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Patient Safety Learning

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  1. Patient Safety Learning
    Ministers are to invest millions in making Britain's maternity wards safer, it was announced on Wednesday after The Independent exposed a series of cases in which mothers and babies had suffered avoidable harm during childbirth.
    The new money, almost £10m, was announced as part of the spending review unveiled by Rishi Sunak, the chancellor, in the Commons and will deliver new pilots of what the Treasury called “cutting-edge training” to improve practice during childbirth.
    Significant failings in maternity safety units across the NHS have devastated families and left some babies needing tens of millions of pounds to look after them in later life.
    In November last year, The Independent joined with the charity Baby Lifeline to call for a new fund to be set up after exposing the single largest maternity scandal in NHS history at Shrewsbury and Telford Hospitals Trust, where dozens of babies have died or been left with brain damage.
    The new funding will also cover the final year of the independent investigation into the Shrewsbury trust.
    Read full story
    Source: The Independent, 26 November 2020
  2. Patient Safety Learning
    Emergency care leaders are warning it will take up to six more months to determine whether pilots of a radical change to accident and emergency are working, even though it is due to go live nationally next week, HSJ  has learned.
    HSJ understands the new “111 First” system — where walk-in patients not in medical emergencies call 111 to “book” urgent care — is set to “go live” across England from next week following pilots in acute trusts which have been run since the summer.
    From 1 December, people will be able to call NHS 111 from anywhere in the country and have urgent care “booked” for them if needed, it is understood. NHS England has been pursuing the 111 First model to help reduce overcrowding and the risk of nosocomial infections in A&Es. The service is also intended to be able to book them into GP practice appointments.
    Well-placed sources confirmed most acute trusts have now implemented some form of 111 First and the model is set to be part of their standard operations when the national system “goes live” next week. A national advertising campaign is expected to promote the approach.
    But the Royal College of Emergency Care Medicine said there was a “vocal minority” of clinicians who are “vehemently against” 111 First as they believe it will increase demand in emergency departments.
    Read full story (paywalled)
    Source: HSJ, 25 November 2020
  3. Patient Safety Learning
    While both ME and long Covid, or post-Covid syndrome, are long-term illnesses, they aren’t the same thing. But, there are ways in which our knowledge of ME has helped experts treat long Covid. It’s also helped those with the illness understand what they’re going through. Evan was diagnosed with ME in 2017, and she believes her experience can help her support those living with long Covid.
    Watch video
    Source: BBC News, 26 November 2020
  4. Patient Safety Learning
    NHS Test and Trace chief Baroness Dido Harding will be interviewed by HSJ editor Alastair McLellan at 9am tomorrow  as part of HSJ’s virtual provider summit.
    HSJ’s subscribers working in the NHS or a non-profit organisation can register to attend the summit here.
    Other speakers will include new Health Education England chief executive Navina Evans and King’s Fund chief executive Richard Murray. The subjects due to be covered include how the NHS will tackle the drive to recover routine care, the service’s workforce challenges and how forthcoming legislation may impact the governance of the service.
    Full details of the programme can be seen here.
  5. Patient Safety Learning
    Across Britain, intensive care nurses and doctors are being pushed to their limits as they try to save lives from coronavirus. During 12-hour shifts in sweltering conditions, they are faced with technical and emotional challenges that many have never faced as they tackle a virus that has swept across the globe in a matter of days, threatening to kill tens of thousands in the UK.
    Britain has yet to even hit the peak of infections, but intensive care specialists are already asking how long they can keep working relentlessly.
    “We are trained for and used to dealing with difficult and emotional scenarios, but this is like a major incident that never ends,” says critical care nurse Karin Gerber.
    As an advanced nurse practitioner in critical care outreach, the 47-year-old sees patients in hospital who are getting sicker and may need to be admitted to intensive care. She says she has never seen anything “at this intensity”.
    The Royal London Hospital is at the forefront of the capital’s fight against the virus and has created more than 200 extra beds at its Whitechapel site in east London. They are filled with COVID-19 patients.
    Simon Richards, senior charge nurse at the Royal London’s critical care unit, tells The Independent: “In 20 years as a nurse this situation is by far the worst I have ever seen and totally unexpected, but the team spirit that people have shown has been amazing.
