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  1. Patient Safety Learning
    Pregnant women are struggling to get the coronavirus vaccine because clinics are unable to guarantee they will have the right type of jab available, Labour MP Stella Creasy has said.
    The Pfizer-BioNTech or Moderna jabs are preferable for pregnant women because there is more safety data available.
    But the online booking system in England does not allow them to specify which vaccine they require.
    Pregnant women are advised to speak to their GP instead of booking online. But Ms Creasy, 44, said GPs do not always know when local vaccination centres will have specific types of the jab available.
    The MP for Walthamstow, who is currently pregnant with her second child, said she had received five invitations to be vaccinated but she could not take them up because there is no system to specify she needs the Pfizer or Moderna jab.
    "I don't think it's been made enough of a priority because there's a presumption it will become more of a priority as they move through the age groups, which is a misreading of the data about pregnancy," she told the BBC.
    Read full story
    Source: BBC News, 7 May 2021
  2. Patient Safety Learning
    Spending on the NHS, social care and public health needs to rise by £102bn over the next decade, funded by big tax rises, to improve Britain’s health in the wake of the coronavirus pandemic, an inquiry has said.
    The massive funding boost would cut avoidable deaths from cancer and heart disease, tackle glaring health inequalities and rebuild the NHS after Covid exposed weaknesses such as a lack of beds and staff, a team of experts have urged ministers.
    The money would come largely from increases in income tax, national insurance and VAT, which evidence suggests the public is willing to pay, according to a four-year commission of inquiry by the London School of Economics and the Lancet medical journal.

    “Without concerted action and increased funding we risk the UK falling further behind other high-income countries in health outcomes and life expectancy, continued deterioration in service provision and worsening inequalities, increased reliance on private funding and an NHS that is poorly equipped to respond to future major threats to health,” said Dr Michael Anderson of the LSE, the commission’s joint research lead.
    Read full story
    Source: 6 May 2021
  3. Patient Safety Learning
    Women and younger adults were more likely to feel depressed during the second UK coronavirus peak than men and other age groups, Office for National Statistics (ONS) data suggests.
    Four in 10 women aged between 16 and 29 were affected, compared to 26% of men. One in five adults experienced depression in early 2021 - more than double pre-pandemic levels.
    But GPs in England diagnosed fewer cases of depression in adults in 2020 compared with the year before. Many people may not be seeking medical help, the ONS says.
    Health experts have always warned that the combined effects of ill health, isolation and job losses during the pandemic would have a negative impact on people's mental health and wellbeing.
    Read full story
    Source: BBC News, 5 May 2021
  4. Patient Safety Learning
    The first new hospital cleaning standards for 14 years have been outlined by regulators, including confirmation of new food hygiene-style star ratings.
    Wards and theatres will be given ratings from one to five stars – based on audits which score the cleanliness of areas against safe standards – and these ratings will be made visible to patients.
    The plans for the new star ratings, which are expected to be easier for patients to understand than the current cleanliness percentage scores, were first revealed by HSJ in 2019.
    The ratings are also designed to encourage a more collaborative approach, by reflecting the cleanliness score for whole areas, as opposed to the performance of individual parties responsible for cleaning certain elements.
    Areas rated one to three stars would require improvement plans and be automatically placed under review, with “immediate action” being required in one-star rated areas.
    Read full story (paywalled)
    Source: HSJ, 6 May 2021
  5. Patient Safety Learning
    The number of people being diagnosed with cancer early in England has plummeted during the Covid pandemic, sparking fears that many will only be treated when it is too late to save them.
    Official figures show a third fewer cancers were detected at stage one, when the chances of survival are highest, in the early months of the pandemic than during the same months a year before.
    Cancer experts fear that the figures, which have been collected by Public Health England’s National Cancer Registration and Analysis Service, mean thousands of people have the disease but have not yet started treatment because of “a shift to later diagnosis”. They urged anyone with possible symptoms of the disease to get them checked out immediately.
    “While it’s fantastic that Covid rates are dropping and lockdown is easing, the knock-on impact of the pandemic on cancer care cannot be overstated,” said Steven McIntosh, the executive director of advocacy and communications at Macmillan Cancer Support. “We are likely to be dealing with Covid’s long shadow for many years to come.”
