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Patient Safety Learning

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  1. Patient Safety Learning
    More men than normal are dying at home from heart disease in England and Wales and more women are dying from dementia and Alzheimer's disease, figures show.
    More than 26,000 extra deaths occurred in private homes this year, an analysis by the Office for National Statistics found.
    In contrast, deaths in hospitals from these causes have been lower than usual.
    The Covid epidemic may have led to fewer people being treated in hospital or it may be that people in older age groups, who make up the majority of these deaths, may be choosing to stay at home – but the underlying reasons for the figures are still not clear.
    Read full story
    Source: BBC News, 19 October 2020
  2. Patient Safety Learning
    When the pain in her shoulders and weakness in her right leg started two years ago, Giovanna Ippolito thought it was just part of getting older — that's until the 46-year-old's doctor ordered an X-ray that showed a five-centimetre long, broken needle embedded in her spine.
    It was a medical error that took more than a decade to discover — after medical staff at the time failed to report it. 
    Exactly when the needle was left in Ippolito's spine is unclear, but she says she's only had something injected into her back twice — during the birth of her son in 2002 and her daughter in 2004. 
    Ippolito says she believes the needle broke off when medical staff at Mackenzie Richmond Hill Hospital in nearby Richmond Hill (called York Central Hospital at the time) administered a spinal block or an epidural during one of the births.
    She's now locked in a battle with the hospital for answers and accountability. But experts say, with a system that's stacked against Canadians harmed by medical errors, it's likely no one will have to take responsibility.
    More than 132,000 patients experienced some kind of medical harm — something both preventable and serious enough to require treatment or a longer hospital stay — in 2018-19, according to the Canadian Institute for Health Information, an independent, not-for-profit organization that collects information on the country's health systems.
    Read full story
    Source: CBC, 5 October 2020
  3. Patient Safety Learning
    The government must immediately deliver a new deal for social care with major investment and better terms for workers, the Care Quality Commission (CQC) has said, as it warned that the sector is “fragile” heading into a second wave of coronavirus infections.
    In a challenge to ministers, the regulator’s chief executive, Ian Trenholm, said overdue reform of the care sector “needs to happen now – not at some point in the future”.
    Boris Johnson said in his first speech as prime minister, in July 2019: “We will fix the crisis in social care once and for all.” But no reform has yet been proposed, and more than 15,000 people have died from COVID-19 in England’s care homes.
    Trenholm said Covid risked turning inequalities in England’s health services from “faultlines into chasms” as the CQC published its annual State of Care report on hospitals, GPs and care services.
    The report reveals serious problems with mental health, maternity services and emergency care before the pandemic, and says these areas must not be allowed to fall further behind.
    The regulator argued that the health system’s response to the pandemic needs to change. After focusing on protecting NHS services from being overwhelmed, health leaders must now adapt to prevent people who need help for non-Covid reasons from being left behind, it said.
    These include people whose operations were cancelled and people from black and minority ethnic backgrounds, people with disabilities, and people living in deprived areas who have suffered more severely from the impact of Covid.
    “Covid is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others,” said Trenholm.
    Read full story
    Source: The Guardian, 16 October 2020
  4. Patient Safety Learning
    Leaking vials and suspected contamination were identified in a batch of more than 500,000 test tubes produced for the NHS Covid test and trace operation over the summer, whistleblowers have said.
    The test tubes were provided by a small UK-based company, Life Science Group (LSG), which produces materials for the diagnostics industry.
    According to the whistleblowers, there have been repeated problems with test tubes filled by LSG leaking. Stocks of some 600,000 test tubes were inspected in August as a result, and records seen by the Guardian describe the discovery of what looked like hair and blood contamination.
    It is understood firms in the supply chain concluded that the contamination was not hair or blood, following inspections. However, records seen by the Guardian suggested at least one bag of LSG test tubes thought to be contaminated “cannot now be found”.
    The whistleblowers said that rather than rejecting the entire potentially compromised batch, as would be normal safety protocol with NHS supplies, only part of the batch with visible problems was removed from use. They said they had blown the whistle because they were concerned for public safety.
