation of face-to-face fundraising and events, despite the increase in demand for services, have led their gross income to be down by an estimated £5.5m for 2021.
    Henny Braund, chief executive of the charity, said people with blood cancer and blood disorders were “heavily impacted by the pandemic and everyone who needs treatment and support must be able to access it without delay”.
    Read full story
    Source: The Independent, 9 May 2021
  21. Patient Safety Learning
    Ten junior doctors have been removed from a struggling hospital over concerns they were being left without adequate supervision on understaffed wards.
    Health Education England (HEE) removed the 10 foundation year one doctors, all on a general medicine rota, from Weston General Hospital last month. The General Medical Council said the trust’s previous efforts to address the issues “have not been sufficient or sustainable”.
    University Hospitals Bristol and Weston Foundation Trust did not say which services HEE had removed the juniors from or what mitigations had been put in place. However, the trust told HSJ none of the positions concerned were from the hospital’s emergency department, where the GMC has already imposed conditions on juniors’ training.
    HEE very rarely uses its power to withdraw trusts’ trainees. HSJ reported last June the regulator had only removed two posts at trusts under enhanced monitoring since the start of 2019. 
    William Oldfield, University Hospitals Bristol and Weston FT medical director, said in a statement to HSJ: “We recognise the seriousness of the step taken by HEE to temporarily suspend the training programme for a small number of junior doctors at Weston General Hospital.
    ”We are working to provide the assurance HEE require to allow this training to recommence, and in the meantime we have appropriately mitigated the impact on services at Weston.”
    Read full story (paywalled)
    Source: HSJ, 10 May 2021
  22. Patient Safety Learning
    More than a million children and young people will have access to mental health support at school, as the NHS rapidly expands services to help deal with the huge disruption caused by coronavirus and lockdown.
    From this year, teams of experts are offering support to children experiencing anxiety, depression, and other common mental health issues.
    Around 400 mental health support teams will be up and running covering 3,000 schools in England, offering support to almost three million pupils, by 2023.
    The roll-out represents a dramatic acceleration of the programme announced in the NHS Long Term Plan, funded from £79 million to boost mental health support for children and young people in England, which is part of £500 million Government pot for investment in mental health services.
    Experts hope that by intervening early they can prevent problems escalating into serious mental health issues, with health chiefs warning that the isolation and upheaval of the pandemic can be compounded by factors like pressure experienced on social media platforms.
    Read full story
    Source: NHS England, 8 May 2021
  23. Patient Safety Learning
    The highest number of alcohol-related deaths in England and Wales since records began was seen in 2020, official data shows. 
    A survey by the Office for National Statistics (ONS) showed that alcohol killed more people in 2020 than in any of the previous 20 years. The data also showed a rise of 20 per cent compared to 2019.
    Overall, there were 7,423 deaths from alcohol misuse last year, compared to 6,209 in 2019. Deaths increased from March 2020 onwards, when the coronavirus pandemic forced the UK into a series of national lockdowns. 
    Read full story
    Source: The Independent, 6 May 2021
  24. Patient Safety Learning
    Police are investigating allegations around the death of a patient who was under the care of Hertfordshire Partnership University Foundation Trust.
    The probe by Hertfordshire Constabulary relates to the case of Margaret Molyneux, 69, who according to a review by the trust’s commissioners, was prescribed doses of anti-psychotic medication which were significantly higher than recommended limits.
    Police said the investigation is ongoing and no arrests have been made.
    Ms Molyneux had been admitted to the trust’s mental health unit in Radlett in 2017, after which her physical health declined and she was admitted to Watford General Hospital with pneumonia and dysphagia, which relates to difficulties swallowing.
    She was discharged back to the Radlett unit, but died several weeks later at Watford General Hospital, after choking on her food and developing aspiration pneumonia. 
    An inquest in February 2018 ruled she died from natural causes, but an investigation into her case commissioned by East and North Hertfordshire Clinical Commissioning Group, seen by HSJ, subsequently suggested high doses of Olanzapine, an anti-psychotic drug, were “likely to have at least contributed to some of the physical problems she experienced… including low blood pressure, falls and dysphagia”.
    Read full story (paywalled)
    Source: HSJ, 6 May 2021
  25. Patient Safety Learning
    Pressure is growing on the government to change its stance on coronavirus infection rules which it is feared may leave NHS staff and patients at risk from airborne transmission.
    Experts told The Independent the current guidance from Public Health England (PHE), which effectively says staff working on general wards can rely on just surgical masks for protection, was “outdated and potentially misleading” and put NHS staff at risk.
    At the start of the pandemic the emphasis on stopping infection was focused around droplets containing the virus both in the air over short distances and on surfaces. Increasingly scientists have begun to warn the virus can also spread through much smaller aerosols which can remain airborne for a lot longer and over further distances.
    On Friday, the World Health Organisation updated its information on how Covid spreads to acknowledge the risk of aerosols and last month papers released by the government’s Scientific Advisory Group for Emergencies (Sage) said health workers may need to use better protection for longer.
    Read full story
    Source: The Independent, 6 May 2021

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