    “It’s extremely difficult, we are working so hard. The whole team is being pushed to their limit and you do wonder how long can this be sustained for? I wish we could see light at the end of the tunnel.”
    Read full story
    Source: The Independent, 24 November 2020
     
  6. Patient Safety Learning
    Hospital trusts have been put on notice that the challenging storage requirements of the first covid vaccines are likely to mean the vaccination of their staff will have to form the vanguard of the planned roll-out next month due.
    HSJ reported last week that healthcare staff would share priority with “care home residents and staff” in the vaccine roll-out. 
    However, a letter sent to trust chief executives by NHS England seeks to clarify the situation by stressing that “different vaccines are likely to be better suited to different settings because the vaccines are likely to have different storage, reconstitution and administration requirements”. 
    “Given what we currently know about the first expected vaccine, the imperative is that NHS trusts are ready to start vaccinating from the beginning of December.” 
    Trusts are one of several components of the vaccination programme that includes primary care-run sites, mass vaccination centres, and “roving” visits to those who need them. Local systems and regional teams will decide “the most appropriate combination of models required to deliver the vaccine to their local populations based on local needs” the letter says. However, during the early stages of the roll-out this is likely to be dictated by the vaccine types that become available.
    Read full story (paywalled)
    Source: HSJ, 25 November 2020
  7. Patient Safety Learning
    Former health secretary and chair of the Commons health committee Jeremy Hunt has criticised Great Ormond Street Hospital after it was accused of covering up errors that may have led to the death of a toddler.
    Writing for The Independent, Mr Hunt, who has set up a patient safety charity since leaving government, said it was “depressing” to see how the hospital had responded to the case of Jasmine Hughes, which has now been taken to the Parliamentary Health Service Ombudsman for a new investigation.
    Mr Hunt said the hospital had chosen to issue a “classic non-apology apology of which any politician would be proud” and added he was left angry over the hospital’s “ridiculous decision” to stop talking to Jasmine’s family and the refusal to apologise for what went wrong.
    The MP for South West Surrey said the case was symbolic of a wider problem in the health service of a blame culture that prevents openness and transparency around mistakes.
    Read full story
    Source: The Independent, 24 November 2020
  8. Patient Safety Learning
    Matt Hancock has called for British people to routinely get tested for the flu, saying covid diagnostic capacity should be kept and used for “everything” once the pandemic dies down.
    Speaking at the Commons health and social care committee this morning, the health and social care secretary said the nation “must hold on to” the mass diagnostic capacity it has created for coronavirus.
    Going further, he called for a change in culture to one of “if in doubt, you get a test”, and for a long-term expansion of diagnostics.
    Mr Hancock said: “Why in Britain do we think it’s acceptable to solider on when you have flu symptoms or a runny nose, and go in [to work] and make everyone ill?
    “If you have flu-like symptoms you should have a test for it and find out what is wrong with you and stay at home. We are peculiar outliers in soldiering on and going to work and that… culture, that should change.”
    Read full story (paywalled)
    Source: HSJ, 24 November 2020
  9. Patient Safety Learning
    The NHS’ current plan for the covid vaccine rollout — dependent on the arrival of supplies — would see the whole adult population able to begin receiving it before the end of January, according to leaked documents seen by HSJ.
    Under the plan, everyone who wants to would have been vaccinated by early April.
    NHS England’s draft COVID-19 vaccine deployment programme, seen by HSJ,  reveals when each cohort is likely to begin receiving it, based on its plans to create huge capacity across GP-run facilities, “large scale mass vaccination sites”, NHS trusts, and “roving models” for those who cannot travel.
    It relies on a range of assumptions including that there will be 75% takeup, outside of residential settings like care homes and prisons, where 100% is expected.
    The plan also relies on supplies, including more than 7 million doses being available in December. It is not clear what impact a delay to this would have on the rollout. With most doses due to be administered between early January and  mid March — at a rate of 4-5 million every week — a small delay may not make a huge impact to the overall schedule.
    The document is dated 13 November and was shared among some senior NHS regional leaders yesterday.
    Read full story (paywalled)
    Source: HSJ, 23 November 2020
  10. Patient Safety Learning
    A care agency which left people "at risk of avoidable harm" by not ensuring staff had been properly trained has been put into special measures.