    Read full story
    Source: The Guardian, 16 October 2020
  5. Patient Safety Learning
    A group of experts in nursing and infection prevention and control (IPC) is today warning against the use of IPC measures as a “rationale” for stopping safe and compassionate visits in care homes during the Covid-19 pandemic.
    In a new open letter published in Nursing Times, the specialists say that preventing people from visiting loved ones in social care settings in the name of IPC is a “misinterpretation and at times even abuse” of IPC principles.
    The letter is the brainchild of independent global health consultant and former Infection Prevention Society (IPS) president, Jules Storr. Among the signatories are five former IPC presidents, current president Pat Cattini as well as incoming president Jennie Wilson. Dr Ron Daniels, chief executive of the UK Sepsis Trust, is also on the list, Helen Hughes, chief executive of Patient Safety Learning, as well as leading IPC nurse specialists, nurse academics, a GP and carers.
    Ms Storr, a nurse by background, and the hub topic lead, said she was motivated to take action after hearing “the most heart-breaking” stories from health professionals and relatives of residents about restricted visits in the UK in the wake of COVID-19.
    Some had not seen relatives for weeks or months, whilst others were only allowed to see their loved one once a week for 20 minutes at a distance, she said.
    One individual had told her how when their father had died only one family member was permitted in the home and they were not allowed to sit close enough to hold his hand.
    Ms Storr said these practices were “absolutely outrageous and wrong from an infection prevention point of view”.
    Read full story
    Source: Nursing Times, 16 October 2020
  6. Patient Safety Learning
    GPs’ warnings about restricted services may have put patients off seeking treatment, delaying diagnoses and worsening existing illnesses, the health and care watchdog has said.
    The Care Quality Commission (CQC) said that millions of people had struggled to see their doctors during the pandemic, which had magnified inequalities and risked “turning fault lines into chasms”.
    Between March and August 119.5 million GP appointments were made in England, down from 146.2 million last year, according to NHS Digital.
    Ian Trenholm, the CQC’s chief executive, said: “The number of lost GP appointments translates into millions of people potentially . . . not getting conditions diagnosed early enough, not getting those referrals on for diagnoses like cancer and other conditions.”
    Read full story (paywalled)
    Source: The Times, 16 October 2020
  7. Patient Safety Learning
    Intensive care units in Liverpool’s hospitals are more than 90% full, according to a local health leader, as the city braces for a second wave of COVID-19 infections.
    Councillor Paul Brant, cabinet member for adult health and social care at Liverpool City Council, warned that hospital services were once again being forced to care for patients critically ill with coronavirus.
    "Our intensive, critical care beds are filling up very fast,” he told BBC Radio 4's Today programme.
    "The most recent figures I've seen suggest they are over 90 per cent full and our acute hospital trusts have occupancy levels of Covid-positive patients of over 250. At the current rate of increase, we would expect Liverpool to surpass the peak of the first wave probably within the next seven to 10 days."
    Addressing the intensive care situation, he added: "They are not all Covid patients, I should say, but they are running very full and they are running with an increasing number of people who are Covid-positive."
    He added: "It has become clear that the intensity of the demand on hospital services here in Liverpool is crowding out anything other than dealing with Covid."
    Read full story
    Source: The Independent, 14 October 2020
  8. Patient Safety Learning
    The government has been told it is ‘not sustainable’ to continue to delay its response to a major review on patient safety as ‘babies are still being damaged’.
    The Independent Medicines and Medical Devices Safety Review spoke to more than 700 people, mostly women who suffered avoidable harm from surgical mesh implants, pregnancy tests and an anti-epileptic drug, and criticised “a culture of dismissive and arrogant attitudes” including the “unacceptable labelling of many symptoms as “attributable to ‘women’s problems’”.
    The review’s author Baroness Julia Cumberlege told HSJ that “time is marching on” for the Department of Health and Social Care to implement the recommendations of her July report, which include setting up a new independent patient safety commissioner.
    The Conservative peer said pressure was building on government to adopt the findings of the review, since it had been endorsed by Royal Colleges and has already been adopted by the Scottish government. She said the government had given “evasive” answers in parliament on the issue.