    Read full story
    Source: The Guardian, 5 May 2021
  6. Patient Safety Learning
    Two doses of the Pfizer-BioNTech vaccine can provide more than 95% protection against infection, severe illness and death from Covid, according to a groundbreaking study in Israel.
    The middle eastern country currently leads the world in its inoculation programme, with more than half (56 per cent) of its population having already received both doses of the Pfizer vaccine.
    The research, published today in The Lancet journal, also concluded that a single dose of the jab provides 58 per cent protection against infection, 76% against hospital admission, and 77% against death.
    The researchers said their study highlights the importance of fully vaccinating adults against the virus but acknowledged challenges remain to get the pandemic under control – including uncertainty around how long immunity lasts, from both vaccines and natural infection, and the emergence of variants that may be resistant to jabs currently on the market.
    Read full story
    Source: The Independent, 6 May 2021
  7. Patient Safety Learning
    General practices are “reaching breaking point” because of the “intense” workload pressure facing doctors and staff, the country’s most senior GP leaders have warned.
    The warning came as new figures from NHS Digital showed that practices in England delivered almost five million more appointments in March 2021 than the month before and nearly three million more than in March 2019.
    Richard Vautrey, chair of the BMA General Practitioners Committee, said that the figures underlined the huge efforts practices were going to and the workload pressure on staff. He said, “GPs and their teams are consistently telling us they’re busier now than they have ever been, and this data—which does not include a large proportion of the vaccine programme undertaken by practices, nor a vast amount of other daily tasks—backs this up.”
    Last week the Ivy Grove Surgery in Derbyshire provided an example of the strain facing some practices in a 16 page open letter to its patients about the huge demand it was facing and the resulting risk of staff burnout. The surgery said it would be reducing its use of the video consultation tool eConsult, as it had seen a doubling of demand over recent months, with some patients submitting several requests a day.
    In a statement the practice told The BMJ, “We are aware of the stir our letter has caused but have also been overwhelmed by the kind feedback from our own patients, and the many encouraging messages of support we have received from GP surgeries all around the country. We therefore know that many of our GP colleagues are experiencing the same issues, but they may be fearful of articulating what is happening."
    “We feel that open and honest debate about demand and workload in general practice is vital. If this letter goes even a little way towards sparking some much needed discussion then it will have been a good thing.”
    Read full story
    Source: BMJ, 4 May 2021
  8. Patient Safety Learning
    Children with asthma are at risk of avoidable deaths in England because of poor NHS systems and a failure to appreciate the dangers posed by the condition.
    A new investigation by NHS safety watchdog the Healthcare Safety Investigation Branch (HSIB) has revealed a series of risks to children with asthma, as concerns emerge of the impact of the pandemic on asthma patients more generally.
    The latest inquiry was sparked by the deaths of three children between 2014 and 2017. All were caused by asthma attacks which were later the subject of warnings by coroners.
    In each case HSIB said there were missed opportunities to recognise asthma as a life-threatening condition as well as problems with how the children were managed by doctors working in different parts of the NHS.
    Read full story
    Source: The Independent, 5 May 2021
  9. Patient Safety Learning
    Women are bearing the overwhelming brunt of the “gargantuan challenges” health and care services are grappling with during the Covid pandemic, health leaders have said.
    A new study by the NHS Confederation’s Health and Care Women Leaders Network found female health and care workers’s physical and mental health substantially deteriorated due to working during the coronavirus crisis.
    The survey, which polled more than 1,200 NHS staff in February and March this year after the virus peaked, found issues with mental and physical health had notably worsened since last summer.
    Researchers found more than 80% of women said the pandemic meant their job had greater detrimental repercussions on their emotional wellbeing. This is a significant rise from 72% of female workers who said the same during equivalent research carried out in June.
    The report, which polled nurses, doctors, administrative staff, allied health professionals and managers, warned there are “still many mountains to climb” as services strive to cope with the chaos unleashed by the Covid crisis, as well as dealing with the long-term consequences of the pandemic.
