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  1. Patient Safety Learning
    Figures released by the Office for National Statistics show that about two-thirds of fatalities from this disease during its peak from start of March to mid-May were people with disabilities. That is more than 22,000 deaths.
    Then dig down into the data. It indicates women under 65 with disabilities are more than 11 times more likely to die than fellow citizens, while for men the rate is more than six times higher. Even for older people the number of deaths was three times as high for women and twice as high for men. There are some explanations for such alarming figures, although they tend to reveal other profound concerns.
    Yet the report showed even when issues such as economic status and deprivation are taken into account, people with disabilities died at about twice the rate of their peers. So where was the fury over this obvious and deep inequality, even in death? Where was the fierce outcry over persistent failures that left many citizens and their families at risk, lacking even the most basic advice, support or protection from the state?
    Chris Hatton, the dedicated professor of public health and disability at Lancaster University, delved into all available data. He found people with autism and learning disabilities were in reality at least four times more likely to die at the peak of pandemic than other citizens.
    They also died at far younger ages. “Information released about deaths of autistic people and people with learning disabilities has been minimal, grudging and seems deliberately designed to be inaccessible,” he says.
    This adds up to one more shameful episode in the scandal of how Britain treats such citizens.
    Read full story
    Source: iNews, 5 July 2020
  2. Patient Safety Learning
    Most people experience COVID-19 as a short-term illness: once the infection has been fought off, they bounce back to health. But evidence is emerging of a significant minority – sometimes referred to as “long haulers” – who struggle with long-term symptoms for a month or longer.
    Anecdotal reports have abounded of people left with fatigue, aching muscles and difficulty concentrating. Online support groups on Facebook and Slack have sprung up, already hosting thousands of members who say they have not got better.
    Speaking to the BBC’s Andrew Marr Show on Sunday, Matt Hancock said it was difficult to gauge the scale of the problem. “This is a really serious problem for a minority of people who have Covid,” the health secretary said. “Some people have long-term effects that look like a post-viral fatigue syndrome.”
    Scientists are only just beginning to investigate the potential causes of enduring fatigue, but say that there are likely to be a wide variety of reasons why some people face a longer road to recovery.
    Read full story
    Source: The Guardian, 5 July 2020
  3. Patient Safety Learning
    We’re swiftly learning the symptoms of Covid-19 may last longer than previously thought. One in 10 people are reporting a longer tail of symptoms, which exceeds the suggested two-week recovery time.
    It’s thought around 30,000 people in the UK could be impacted by a prolonged version of the illness – what some are calling ‘long covid’. These people are months into their recovery from the virus and still fighting a range of persistent symptoms. In some cases, the symptoms disappear for a while before coming back. In others, they’re gradually improving over time.
    Research from the Covid-19 Symptom Study in the UK, led by Professor Tim Spector of King’s College London, shows after three weeks of first reporting symptoms, a group of people continue to experience fatigue, headaches, coughs, loss of smell, sore throats, delirium and chest pain.
    People with mild cases of the disease are more likely to have a wide range of symptoms that come and go over an extended period, Prof Spector found. And these people are often flying under the radar because they’re not in hospital.
    Those who believe they’ve had ‘long covid’ are now calling on the government to recognise their plight, invest in research and put support in place.
    Read full story
    Source: Huffpost, 2 July 2020
  4. Patient Safety Learning
    The “hazardous” use of personal protective equipment (PPE) required because of COVID-19 is contributing to the spread of secondary infections in intensive care units and other hospital settings, a leading expert has told HSJ.
    Infection Prevention Society vice president Professor Jennie Wilson, said: “[PPE] has been used to protect the staff, but the way it has been used has increased the risk of transmission between patients. The widespread use of PPE particularly in critical care environments has exacerbated the problem (of patient to patient transmission). Unless we tackle the approach to PPE we will continue to see this major risk of transmission of infections between patients.”
    Professor Wilson warned this was espeically worrying as the risk includes spreading antibiotic resistant infections among ICU patients. There is increasing concern these are developing more often in covid patients due to widespread use of broad spectrum antibiotics in the early days of the pandemic, she added.
    Read full story (paywalled)
    Source: HSJ, 3 July 2020
  5. Patient Safety Learning
    Psychiatrist Dr. Scott Krakower was diagnosed with the coronavirus in April and continues to have symptoms more than two months later, making him what’s known as a “long hauler.”