    In an exclusive interview with HSJ, Baroness Cumberlege said:
    There is a crowded field of regulators but “there’s a void” for a service that listens and responds to patients’ safety concerns. She feels “diminished” that women’s concerns are still being dismissed by clinicians, but said young doctors are a cause for hope. She is “very optimistic” report will be implemented – but the NHS has to have the will to make changes. Read full story (paywalled) 
    Source: HSJ, 13 October 2020
  9. Patient Safety Learning
    The introduction of weekly covid tests for NHS staff in ‘high risk areas’ will mean other groups missing out or waiting longer, well-placed sources have told HSJ.
    There is also understood to be a standoff between NHS England and Test and Trace over the regular testing of asymptomatic staff, which was announced for the North of England on Monday.
    NHS trust labs don’t have enough capacity to test all their staff; and there is not enough spare in “pillar two” commercial labs to carry out hundreds of thousands of additional tests. National bodies are said to be in disagreement over who should do it.
    NHSE believes they should be provided by T&T, and T&T says NHS labs should expand their capacity to carry them out themselves, HSJ has been told.
    A senior source involved in the testing programme said there would have to be “trade-offs” for T&T to meet the new NHS demand, with supply having to be cut for others who want tests — mostly the general population, or care home staff.
    At present the NHS has agreed to carry out 100,000 daily tests by the end of the month, as part of the T&T’s overall 500,000 target. It has been encouraged to do more by T&T, but any expansions may face shortages of equipment and supplies such as reagents, as well as staff and space.
    Read full story (paywalled)
    Source: HSJ, 13 October 2020
  10. Patient Safety Learning
    A man in the United States has caught Covid twice, with the second infection becoming far more dangerous than the first, doctors report.
    The 25-year-old needed hospital treatment after his lungs could not get enough oxygen into his body.
    Reinfections remain rare and he has now recovered. However, the study in the Lancet Infectious Diseases raises questions about how much immunity can be built up to the virus.
    The man from Nevada had no known health problems or immune defects that would make him particularly vulnerable to Covid.
    Scientists say the patient caught coronavirus twice, rather than the original infection becoming dormant and then bouncing back. A comparison of the genetic codes of the virus taken during each bout of symptoms showed they were too distinct to be caused by the same infection.
    "Our findings signal that a previous infection may not necessarily protect against future infection," said Dr Mark Pandori, from the University of Nevada.
    "The possibility of reinfections could have significant implications for our understanding of COVID-19 immunity."
    Read full story
    Source: BBC News, 13 October 2020
  11. Patient Safety Learning
    All pregnant women have been urged by doctors to get a free flu vaccination this winter to ensure they and their babies are protected.
    People can get infected with flu and coronavirus at the same time - with Public Health England finding if you get both simultaneously you may get more seriously ill.
    Researchers previously said those who have been infected with both viruses face a serious increase to their risk of death and warned the public “not to be complacent” in the wake of fears flu could circulate around the country alongside COVID-19.
    The Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives note while getting flu is not a big deal for most people, getting the virus while you are pregnant can be serious for a small proportion of women and their babies. Flu can occasionally lead to stillbirth, maternal death and raise the chances of having a miscarriage.
    Dr Edward Morris, president of RCOG, said: “We are keen to reassure pregnant women that flu vaccination is safe for women to have at any stage in pregnancy - from the first few weeks right up to their due date, and while breastfeeding."
    "Over the last 10 years, the flu vaccine has been routinely and safely offered to pregnant women in the UK. The vaccine can also pass some protection to babies, which lasts for the first months of their lives."
    Read full story
    Source: The Independent, 12 October 2020
     
  12. Patient Safety Learning
    An NHS hospital which has faced repeated criticism by regulators for poor standards of care has been fined £4,000 for failing to assess A&E patients quickly enough.
    The Shrewsbury and Telford Hospitals Trust has been fined by the Care Quality Commission (CQC) after patients were not triaged within 15 mimutes of arrival in A&E – in breach of conditions set by the regulator last year and a national target.
    The care of emergency patients at the hospital trust, which is also facing an inquiry into poor maternity care, has been a long running concern for the watchdog which has rated the trust inadequate and put it in special measures in 2018.
    Earlier this year the CQC’s chief inspector of hospitals, Professor Ted Baker, wrote to NHS England warning of a “worsening picture" at the Midlands hospital and demanding action be taken.