    Stars Social Support, which provides personal care to people living in their own home, was inspected by the Care Quality Commission earlier this year.
    Inspectors found safe recruitment procedures were not in place to make sure suitable staff were employed.
    A report following the inspection states that "safe recruitment procedures were not in place to ensure only staff suitable to work in the caring profession were employed."
    It said people's references had not been followed up after they had been requested, according to the Local Democracy Reporting Service. The report added: "When the disclosure and barring service (DBS) identified concerns, a risk assessment had not been completed to assess staff suitability."
    Inspectors also found not all staff who provided care had received appropriate training or training updates to ensure they were competent.
    Read full story
    Source: BBC News, 21 November 2020
  11. Patient Safety Learning
    Coronavirus antibodies last at least six months and offer protection against a second infection, a study of healthcare workers suggests.
    Staff at Oxford University Hospitals were regularly tested both for COVID-19 infections and for antibodies revealing a past infection.
    The more antibodies people had, the lower their chances of re-infection.
    A separate study found pre-existing immunity from other coronaviruses also protected against Covid.
    Infection consultant Dr Katie Jeffery described the Oxford findings as "encouraging news" ahead of forthcoming Covid vaccines.
    They indicated that having the virus once "provides at least short-term protection" from getting it again, she said.
    Read full story
    Source: BBC News, 21 November 2020
  12. Patient Safety Learning
    More than a million patient operations could be delayed because of widespread shortages of anaesthetists in the NHS – with 9 out of every 10 hospitals reporting at least one vacancy.
    As coronavirus paralysed the NHS earlier this year, more than 140,000 NHS patients have already waited over a year for treatment. 
    The Health Foundation has warned that 4.7 million fewer patients have been referred for treatment because of the impact of coronavirus on NHS services.
    The Royal College of Anaesthetists (RCOA) told The Independent the scale of the vacancies was getting worse and labelled it a “workforce disaster” that could cost patients’ lives and have a widespread impact on hospital services.
    Read full story
    Source: The Independent, 22 November 2020
  13. Patient Safety Learning
    The coronavirus vaccine developed by the University of Oxford is highly effective at stopping people developing COVID-19 symptoms, a large trial shows.
    Interim data suggests 70% protection, but the researchers say the figure may be as high as 90% by tweaking the dose.
    The results will be seen as a triumph, but come after Pfizer and Moderna vaccines showed 95% protection.
    However, the Oxford jab is far cheaper, and is easier to store and get to every corner of the world than the other two.
    So the vaccine will play a significant role in tackling the pandemic, if it is approved for use by regulators.
    "The announcement today takes us another step closer to the time when we can use vaccines to bring an end to the devastation caused by [the virus]," said the vaccine's architect, Prof Sarah Gilbert.
    Read full story
    Source: BBC News, 23 November 2020
  14. Patient Safety Learning
    Young, low risk patients with ongoing symptoms of COVID-19 had signs of damage to multiple organs four months after initially being infected, a preprint study has suggested.
    Initial data from 201 patients suggest that almost 70% had impairments in one or more organs four months after their initial symptoms of SARS-CoV-2 infection.
    The results emerged as the NHS announced plans to establish a network of more than 40 long covid specialist clinics across England this month to help patients with long term symptoms of infection.
    The prospective Coverscan study examined the impact of long covid (persistent symptoms three months post infection) across multiple organs in low risk people who are relatively young and had no major underlying health problems. 
    The research has not yet been peer reviewed and could not establish a causal link between organ impairment and infection. But the authors said the results had “implications not only for [the] burden of long covid but also public health approaches which have assumed low risk in young people with no comorbidities.”
    Read full story
    Source: BMJ, 17 November 2020
  15. Patient Safety Learning
    As more people suffer lasting symptoms from Covid including fatigue, ME patient advocates fear they will get bad advice,
    Based on current estimates, about 10% of COVID-19 patients develop lasting symptoms, one of the most common being fatigue. The underlying mechanism is still unclear, but possible explanations include reduced oxygen supply to tissues caused by heart or lung damage, or muscle weakness from prolonged bed rest.