    Although Krakower said he's feeling better, he is not able to return to work.
    “Each day is different. Some days are up, some days are down. I would say the mornings are better for me and then by 1 or 2 o’clock is when my voice and my shortness of breath kick in more and then it’s harder to do things.”
    Krakower hasn’t had a clear answer about when he will recover or whether that may happen, although he takes solace in the fact that he is improving.
    Krakower continues to try and shake off the symptoms, a signature of long hauling. It’s a trait that has been on display before with MERS and SARS, says Dr Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City.
    “What we’re seeing is that this is a byproduct of the inflammation from the virus itself. In other words, dead fragments of virus elicit an immune response. And as a result of this, the body reacts and produces certain types of substances that can really have adverse effects,” Glatter said.
    Read full story
    Source: Today, 1 July 2020
  6. Patient Safety Learning
    Problems with hospital discharges in England, highlighted in the largest annual patient survey, reinforce the need for greater integration between health and social care, the sector regulator has said.
    The Care Quality Commission inpatient survey found that a majority of patients were positive about their hospital care but a significant minority experienced problems on discharge.
    A third of respondents who were frail said the care and support they expected when they left hospital was not available when they needed it. Three in 10 frail people said they had not had discussions with staff about the need for further health and social care services they might require post-discharge.
    Four in 10 of all patients surveyed left hospital without printed or written information about what they should or should not do after discharge, and the same proportion said their discharge was delayed.
    Read full story
    Source: The Guardian, 2 July 2020
  7. Patient Safety Learning
    The leader of the Morecambe Bay inquiry has spoken of his disappointment that some of the recommendations have not led to changes, and said royal colleges could inform regulators when they are commissioned to carry out care quality reviews.  
    Bill Kirkup was speaking after HSJ revealed only a small proportion of royal college “invited reviews” were made public, and in some cases even the Care Quality Commission (CQC) had not been made aware of the reviews, or seen final reports. Trusts had commissioned dozens of them into care failings over three years.
    The inquiry which he chaired into maternity services at the University Hospitals of Morecambe Bay Foundation Trust recommended that all external reviews of suspected service failings should be registered with the CQC and that NHS boards should have a duty to report their findings “openly”. The recommendations of the inquiry were accepted by both the government and the CQC.
    HSJ used freedom of information law to get copies of reports from recent years, but in many cases trusts refused to share them.
    Dr Kirkup, who stressd his comments did not refer to any individidual trust, said the findings highlighted a weakness in implementation of “an important recommendation”.
    Read full story (paywalled)
    Source: HSJ, 3 July 2020
  8. Patient Safety Learning
    Staff working in care homes are to be tested every week starting on Monday, with residents tested every month, the government has said.
    The expansion of testing comes as a whistleblower at one of the testing laboratories revealed dozens of shifts had been cancelled throughout May and June because of a lack of test samples.
    Ministers hope that the expansion of testing will help to prevent the spread of infection to vulnerable residents.
    Read full story
    Source: The Independent, 3 July 2020
  9. Patient Safety Learning
    Parents of babies who died at a hospital trust at the centre of a maternity inquiry say a police investigation has come "too late".
    West Mercia Police said it was looking at whether there was "evidence to support a criminal case" at Shrewsbury and Telford NHS Hospital Trust. An independent review, contacted by more than 1,000 families, said it was working with police to identify relevant cases.
    "It's bittersweet," one mother said. 
    "It's come too late for my daughter, she should still be here," said Tasha Turner, whose baby, Esmai, died four days after she was born at Royal Shrewsbury Hospital in 2013.
    Ms Turner's case is part of the Ockenden Review, an independent investigation into avoidable baby deaths at the trust, which runs Royal Shrewsbury Hospital and Telford's Princess Royal.
    LaKamaljit Uppal, 50, from Telford, who is also part of the review following the death of her son Manpreet in April 2003 at Royal Shrewsbury Hospital, said she hoped the police inquiry would bring some closure.
    "The trust put me through hell, someone should be held accountable," she said.