    The CQC said it had issued the fixed penalty notice to the trust because it failed to comply with national clinical guidance that all children and adults must be assessed within 15 minutes of arrival. It also failed to implement a system that ensured all children who left the emergency department without being seen were followed up.
    After inspections in April 2019 and November 29 the CQC imposed seven conditions on the hospital over emergency care. The regulator said it was now clear the trust had not stuck to the conditions and had breached them both at Royal Shrewsbury Hospital and Princess Royal Hospital.
    Professor Baker said: "The trust has not responded satisfactorily to previous enforcement action regarding how quickly patients are assessed upon entering the urgent and emergency department."
    “We have issued a penalty notice due to the severity of the situation and to ensure the necessary, urgent improvements are made. It is essential that patients are seen in a timely way when they arrive at an emergency department; failure to do so could result in deteriorating health, harm, or even death, which is why national guidelines exist and must be followed."
    Read full story
    Source: The Independent, 12 October 2020
  13. Patient Safety Learning
    East Cheshire faces a serious issue with head and neck cancer, with missed target times and inefficient practices leading to worsening outcomes for patients.
    That’s prompted officials from the NHS Cheshire Clinical Commissioning Group (CCG) to come up with a plan of action to tackle the problem — but as Cheshire East councillors heard this week, it’s hit a snag.
    Since 2014, the East Cheshire NHS Trust and Manchester Foundational Trust (MFT) have co-delivered the head and neck cancer pathway. This means that patients are seen by staff at Macclesfield Hospital for diagnostic tests — and if malignant cells are detected, then the patient will be referred on to Wythenshawe for surgery or, if sadly needed, East Cheshire’s own palliative care team for supportive care.
    In a presentation to CEC’s health scrutiny committee, the CCG said just 10% of patients in the borough were seen at Macclesfield within the 62-day target time in Q3 of 2019/20 — against a desired level of 85%.
    Simon Goff, chief operating officer of East Cheshire NHS Trust, told the committee: “There is no one stop service - which is where a patient gets diagnostics all on the same day. Biopsies are not always up to the standards required so patients need to have it again. This is a key weakness in the existing service.”
    The lack of a ‘one stop service’ means there are no on-site pathology services — so samples are taken off-site for testing, and with biopsies needing to be analysed within 24 hours of collection, it results in 39% of all patients having to undergo the procedure again.
    So what did East Cheshire do about it?
    The first step was to launch a consultation, with 64 former patients out of roughly 300 eligible providing feedback to the Trust over the summer. The ‘robust’ consultation, saw patients express their desire to ‘know what is going on as soon as possible’, with the ‘issue of travel being outweighed by [the desire for] a quick diagnosis’.
    Fortunately for health chiefs in Cheshire, there are ‘outstanding’ hospitals surrounding the county — with the Care Quality Commission giving top marks to hospitals in Salford, St Helens, and The Christie in Didsbury.
    So with East Cheshire’s patients happy to travel a distance in order to gain a quick and accurate diagnosis, and the existing partnership with Manchester’s trust, officials are proposing moving some patients experiencing positive diagnoses and ‘bad news’ cases to MFT sites, such as The Christie or Wythenshawe Hospital.
    The idea is that ‘neck lump’ patients will be immediately sent to Wythenshawe, with all other patients undergoing initial tests in Macclesfield first before being either sent home with the all clear, or referred on.
    Biopsies will be done in Wythenshawe, as will ‘breaking bad news’ appointments — where patients are told of a positive cancer diagnosis.
    Officials say this solution ‘would start to address some of the clinical and performance concerns’ by cutting the average diagnosis wait time from four weeks down to one, reducing the amount of appointments patients need to attend, and allowing for continuity of care throughout treatment.
    Read full story
    Source: Knutsford Guardian, 10 October 2020
  14. Patient Safety Learning
    Saskatchewan's highest court has ruled in favour of a nurse who was disciplined after she complained on Facebook about the care her grandfather had received in a long-term care facility.
    In a decision delivered Tuesday, the Saskatchewan Court of Appeal set aside a decision by the province's Registered Nurses Association that found Carolyn Strom guilty of unprofessional conduct. 