    The study said: ”This includes tackling the growing issue of long Covid, meeting increased demand for mental health services, continuing to deliver the largest vaccination programme the UK has ever seen, and addressing a backlog of treatment that could extend to nearly seven million people by the end of 2021."
    Read full story
    Source: The Independent, 5 May 2021
  10. Patient Safety Learning
    When we put people on a pedestal, my experience is that they are less likely to be asked, ‘are you OK?’, writes Samantha Batt-Rawden, a senior registrar in intensive care medicine.
    Like many she has been touched by the groundswell of support from the public. But there’s a problem with this hero image, she says. 
    "It’s not just that many NHS staff are feeling increasingly uncomfortable with being hailed as heroes for what they see as simply doing their jobs. Of course, we were going to step up to the plate when the COVID-19 pandemic hit. As doctors it was our duty. There was never any question.
    "But there’s something more than just feeling undeserving of the cape weighing heavily on our shoulders. The worst thing about being seen as a superhero? Very few think to ask if you’re OK.
    And herein lies the problem. Because healthcare workers are not heroes, we are human. Completely, painstakingly, fallibly human."
    Read full story
    Source: The Independent, 2 May 2021
     
  11. Patient Safety Learning
    Healthcare workers and patients are being put at risk not only from COVID-19 but other deadly diseases as a result of an increase in sharps injuries due to the pandemic. 
    Sharps injuries are accidents where a needle or other medical sharp instrument penetrates the skin with the potential to transfer blood borne viruses, including HIV or hepatitis B or C, from the patient to healthcare worker and vice versa. Sharps injuries cause increased costs and disruption in the healthcare system, which have all been exacerbated by the pandemic anyway. Sharps injuries also have a major emotional and mental impact on staff who always put patients first and literally have put their lives on the line during COVID-19.
    The European Biosafety Network has commissioned a survey to be published in June on the impact COVID-19 has had on sharps injuries in Europe. The preliminary findings of the survey by Ipsos MORI, covering more than 300,000 healthcare workers in 80 large public hospitals across Europe, show that the number of sharps injuries has increased by some 276,000 injuries (23%) over the last year: with 98% of respondents saying that the increase was a result of the increased pressure and stress due to COVID-19.
    Other recent published survey results also show that the number of reported sharps injuries has increased as a result of the pandemic. We need to ensure that other existing legislation and regulations which prevent sharps injuries are both understood and complied with.
    Read full story
    Source: The Brussels Times, 28 April 2021
  12. Patient Safety Learning
    Patients with life-threatening coronary heart disease will be treated five times faster thanks to 3D scans being introduced on the NHS that allow for a diagnosis in just 20 minutes.
    The revolutionary technology can turn a regular CT scan of the heart into a 3D image, allowing doctors to diagnose them rapidly, NHS England said.
    It added that about 100,000 people will be eligible to use the HeartFlow technology over the next three years.
    Patients – who would previously have had to undergo an invasive and time-consuming angiogram in hospital – will now be seen, diagnosed and treated around five times faster.
    The new technology, introduced from last month, is part of the NHS long-term plan to cut the number of heart attacks and strokes by 150,000.
    NHS England said more people here will have access to the potentially life-saving technology than anywhere else in Europe, the US or Japan.
    Matt Whitty, director of innovation and life sciences for NHS England, said HeartFlow had been a “huge success” in clinical trials and would now help “tens of thousands of people a year receive quick diagnosis and treatment and ultimately save lives”.
    Read full story
    Source: The Guardian. 4 May 2021
  13. Patient Safety Learning
    On Christmas Day, Gail Jackson’s 16-year-old daughter said she was in so much pain she thought she would die. Liliana had been briefly admitted to hospital with Covid in September. Her symptoms never went away and, as time went on, new ones had emerged.
    “For months she had a relentless, agonising headache, nausea, tinnitus, fatigue and insomnia, but the worst thing was the agonising nerve pain,” said Jackson. “I couldn’t even touch her without her screaming in pain.”