    However, some doctors are increasingly concerned about the overlap between long Covid and another largely virus-triggered illness: “It’s extraordinary how many people have a postviral syndrome that’s very strikingly similar to myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS),” said the US’s top public health official, Dr Anthony Fauci, in July. “They just don’t get back to normal energy or normal feeling of good health.”
    Like people with ME/CFS, many long-Covid patients report headaches, brain fog, sleep problems, a racing heart, joint and muscle pain and fatigue. Some also experience a relapse of fever, muscle pain and exhaustion, known as “post-exertional malaise”, if they exercise beyond their capabilities.
    “There are so many similarities between long Covid and ME/CFS it leads me to believe the underlying pathology is probably the same – except that long Covid is presenting as an epidemic, whereas ME/CFS has presented in a very sporadic way, and by no means in such large numbers in such a short space of time,” said Dr William Weir, a consultant in infectious diseases with a special interest in ME.
    Read full story
    Source: The Guardian, 19 November 2020
  16. Patient Safety Learning
    A drug used to treat rheumatoid arthritis appears to help patients who are admitted to intensive care with the most severe coronavirus infections, researchers say.
    Tocilizumab, a medicine that dampens down inflammation, improved outcomes for critically ill patients, according to early results from an international trial investigating whether the drug and others like it boost survival rates and reduce the amount of time patients spend in intensive care.
    The findings have not been peer-reviewed or published in a journal, but if confirmed by more trial data, the drug will be on track to become only the second effective therapy for the sickest Covid patients, following positive results for the steroid dexamethasone earlier this year.
    “We think these are very exciting results, we are encouraged by them,” said Prof Anthony Gordon, of Imperial College London, the UK’s chief investigator on the REMAP-CAP trial. “It could become the standard of care once we have all the data reviewed by guidelines groups, and also drug regulators.”
    Read full story
    Source: The Guardian, 20 November 2020
  17. Patient Safety Learning
    People aged 50 to 64 in England will be able to get a free flu jab from 1 December in an attempt to fight the "twin threats" of flu and COVID-19.
    The group has been added to a list of people who are already eligible for a flu jab in England, such as those over 65 and health and social care workers.
    Thirty million people are being offered the vaccine in England's largest flu-immunisation programme to date.
    Health Secretary Matt Hancock said it was a winter "like no other".
    "We have to worry about the twin threats of flu and COVID-19," he said, adding that the coronavirus pandemic meant it was "more important than ever" that people got their flu jabs.
    Mr Hancock told BBC Breakfast that all over 50s would be able to get the vaccine by January.

    Read full story
    Source: BBC News, 20 November 2020
  18. Patient Safety Learning
    The NHS is going into this winter with 5,500 fewer general acute beds than last year, NHS England data has revealed.
    The numbers of general and acute beds open overnight from July to September this year was 94,787 compared with 100,370 for the same period in 2019, a fall of 5.6% or 5,583 beds. 
    The reduction in bed numbers is thought to be partly because of covid infection control measures, such as creating more distance between beds. HSJ reported this week that Cambridge University Hospitals Foundation Trust had taken nearly 100 beds out of use to allow for better social distancing.
    The figures showed significant regional differences. London had 8% fewer beds available compared with last year, while the East of England and the North East only had 3.4% fewer. The North West, which has been badly affected by the second wave of covid, had 6.6% fewer beds than last year. 
    NHS Providers deputy chief executive Saffron Cordery said: “We have been arguing for some time that the NHS is short of beds as we head into winter… This is a real problem as trusts deal with pressures posed by the virus, growing demand for urgent and emergency care and the work to recover the backlog of routine operations.”
    Nuffield Trust deputy director of research Sarah Scobie said: “This drop in the number of beds available bears out our warning that infection control will mean a loss of capacity even between waves of the virus. Many of these will have been beds too close to others for physical distancing. This is why it will be so difficult to return to previous rates of activity while the virus remains at large, worsening waiting times and forcing difficult decisions about who gets priority."
    Read full story (paywalled)
    Source: HSJ, 19 November 2020
  19. Patient Safety Learning
    Death rates for a major emergency abdominal surgery are almost eight times higher at some outlier hospitals compared with top performers, a national report has found.