    Strom was off-duty when she aired her concerns on Facebook in 2015, a few weeks after her grandfather's death. In her Facebook post, she said staff at St. Joseph's Integrated Health Centre in the town of Macklin, about 225 kilometres west of Saskatoon, needed to do a better job of looking after elderly patients.
    The lawyer for the Saskatchewan Registered Nurses Association argued that Strom personally attacked an identifiable group without attempting to get all the facts about her grandfather's care. In 2016, she was found guilty of professional misconduct by the Saskatchewan Registered Nurses Association and ordered to pay a $1,000 fine and $25,000 to cover the cost of the tribunal.
    After the association's decision, she received support from the Saskatchewan Union of Nurses, as well as nurses and civil liberties groups across the country.
    "Once I understood what this case meant ... once it was past being just about me, I didn't want someone else to have to go through the same thing. Because it's been rough," Strom said. 
    Strom says she continued to fight the decision because she wanted nurses to be able to talk about, and advocate for, better care for family members publicly and in a respectful manner.
    "You should be able to properly advocate for family members, regardless of whether you're a health-care member."
    "And I felt that if this decision went wrong, it would actually hurt people who have healthcare members as family members. because they would have to be a little more careful and not express concerns for fear of punishment."
    Appeal court Justice Brian Barrington-Foote wrote in his decision that Strom's freedom of expression was unjustifiably infringed, and she had a right to criticise the care her grandfather received.
    The judge ruled that criticism of the healthcare system is in the public interest, and when it comes from front-line workers it can bring positive change.
    Read full story
    Source: CBC News, 6 October 2020
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  15. Patient Safety Learning
    Less than half of the UK population will get a Covid vaccine with the elderly being top priority - a top advisor has warned.
    Kate Bingham, who was appointed as the chair of the Vaccine Taskforce back in May has claimed that the public has been “misguided” when it comes to availability of a vaccine.
    In an interview with the Financial Times, she said the government “needs to vaccinate everyone at risk”.
    She said: “People keep talking about ‘time to vaccinate the whole population’, but that is misguided."
    “There’s going to be no vaccination of people under 18. It’s an adult-only vaccine, for people over 50, focusing on health workers and carehome workers and the vulnerable.”
    Read full story
    Source: Financial Times, 4 October 2020
  16. Patient Safety Learning
    A pair of Conservative former ministers have announced they are to lead a rapid, cross-party investigation into the UK’s handling of the coronavirus crisis, amid worries a government inquiry will take too long for lessons to be learned in time.
    In a rare set of joint hearings, the Commons health committee, led by ex-health secretary Jeremy Hunt, and the science committee, chaired by Greg Clark, who was business secretary, are to hear from witnesses in the hope of producing a report by the spring.
    Announcing the plan, Hunt and Clark said the inquiry would aim to produce interim recommendations along the way. It will hold weekly joint sessions, with early witnesses set to include Chris Whitty, the chief medical officer for England, and Patrick Vallance, the government’s top scientific adviser.
    Hunt said he would expect the inquiry to cover the need for regular, large-scale coronavirus testing, an issue he has repeatedly raised in parliament, and whether this could help people visit loved ones in care homes.
    The hearings begin next Tuesday with a session on social care. Other promised areas of examination include the efficacy of lockdown measures; how well modelling and statistics have been used; the efficacy of government messaging; wider preparedness for a pandemic; and the impact on BAME communities.
    Read full story
    Source: The Guardian, 8 October 2020
  17. Patient Safety Learning
    Doctors are being told to "think carefully" before ordering any tests for their patients, amid shortages caused by a supply chain failure at a major diagnostics company.
    Swiss pharmaceutical firm Roche said problems with a move to a new warehouse had led to a "very significant" drop in its processing capacity.
    A spokesman said COVID-19 tests would be prioritised, but the backlog could affect tests including for cancer and heart disease.
    One NHS trust in the south west has already advised its GPs to stop all non-urgent blood tests.
    A memo seen by the BBC, sent to clinicians within a large hospital trust in London, said leaders were "preparing for a sustained disruption".
    "We urgently need all clinical teams to only send tests that are absolutely essential for immediate patient care, delaying testing where possible," it said.