    On Christmas morning, Jackson drove to hospital with her daughter vomiting from pain in the passenger seat. When they got to the hospital, however, the A&E doctor said there was no such thing as long Covid in children. “He said she just needed to go home and get on with her life,” Jackson said. “It was jaw-dropping.”
    It is extremely rare for children and young people to contract severe Covid, but recent research has shown that even mild or asymptomatic infection can lead to long Covid in children. A study at UCL is investigating long Covid in 11- to 17-year-olds who were not hospitalised with the disease.
    The National Institute for Health and Care Excellence (NICE) has recommended more research to produce guidance on how children and young people are affected and how they can be treated. However, there is no case definition of long Covid in children and young people in the way there is in adults.
    Read full story
    Source: The Independent, 3 May 2021
  14. Patient Safety Learning
    The critical finding at the inquest into Laura Booth’s death raises alarming concerns about the failing system of investigation into the deaths of people with learning disabilities.
    Initially, Laura’s death was said to be expected and was attributed to natural causes on the basis of a death certificate signed by a hospital doctor. Without the determination of Laura’s family and the intervention of the media, this inquest would never have happened, and the truth about her death from malnutrition and neglect would not have been uncovered. 
    The concerns about how many other avoidable deaths have not been scrutinised because there is no one to speak up on behalf of those who died or because families are obstructed in their search for answers by the prevailing assumption that people will die early. The premature deaths of people with learning disabilities (on average 30 years before their non-disabled peers) demand robust scrutiny particularly as when inquests do take place, they so often reveal basic failings in healthcare. The way in which the Booth family were so nearly failed by the coronial system is a sharp reminder of how urgently reform of these processes is needed.
    Read full story
    Source: The Guardian, 2 May 2021
  15. Patient Safety Learning
    Thousands of UK doctors are planning to quit the NHS after the Covid pandemic because they are exhausted by their workloads and worried about their mental health, a survey has revealed.
    Almost one in three may retire early while a quarter are considering taking a career break and a fifth are weighing up quitting the health service to do something else.
    Long hours, high demand for care, the impact of the pandemic and unpleasant working environments are taking their toll on medics, the British Medical Association findings show.
    Dr Chaand Nagpaul, the leader of the BMA, said the high numbers of disillusioned doctors could worsen the NHS’s staffing problems and leave patients waiting longer for treatment.
    “It’s deeply worrying that more and more doctors are considering leaving the NHS because of the pressures of the pandemic – talented, experienced professionals who the NHS needs more than ever to pull this country out of a once-in-a-generation health crisis,” Nagpaul said.
    Read full story
    Source: The Guardian, 2 May 2021
  16. Patient Safety Learning
    Pregnant women are facing a postcode lottery over whether they can bring a partner to maternity appointments.
    Health boards were given flexibility in November to allow pregnant woman in low Covid rate areas to take their partners to maternity appointments.
    But many parts of Wales with the lowest rates are still forcing pregnant women to attend some appointments alone.
    There are calls, as lockdown eases, for partners Wales-wide to be allowed to all appointments and during labour.
    Emma Fear, 30, was not able to take her partner with her to hospital when she experienced bleeding during pregnancy in June last year and was told, alone, that she was losing her baby.
    She then had to repeat the news to her partner, who was waiting outside in the car.
    "At the time, he could have come and sat outside a pub with me, but he couldn't come with me when I'd had severe bleeding and knew I had probably lost my baby."
    Read full story
    Source: BBC News, 2 May 2021
  17. Patient Safety Learning
    Younger adults are particularly affected by the rare blood clotting disorder linked to the Oxford-AstraZeneca vaccine, the UK's medicines regulator has said.
    The Medicines and Healthcare products Regulatory Agency (MHRA) said there were 209 cases in the UK of the rare combination of blood clots with low platelet counts following being vaccinated the Oxford-AstraZeneca jab, with 41 deaths, up to 21 April.
    This is up from 168 cases and 32 deaths the previous week.
    The new data also shows 24 cases of clots in people aged 18 to 29, 28 in those in their thirties, 30 in people in their forties, 59 in people in their fifties and 57 in those aged 60 and above, with the age not known in the remaining cases.