    A review of emergency laparotomies in England and Wales has identified six hospitals as having much higher-than-average 30-day mortality rates for the surgery between December 2018 and November 2019.
    Hospitals identified by the annual National Emergency Laparotomy Audit as having the best outcomes, such as Stepping Hill Hospital and Salford Royal Hospital, had mortality rates of around 2.5%.
    But the review, published this month, found some hospitals, such as George Eliot Hospital, had 30-day mortality rates for emergency laparotomies as high as 19.6%
    The national 30-day mortality rate for emergency laparotomies in England and Wales was 9.3% last year and has fallen consistently since the review started in 2013.
    Some trusts told HSJ that data collection issues were partly to blame for the high mortality rates recorded in the review.
    Read full story (paywalled)
    Source: HSJ, 20 November 2020
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  20. Patient Safety Learning
    PRESS RELEASE
     (London, UK, 19 November 2020) – The charity Patient Safety Learning and the Royal College of GPs have published new guidance to help patients with post COVID-19 syndrome (also known as Long COVID) understand the support they can expect from their GP.
     This guidance draws on the RCGP's recent summary and top tips for GPs caring for patients with post COVID-19 syndrome. Both these documents have been produced in advance of more detailed national guidance being developed by the National Institute of Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of GPs, due to be published in December 2020.
     Helen Hughes, Chief Executive of Patient Safety Learning, said:
     “We have used the RCGP’s guidance to produce a simple patient-friendly guide to help support people living with Long COVID in the interim period before more detailed guidance is produced by NICE.
     We hope that this guidance will empower and inform patients, providing them with an evidence-based document that can be shared with those around them. We believe that this will also help raise awareness of the health challenges these patients are facing so that their health and recovery needs can be better met.”
     Professor Martin Marshall, Chair of the Royal College of GPs, said:
     “It’s important that patients experiencing debilitating prolonged effects of Covid-19, which we know affect a small but significant number of people who have had the virus, feel that they have the understanding and support of the GPs and other healthcare professionals delivering their care. To this end we hope this guidance is helpful for them. The RCGP is working  hard to ensure that the long term effects of Covid-19 are recognised, especially in those who were never admitted to hospital, and that our GP members have interim guidance whilst waiting for formal national guidance, currently being developed by NICE, SIGN and the College, to be published.”
     Notes to editors:
     1.     The new Patient Safety Learning and RCGP guidance can be found here: Post COVID-19 syndrome: What support can patients expect from their GP?
     2.     Patient Safety Learning is a charity and independent voice for improving patient safety. We harness the knowledge, insights, enthusiasm and commitment of health and social care organisations, professionals and patients for system-wide change and the reduction of avoidable harm. We believe patient safety is not just another priority; it is a core purpose of health and social care. Patient safety should not be negotiable.
     3.     The RCGP guidance for GPs can be found here: RCGP, Management of the long term effects of COVID-19. The RCGP response and top tips for caring for our patients, V1 30 October 2020.
  21. Patient Safety Learning
    A hospital trust in Bristol has been accused of risking lives after raising its patient-to-nurse ward ratio to dangerously high levels, having allegedly dismissed staff concerns and national guidance on safe staffing.
    University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) has introduced a blanket policy across its hospitals that assigns one nurse to 10 patients (1:10) for all general adult wards. This ratio, which previously stood at 1:6 or 1:8 depending on the ward, rises to 1:12 for nights shifts.
    The new policy, which is applicable to Bristol Royal Infirmary (BRI) and Weston General Hospital, also extends to all specialist high-care wards, which treat patients with life-threatening conditions such as epilepsy and anaphylaxis.
    Nurses at the trust have expressed their anger over the decision, saying they were never fully consulted by senior officials. Many are fearful that patient safety will be compromised as the second coronavirus wave intensifies, culminating in the unnecessary loss of life.
    “Patients who would have extra nursing staff because they are very acutely unwell and need close observation I think are going to unnecessarily die,” one nurse at BRI told The Independent. 
    “Or if they survive, they’ll suffer long-term conditions because things were missed as they don’t have the staff at their bed side to watch the deterioration.”
    Read full story
    Source: The Independent, 18 November 2020
  22. Patient Safety Learning
    An Essex maternity department has been served with further warnings by the Care Quality Commission (CQC) and again rated “inadequate”.