    Thyroid and cortisol tests were unavailable, while certain cholesterol, liver function and inflammation tests were "severely restricted".
    Read full story
    Source: BBC News, 7 October 2020
  18. Patient Safety Learning
    A baby died during birth because of systemic errors in one of Britain's largest NHS hospitals, months after staff had warned hospital chiefs that the maternity unit was “unsafe”, an inquest has found.
    A coroner ruled that neglect by staff at Nottingham University Hospitals Trust contributed to the death of baby Wynter Andrews last year.
    She was delivered by caesarean section on 15 September after significant delays. Her umbilical cord was wrapped around her neck and leg, resulting in her being starved of oxygen.
    In a verdict on Wednesday, assistant coroner Laurinda Bower said Wynter would have survived if action had been taken sooner, criticising the units “unsafe culture” and warning that her death was not an isolated incident.
    Wynter’s mother, Sarah Andrews, called on the health secretary, Matt Hancock, to investigate the trust’s maternity unit.
    She said: “We know Wynter isn’t an isolated incident; there have been other baby deaths arising because of the trust’s systemic failings.  She was a victim of the trust’s unsafe culture and practices.”
    Read full story
    Source: The Independent, 7 October 2020
  19. Patient Safety Learning
    NHS England will spend £10m on new clinics for ‘long covid’ sufferers, it was announced yesterday.
    Sir Simon Stevens, NHSE chief executive, told the NHS Providers annual conference the clinics would offer support to the “probably hundreds of thousands” of people suffering persisting symptoms such as fatigue, breathlessness and ‘brain fog’ months after being infected with COVID-19.
    It comes amid growing calls for wider services to support people with ‘long covid,’ as hospital follow-up clinics are generally only open to those who were previously admitted with the virus.
    HSJ was last month only able to identify one genuine “long covid clinic”, despite claims by health secretary Matt Hancock they had “announced them in July”. It appears that comment was a mistake.
    Speaking about long covid, he said: “The NHS has got to be just as responsive and agile in respect of… new needs, including long covid, as we were in repurposing critical care, and ventilators, and acute capacity in the first phase in March, April and May."
    “Today we are going to be allocating £10m to establish a network of designated long covid clinics across the country, which, in line with new NICE guidelines on effective treatment pathways, will offer support for the tens of thousands, probably hundreds of thousands, of patients who have got long covid.”
    Sir Simon also told the conference today that NHSE was “enthusiastic” about introducing regular asymptomatic covid testing for NHS staff “if and when” it is recommended by the government chief medical officer, and when Test and Trace has enough capacity. 
    There are growing calls for regular testing of asymptomatic NHS staff, especially in hotspot areas, including from former health secretary Jeremy Hunt.
    Sir Simon said it was “something the chief medical officer and the test and trace programme are continuing to review”.
    He said: “We would be enthusiastic about doing that if and when that is the clinical recommendation and if and when the Test and Trace programme has got the testing capacity to do that. The plan was always that it would largely have to be sourced out of the total testing capacity available to the nation, not just the NHS labs.”
    Read full story
    Source: HSJ, 7 October 2020
    Read Patient Safety Learning's response to this news
    Please share your thoughts with us on the support that is needed on our patient safety platform, the hub.
  20. Patient Safety Learning
    People suffering 'Long Covid’ symptoms will be offered specialist help at clinics across England, the head of the NHS announced today.
    Respiratory consultants, physiotherapists, other specialists and GPs will all help assess, diagnose and treat thousands of sufferers who have reported symptoms ranging from breathlessness, chronic fatigue, 'brain fog', anxiety and stress.
    Speaking at the NHS Providers conference today (Wednesday), NHS chief executive Sir Simon Stevens will announce that £10 million is be invested this year in additional local funding to help kick start and designate Long Covid clinics in every area across England, to complement existing primary, community and rehabilitation care.