    The numbers appear to rise with age but that is because more older people have been vaccinated. Fewer than one in five clots was fatal.
    The latest NHS England data show that 5.5 million people under 45 had received a first dose by 25 April, while 22.6 million of those 45 and over had done so.
    MHRA chief executive June Raine said no medicine or vaccine was without risk, but that blood clots were extremely rare.
    She added: “The benefits of the vaccine continue to outweigh the risks for most people. It is still vitally important that people come forward for their vaccination when invited to do so."
    Read full story
    Source: The Independent, 3 May 2021
  18. Patient Safety Learning
    Tees, Esk and Wear Valleys NHS FT has launched a deaf digital inclusion project, to find the best practice for communicating with deaf and deafblind patients.
    The project will look at the barriers faced by the patients around digital communications, and how to help the staff become more deaf aware.
    The deaf and deafblind patients supported by the trust, their carers, staff, and members of deaf wellbeing groups and networks, are taking part in the project to help provide the best digital communications support to meet deaf patients’ needs.
    The project is led by the trust’s deaf services team which provides a range of support to deaf and deafblind people aged 18 and over, who mainly use British Sign Language (BSL) to communicate, who also have mental health problems.
    Emmanuel Chan, Clinical Nurse Specialist for the deaf services team, :explained: “People who are oral and require lip reading can find video appointments a challenge if others on the call are not fully deaf aware and talk over one another. Alongside our project, our team aims to help our staff become more deaf aware to avoid this happening.”
    Read full story
    Source: NHE, 26 April 2021
  19. Patient Safety Learning
    A consultant at St Luke’s Hospital in Kilkenny who carried out unauthorised research on five female patients during routine gynaecological procedures has failed in a High Court challenge to prevent his dismissal by the HSE.
    Consultant gynaecologist Ray O’Sullivan claimed a decision by the HSE’s chief executive, Paul Reid, on December 23rd, 2019 to recommend his dismissal was “fatally flawed” for reasons including a failure to allow him the opportunity to comment on an expert’s report into his professional performance.
    The hospital began an investigation after nursing staff expressed concern about the risk of infection from a procedure carried out on five patients on September 4th and 5th, 2018 under the direction of Prof O’Sullivan.
    A catheter and small pressure pad was placed, without their consent and without seeking approval from the hospital’s ethics committee, inside the vagina of five patients who were having a hysteroscopy.
    This was done as part of a feasibility study designed to see if certain procedures could be carried out without the use of a speculum (a device commonly used in vaginal exams) .
    The court heard the five patients, who were tested for infection including HIV, were greatly shocked and upset when St Luke’s informed them about what happened at open disclosure meetings.
    Read full story
    Source: The Irish Times, 27 April 2021
  20. Patient Safety Learning
    An antiviral typically used to treat influenza is a “good contender” for a drug that could be taken at home by people infected with COVID-19, according to a scientist who is trialling the medicine.
    Favipiravir, licensed as a flu treatment in Japan since 2014, has already shown potential in reducing lung damage in hospitalised Covid patients and speeding up the time taken to clear the virus from the body.
    But two UK trials, in Glasgow and London, are investigating whether the drug could be taken by people in the community before their disease has progressed, therefore keeping them out of hospital.
    The government has promised to “supercharge” the search for and development of a new generation of easy-to-take, at-home drugs that can reduce transmission and quicken recovery from COVID-19.
    A new taskforce, modelled on the team behind Britain’s vaccine procurement programme, is to oversee this work. It intends to deliver two effective treatments - offered in tablet form - to the public as early as autumn.
    Read full story
    Source: The Independent, 22 April 2021
  21. Patient Safety Learning
    A man who died from lung cancer might have been saved if a hospital trust had not "failed to act" on two abnormal chest X-rays, an investigation found.
    Growths identified in the patient's examinations were not followed up for three years and were then untreatable, the health ombudsman said.
    North Cumbria University Hospitals NHS Trust also failed to correctly handle a complaint from the man's daughter.
    The trust, which runs hospitals in Carlisle and Whitehaven, apologised.