    Read full story
    Source: BBC News, 1 July 2020
  10. Patient Safety Learning
    A Scottish Government committee has found that the “profound failings” of IT systems are the biggest problem facing a medicine-prescribing service that does not sufficiently focus on patients.
    A report from the members of Scottish Parliament on the Health and Sport Committee describes a medicines system “burdened by market forces, public sector administrative bureaucracy and under resourcing, inconsistent leadership and a lack of comprehensive, strategic thinking and imagination, allied to an almost complete absence of useable data”.
    The committee particularly criticised the failure of the NHS to introduce appropriate IT systems.
    “We are extremely disappointed that once again all roads lead to the dismal failure of the NHS in Scotland to implement comprehensive IT systems which maximise the use of patient data to provide a better service,” the report says.
    Committee members are calling for an overhaul of the system to allow for collection and analysis of data that would ensure the best possible outcomes for patients and cost savings for the NHS.
    MSPs found a “lack of care” to understand patients’ experience of taking medicines and a lack of follow up to ensure that medicines were effective or even being used.
    Prescribers were “instinctively reaching for the prescription pad” and not taking the time to discuss medicines with patients, nor were the principals of realistic medicine, in which patients and clinicians share decision making about their care, being followed.
    Read full story
    Source: Public Technology.net, 1 July 2020
  11. Patient Safety Learning
    NHS England and NHS Improvement have ordered urgent reviews into the deaths of people with a learning disability and autism during the pandemic, HSJ has learned.
    In May, the regulators said the COVID-19 death rates among this population were broadly in line with the rest of the population.
    But in early June, the Care Quality Commission published data which suggested death rates of people with learning disabilities and/or autism had doubled during the pandemic.
    In an announcement posted on a social media group for Royal College of Nursing members last week, NHSE/I said they were “urgently seeking clinical reviewers with experience in learning disability”.
    The message to the private Facebook group, seen by HSJ, added: “The effects of coronavirus are having a far-reaching impact on all our lives. As we learn more about the virus, we are taking steps to make changes to safeguard our well-being.
    “For people with a learning disability, the number of deaths has doubled during the covid pandemic. (compared to data on the number of deaths recorded during the same period last year). As a result, we have a large number of deaths of people with a learning disability who have died during the pandemic whose deaths we want to review.”
    Read full story (paywalled)
    Source: HSJ, 1 July 2020
  12. Patient Safety Learning
    Waiting times for tests and treatment not related to COVID-19 are likely to increase significantly in the second half of 2020 because of the fallout from the pandemic, the head of NHS England has acknowledged.
    Giving evidence to the Commons health select committee on 30 June, NHS England’s chief executive Simon Stevens said that contrary to some commentary, the NHS’s overall waiting list actually dropped by over half a million people between February and April 2020 because fewer people were coming forward for treatment.
    But, he added, “As referrals return we expect that will go up significantly over the second half of the year.”
    Stevens said that there were 725 000 fewer elective admissions to NHS hospitals during March and April, but that number has begun to recover significantly. “As we speak, we think we’re now somewhere north of 55% of pre-covid-19 elective activity levels,” he said. He added that he hoped the NHS would return to around three quarters of normal activity levels by July or August.
    Stevens told MPs that the NHS would pursue a range of measures to increase capacity over the coming months, including extending the deal with the private sector to use its facilities, and repurposing some of the Nightingale hospitals for diagnostic testing.
    Read full story
    Source: BMJ, 1 July 2020
  13. Patient Safety Learning
    Inspectors have raised “new and ongoing” patient safety concerns at Shrewsbury and Telford Hospitals Trust, it has emerged.
    The Care Quality Commission has issued a new warning notice to the Midlands trust after an inspection of the hospital earlier this month sparked concerns for the welfare of patients on its medical wards.
    These concerns are separate from the trust’s maternity service, which, it was revealed on Tuesday, is now facing a police investigation alongside an NHS inquiry into more than 1,200 allegations of poor maternity care dating back to the 1970s.
    In October, a patient at the hospital bled to death after a device used to access his bloodstream became inexplicably disconnected while he was receiving care on the renal unit.
    The Health Service Journal reported the latest concerns related to the inappropriate use of bed rails and risks of patients falling from beds after several incidents. The CQC is also concerned about the trust’s use of powers to detain elderly or vulnerable patients on wards.