    Sir Simon said new network will be a core element of a five-part package of measures to boost NHS support for Long Covid patients:
    New guidance commissioned by NHS England from NICE by the end of October on the medical ‘case definition’ of Long Covid. This will include patients who have had covid who may not have had a hospital admission or a previous positive test. It will be followed by evidence-based NICE clinical guidelines in November on the support that Long Covid patients should receive, enabling NHS doctors, therapists and staff to provide a clear and personalised treatment plan. This will include education materials for GPs and other health professionals to help them refer and signpost patients to the right support. The ‘Your Covid Recovery’ – an online rehab service to provide personalised support to patients. Over 100,000 people have used the online hub since it launched in July, which gives people general information and advice on living with Long Covid. Phase 2 of the digital platform will see people able to access a tailored rehabilitation plan. This service will be available to anyone suffering symptoms that are likely due to COVID-19, regardless of location or whether they have spent time in hospital.  Designated Long Covid clinics, as announced today. This will involve each part of the country designating expert one-stop services in line with an agreed national specification. Post-covid services will provide joined up care for physical and mental health, with patients having access to a physical assessment, a cognitive assessment and a psychological assessment. Patients could also then be referred from designated clinics into specialist lung disease services, sleep clinics, cardiac services, rehabilitation services, or signposted into IAPT and other mental health services. NIHR- funded research on Long Covid which is working with 10,000 patients to better understand the condition and refine appropriate treatment. The NHS’s support will be overseen by a new NHS England Long Covid taskforce which will include Long Covid patients, medical specialists and researchers. Read full story
    Source: NHS England, 7 October 2020
    Read Patient Safety Learning's response to this news
    Please share your thoughts with us on the support that is needed on our patient safety platform, the hub.
  21. Patient Safety Learning
    The care model run by independent sector mental health and learning disability hospitals is ‘inherently risky’, a Care Quality Commission (CQC) chief inspector has warned.
    Speaking at the NHS Providers conference, Ted Baker, chief inspector of hospitals for the Care Quality Commission, unveiled the regulator’s plans to change how it inspects health and care services.
    When asked by HSJ how its new “streamlined” approach would be applied to inpatient units run by the independent sector for people with mental health and learning disability, Professor Baker said: ”One of the things we’ve been doing during the pandemic, and will continue in our transitional approach, is target risk. And one of the risks we have been targeting is exactly this, patients with learning disability and/or autism in some of these small units that have got closed cultures."
    “I think we do recognise that model of care is an inherently risky model of care and so we have been inspecting many of those under this risk driven model and taking action against many of them.
    But there is ongoing concern about that model of care and in a few weeks’ time we will be publishing a report on our assessment of that model of care and the importance of it being changed for the benefit of the people being looked after. The model of care needs to be improved but we need to make sure we are tackling the risk.”
    The chief’s comments come ahead of the regulator’s state of care report, which is due to be published next week.
    In its report published last year the CQC highlighted a concern regarding the quality and safety of independent learning disability and autism units. In particular it warned these were at a higher risk of developing closed cultures. 
    Read full story (paywalled)
    Source: HSJ, 7 October 2020)
  22. Patient Safety Learning
    Patients who saw a pain medicine specialist via telemedicine saved time and money and were highly satisfied with their experience, even before the COVID-19 pandemic, according to a study presented at the ANESTHESIOLOGY® 2020 annual meeting.
    Results of the study confirm many chronic pain patients are confident they will receive good care via telemedicine, while avoiding lengthy commutes and time spent in traffic.
    "This era of contactless interactions and social distancing has really accelerated the adoption of telemedicine, but even before the pandemic, patient satisfaction was consistently high," said Laleh Jalilian, M.D., lead author of the study and clinical assistant professor at the University of California, Los Angeles (UCLA).
    "Patients who are being evaluated for new conditions may be better off having office visits initially. But once patients establish a relationship with providers, follow-up visits can occur efficiently with telemedicine, while maintaining patient rapport and quality outcomes. We believe 50% of our visits could be conducted via telemedicine."
    "Now that telemedicine is more widespread, it may become a valued part of care delivery in chronic pain practices," said Dr. Jalilian. "Clearly many patients benefitted from remote consultations and follow-up appointments using telemedicine. We hope it will encourage policymakers and insurance providers to continue to support these platforms and inspire more innovation in this developing field of research and patient care."
    Read full story
    Source: EurekAlert, 5 October 2020
  23. Patient Safety Learning
    Almost half of NHS Trusts in England have reported risks classified as “significant” or “extreme”, with issues facing funding, buildings and failing equipment, according to an analysis by Labour.