    The investigation was carried out by the Parliamentary and Health Service Ombudsman (PHSO), which deals with unresolved NHS England complaints.
    The patient, referred to only as Mr C, was admitted twice to hospital with stroke-like symptoms in 2014 and 2015. On both occasions X-rays were carried out which found abnormal growths in his lungs, but no action was taken. In July 2017, Mr C was found to have advanced lung cancer and he died weeks later.
    Read full story
    Source: BBC News, 29 April 2021
  22. Patient Safety Learning
    The Equality and Human Rights Commission has required an ambulance trust to sign a legally-binding agreement stating how it will protect its staff from sexual harassment.
    This is thought to be the first time the EHRC has taken such action against an English NHS organisation and follows repeated concerns about the culture at East of England Ambulance Service Trust.
    As a result, EHRC will now monitor the trust’s action plan for protecting staff from sexual harassment.
    The Care Quality Commission asked the EHRC to consider taking enforcement action against the trust last summer, after a CQC investigation found evidence of “bullying and predatory behaviour” and warned the trust’s leaders were not adequately promoting patients’ and staff’s wellbeing.
    The CQC also found at least 10 incidents in 2019-20 involving allegations of sexual assault, harassment or inappropriate behaviours, and 13 instances of staff, including those working for subcontractors, being referred to the police for sexual misconduct and predatory behaviour. The trust was subsequently placed in special measures for quality.
    Read full story (paywalled)
    Source: HSJ, 28 April 2021
  23. Patient Safety Learning
    Three private mental health hospitals have been placed in special measures after the Care Quality Commission found concerns over infection control.
    John Munroe Hospital and Edith Shaw Hospital, both in Staffordshire and run by the John Munroe Group, were inspected after the CQC received several whistleblowing complaints over poor covid-19 infection control and covid deaths. 
    A third hospital, Priory Hospital Arnold, based in Nottinghamshire, was criticised over hygiene and infection control failures after the regulator found dried blood, faeces, food and sputum on seclusion room walls.
    In reports published this week, the CQC revealed it had placed all three hospitals in special measures and imposed urgent enforcement action against the providers. 
    Read full story (paywalled)
    Source: HSJ, 29 April 2021
  24. Patient Safety Learning
    A nurse says the effects of "long Covid" mean she is "not the same person any more".
    Lynne Wakefield from Holyhead is still suffering with fatigue and "brain fog" after contracting Covid in June 2020. She said her employer had been "very good" supporting her, but other NHS staff told BBC Wales they felt pressurised to go back to work.
    The NHS Confederation said there was a package of support for staff affected by "longer term effects of Covid".
    A recent survey suggested about 56,000 people in Wales have symptoms of long Covid, which include fatigue, headaches and coughing.
    Other NHS workers with long Covid symptoms, who did not want to be named, told BBC Wales Live how they feel about the ways they are being treated by their employers:
    "I knew that returning to work would put my recovery at risk, but it was work or starve. On my return, I was informed that any further days absent in the next 12 months would result in a formal warning."
    "I'm so worried about losing my job as I've been off work for so long and I'm still nowhere near well enough to return."
    "If they say I have to come back or be dismissed, I'll have to do it, I'll have to try [and go back] and survive. I am so emotional at the moment, I can't stop crying - I feel I am going crazy."
    Read full story
    Source: BBC News, 28 April 2021
  25. Patient Safety Learning
    A cutting-edge child and adolescent mental health centre hopes to help prevent young people from experiencing mental health problems.
    As we look hopefully towards a June bonfire of pandemic regulations and restrictions, many recognise that soaring rates of mental health problems and distress amongst our children and young people must be near the top of a 21st century list of challenges in “building back better”.
    School closures, uncertainty and being cut off from friends and social and sporting events have seen more children and young people referred to CAMHS — a service that was facing growing demand even before the pandemic.
    The long-term impact is obviously still unknown.
    However, a cutting-edge child and adolescent mental health centre opening in south London two years from now will play a big role in responding to the likely increased demand for ongoing support — and in developing innovative treatment responses.
    Read full story (paywalled)
    Source: HSJ, 27 April 2021

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