    The concerns also include patients being at risk of abuse and learning from past incidents not being shared with staff.
    Read full story
    Source: The Independent, 1 July 2020
  14. Patient Safety Learning
    Police in Bristol have launched investigations into the circumstances that led to the death of a teenager with autism and learning disabilities. Avon and Somerset Police told HSJ they are investigating the circumstances behind the death of Oliver McGowan in 2016, at North Bristol Trust.
    They said: “As part of the enquiry [officers] will interview a number of individuals as they seek to establish the circumstances around Oliver’s death before seeking advice from the Crown Prosecution Service.”
    Oliver died in 2016 at Bristol’s Southmead Hospital after being admitted following a seizure. He had mild autism, epilepsy and learning difficulties.
    During previous hospital spells he experienced very bad reactions to antipsychotic medications, prompting warnings in his medical records that he had an intolerance to these drugs. Despite this Oliver was given anti-psychotic medication by doctors at Southmead against his own and his parents’ wishes. This led him to suffer a severe brain swelling which led to his death.
    His death has since prompted a national training programme for NHS staff on the care of people with autism and learning disabilities. 
    Read full story (paywalled)
    Source: HSJ, 1 July 2020
  15. Patient Safety Learning
    The government must set out plans for an inquiry into its handling of the coronavirus pandemic, the health service ombudsman has said. This was not about blaming staff but about "learning lessons", he said.
    Ombudsman Rob Behrens said patients were reporting concerns about cancelled cancer treatment and incorrect COVID-19 test results.
    Ministers have not committed to holding an inquiry, but have accepted there are lessons to be learned.
    The Parliamentary and Health Service Ombudsman (PHSO) stopped investigating complaints against the NHS on 26 March, to allow it to focus on tackling the COVID-19 outbreak.
    But people had continued to phone in with these concerns, Mr Behrens said.
    "Complaining when something has gone wrong should not be about criticising doctors, nurses or other front-line public servants, who have often been under extraordinary pressure dealing with the Covid-19 crisis," he said.
    "It is about identifying where things have gone wrong systematically and making sure lessons are learned so mistakes are not repeated."
    Read full story
    Source: BBC News, 1 July 2020
  16. Patient Safety Learning
    The Professional Record Standards Body would like you to take part in two surveys about the information that should be shared between health and social care. The project aims to improve connections between different services, to allow people better access to the personalised care and wellbeing support they need. They’ve also produced an easy read version for anyone who has difficulty reading, which can be found here.
  17. Patient Safety Learning
    Delays in going to the emergency department because of the coronavirus pandemic lockdown may have been a contributory factor in the deaths of nine children, a snapshot survey of consultant paediatricians in the UK and Ireland has shown.
    Three of the reported deaths associated with delayed presentation were due to sepsis, three were due to a new diagnosis of malignancy, in two the cause was not reported, and one was a new diagnosis of metabolic disease.
    Read full story (paywalled)
    Source: BMJ, 30 June 2020
  18. Patient Safety Learning
    A quarter of people who sought help for mental health problems during lockdown were unable to access NHS services, a new survey shows.
    A survey by the mental health charity Mind found that 25% of respondents who contacted primary care services could not get support.
    More than a fifth (22%) of adults with no previous experience of poor mental health now say that their mental health has deteriorated, according to the survey.
    Many people who were previously well will develop mental health problems as a “direct consequence of the pandemic and all that follows”, according to Mind.
    Two out of three (65%) adults aged 25 and over and three-quarters of young people aged 13-24 with an existing mental health problem reported worse mental health during the lockdown.
    Mind predicts that prolonged worsening of wellbeing and “continued inadequate access” to NHS mental health services will lead to a marked increase in people experiencing longer-term mental health problems.
    Read full story
    Source: The Independent, 30 June 2020
  19. Patient Safety Learning
    A new report by Research Australia details more than 200 ongoing COVID-19 studies that extend far beyond the search for a vaccine.
    Almost every COVID-19 research project being led by Australians has been in the new report, including studies of breastfeeding guidelines for parents with COVID-19, filter systems to remove the virus via air-conditioning systems, monitoring of sewage to detect the prevalence of COVID-19, and repurposing technology normally used to identify explosives to see if it can detect the presence of COVID-19.