    Serious concerns were raised about the services at Basildon University Hospital in the summer, after several babies were found to have been starved of oxygen and put at risk of permanent brain damage.
    Despite the CQC issuing warning notices to Mid and South Essex Foundation Trust in June 2020, a subsequent visit on 18 September found multiple problems had persisted.
    The CQC’s findings at Basildon included:
    the service was short-staffed and concerns were not escalated appropriately multidisciplinary team working was “dysfunctional”, which sometimes led to safety incidents doctors, midwives and other professionals did not support each other to provide good care. Read full story (paywalled)
    Source: HSJ, 19 November 2020
  23. Patient Safety Learning
    Covid patients could be left to languish in hospital and block NHS beds amid delays in setting up “hot” care homes dedicated to receiving them, health chiefs have warned.
    A plan to reduce care home coronavirus outbreaks by setting up “hot homes” to receive infected people discharged from hospital is running late after dozens of councils missed a government deadline to nominate locations.
    By the end of October every area of England was supposed to have at least one facility approved for Covid-positive discharges, the government pledged last month. It was part of an attempt to prevent a repeat of the spring pandemic, which killed more than 18,000 residents after thousands of patients were discharged into care homes without tests.
    But as hospital admissions with Covid continue to rise, only 67 out of 151 local authorities have one set up, according to figures from the Care Quality Commission (CQC).
    NHS Providers, which represents NHS trusts, said the delays were adding to discharge problems, causing increasing patient stays and a growing number of “super-stranded” patients.
    “While the new discharge requirements are well-intentioned and aimed at protecting the most vulnerable in care homes, the challenge of implementing the changes has created blockages across mental health, acute and community beds,” said Miriam Deakin, the director of policy and strategy at NHS Providers.
    Read full story
    Source: The Guardian, 18 November 2020
  24. Patient Safety Learning
    A coroner has urged ministers to revisit plans to make it possible to hold inquests into babies that are stillborn after a baby died due to “excessive force” during an attempted forceps delivery.
    Senior coroner Caroline Beasley-Murray has written to the Ministry of Justice after she was forced to stop hearing evidence into the death of baby Frederick Terry, known as Freddie, who died under the care of the Mid and South Essex Hospitals Trust on 16 November, last year.
    An inquest into his death was started in September where Freddie was found to have died after suffering hypovolaemic shock as a result of losing a fifth of his blood when his skull was fractured during a traumatic birth attempt. In a report on the case the coroner said: “Baby Frederick Joseph Terry was delivered by caesarean section, after a failed forceps attempted delivery on 16 November 2019 and death was confirmed after 40 minutes of resuscitation attempts."
    "The evidence showed that baby Freddie's very serious scalp and brain injuries were sustained during the failed forceps attempted delivery and, but for these, baby Freddie would have survived as a perfectly formed, healthy baby."
    The coroner said the injuries he sustained implied “an excessive degree of force” in the application of the forceps, which are curved metal instruments that fit around a baby’s head and are designed to help deliver the baby.
    The inquest had to be stopped from hearing any more evidence because coroners are not able to investigate stillborn babies.
    As part of her report, the coroner said: “It would have been helpful for there to have been, during the course of the inquest, an exploration, in the course of evidence, of the treatment and care provided to baby Freddie and his parents at the time of delivery.
    "Currently there is no legislation to cover the holding of a coroner’s inquest into a stillbirth. In March 2019, the Government issued a consultation on coronial investigations of stillbirths It would be helpful for this important topic to be progressed, whatever the ultimate jurisdictional decisions.”
    Read full story
    Source: The Independent, 17 November 2020
  25. Patient Safety Learning
    Lifting lockdown must be handled better this time round to avoid a surge in Covid that could overwhelm the NHS, doctors say.
    The British Medical Association has published a blueprint for how it thinks England should proceed with any easing. It includes replacing the "rule of six" with a two-households restriction to reduce social mixing and banning travel between different local lockdown tiers.
    Government has yet to say if or exactly how England will exit on 2 December.
    It will decide next week, based on whether cases have fallen enough and how much strain hospitals are under.
    Read full story
    Source: BBC News, 18 November 2020

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