    Highlighting warnings of staff shortages and patient safety, the party demanded urgent action from the government to prepare the health service for the winter months as cases of COVID-19 accelerate across the country.
    Labour said its study of 114 NHS Trusts’ risks registers showed that over three quarters of trusts logged a workforce risk. 
    The analysis also revealed that 66% reported a financial risk, 82% highlighted risks directly related to COVID-19 and 84% recorded a risk to patient safety. Almost half of Trusts (54), the party said, had outlined risks described as “significant” or “extreme”.
    One hospital trust reported it was “not financially stable” beyond the current financial year while another recorded a potential risk to patient safety due to “structural deficiencies” in roof structure.
    NHS hospitals are expected to consider risks to their operations and processes and when risks are identified, it is likely they will have been considered at board level and mitigations put in place.
    Describing the registers – compiled between March and August - as “worrying” in a normal winter, Jonathan Ashworth, the shadow health secretary, said: “In the coming winter, with the incompetent handling of the test and trace system leaving the NHS wide open and poorly supported, they take on a whole new meaning."
    "We urgently need a commitment from ministers to fix the problems with test and trace and a timetable by which these issues will finally be sorted. On top of this it is vital that ministers confirm that the NHS will get the additional support it needs to address these risks."
    Read full story
    Source: The Independent, 6 October 2020
  24. Patient Safety Learning
    The Prime Minister has confirmed a £3.7bn funding package to facilitate the construction of 40 new hospitals around the England by 2030, with a further eight schemes invited to bid for future funding.
    Talked about over the coming months, the funding announcement comes as the first official confirmation to deliver on the Government’s manifesto commitment.
    New standards are set to be developed over the coming months to help standardise the design of new hospitals and make use of modular construction methods to speed up the build process.
    Originally launched last September with a £2.8bn investment which provided six new hospitals with the funding to go ahead, alongside seed funding for trusts to work up business cases, the health infrastructure plan (HIP) represents the largest hospital building programme in the UK for a generation.
    The trusts which received seed funding will now all be fully funded to deliver 25 new hospitals. An additional site – a new hospital in Shotley Bridge – has also been added to the programme.
    The new Shotley Bridge hospital represents a commitment from the Government to ensure much of the funding also goes to rebuilding across the North of England, as part of its levelling up agenda.
    As part of welcoming new schemes to bid for funding for the eight further new hospitals down the line, the Government also committed that a proportion of these would be new mental health hospitals.
    Prime Minister Boris Johnson said: “The dedication and tireless efforts of our nurses, doctors and all healthcare workers have kept the NHS open throughout this pandemic. But no matter what this virus throws at us, we are determined to build back better and deliver the biggest hospital building programme in a generation."
    Read full story
    Source: NHE, 5 October 2020
    40hospitals.pdf
  25. Patient Safety Learning
    NHS Payouts linked to medication blunders have doubled in six years, fuelling record spending, official figures show.
    The NHS figures show that in 2019/20, the health service spent £24.3 million on negligence claims relating to medication errors - up from £12.8 million in 2013/14. The statistics show that in the past 15 years, almost £220 million has been spent on claims relating to the blunders.
    Previous research has suggested that medication errors may be killing up to 22,000 patients in England every year. Errors occur when patients are given the wrong drugs, doses which are too high or low, or medicines which cause dangerous reactions.
    In some cases, patients have been given medication which was intended for another person entirely, sometimes with fatal consequences. Other studies suggest that 1 in 12 prescriptions dispensed by the NHS involve a mistake in medication, dose or length of course. 
    In some cases, patients have died after being given a dose of morphine ten times that which should have been administered, with other fatalities involving fatal reactions. Confusion often occurs when drugs are not labelled clearly, or when packaging of different medications looks similar.
    Jeremy Hunt, now chairman of the Commons Health and Social Care Committee, said the NHS needed to make far more progress preventing harms, instead of seeing an ever increasing negligence bill.
    He said: “It is nothing short of immoral that we often spend more cleaning up the mess of numerous tragedies in the courts, than we actually do on the doctors and nurses who could prevent them."
    Read full story (paywalled)
    Source: The Telegraph, 3 October 2020

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