    The report was compiled by Research Australia, the national peak body for health and medical research.
    It’s chief executive, Nadia Levin, said the report was not a complete catalogue of COVID-19 related research in Australia, but provided a useful insight into the scale of the response from the health and innovation sectors.
    “All of this Australian research kept popping up and we were blown away by the scale and scope of it, so we asked all of our members to share what they are working on,” Levin told the Guardian Australia.
    Read full story
    Source: The Guardian, 27 June 2020
  20. Patient Safety Learning
    The NHS will not be able to get back to providing its full range of services for as long as four years because of the huge disruption caused by COVID-19, hospital bosses have warned.
    Patients will face much longer waits than usual for operations and diagnostic tests because hospitals’ drive to remain infection-free means they are closing beds, and surgeons’ need to wear protective clothing means they are carrying out fewer procedures than before the pandemic.
    In a stark admission of the complexity of reopening the NHS, a key health service leader has predicted that some hospitals will be able to provide only 40% of the care they previously delivered.
    Hospitals are under pressure from ministers and health charities to restart services as soon as possible for patients with conditions such as cancer, obesity and joint problems. But the chief executives of three NHS trusts in England have told the Observer that the “sheer complexity” of getting back to normal amid the lingering effects of COVID-19 means progress will be very slow.
    “It could be four years before waiting times get back to pre-Covid levels. We could see that. It’s certainly years, not months,” said Glen Burley, the group chief executive of Warwick hospital, George Eliot hospital in Nuneaton and County hospital in Hereford.
    Read full story
    Source: The Guardian, 27 June 2020
  21. Patient Safety Learning
    Some hospitals have sought to water down PPE requirements in order to “accelerate” the return of planned surgery, senior doctors have said, as they issued new guidance aiming to inform the decision. 
    The Royal College of Anaesthetists, along with partners including the Faculty of Intensive Care Medicine, released a document to members to tackle “marked uncertainty amongst operating theatre team members as to which infection prevention and control precautions should be taken when treating screened patients in planned surgical pathways”.
    The document provides recommendations for teams on how to adjust PPE usage, which the college said was “supportive and consistent” with current Public Health England guidance.
    Professor William Harrop-Griffiths, consultant anaesthetist and council member of the Royal College of Anaesthetists, told HSJ some hospitals wanted to decrease the amount of PPE used as it might enable them to “accelerate and increase the workload”.
    However, the college has argued that there is currently “no clear guidance on when you might consider making that change”.
    “You have to balance that to the risk to the staff,” Professor Harrop-Griffiths stressed.
    Read full story (paywalled)
    Source: HSJ, 29 June 2020
  22. Patient Safety Learning
    Regulators have uncovered multiple examples of patients being put at risk when junior doctors are left with tasks they are not trained for, lacking support, and facing bullying and inappropriate behaviour.
    Inspection teams have had to intervene – in some cases contacting senior trust staff – to ensure urgent issues are addressed, after the inspections.
    Health Education England oversees training nationally, which includes making the checks at trusts which have been put under “enhanced monitoring” by the professional regulator, the General Medical Council, because of concerns from trainees.
    HSJ has obtained and examined 20 reports, all produced since the beginning of 2019. Themes running through the reports included:
    Lack of support from consultants. Trainees struggled to contact consultants out of hours.  Bullying and inappropriate behaviour was reported at several trusts.  Inspectors found a reluctance to report concerns and/or a lack of knowledge of how to do it.  Teaching was often of poor quality or cancelled – and sometimes trainees struggled to attend sessions because of how their shifts and rotations were scheduled. Trainees in several trusts reported IT problems, such as being locked out of systems so being unable to access clinical notes and blood tests, and IT systems taking up to 30 minutes to start up, sometimes delaying patient care.  Read full story (paywalled)
    Source: HSJ, 29 June 2020
  23. Patient Safety Learning
    London’s Nightingale hospital recorded 144 patient safety incidents during its 29 days treating 54 patients, it has emerged.
    There were two serious incidents at the field hospital, a doctor told a Royal Society of Medicine webinar.
    Dr Andrew Wragg, consultant cardiologist and director of quality and safety at Barts Health NHS Trust, said a study of the long-term outcomes of the 54 patients was ongoing, as 20 of those treated at the ExCel conference centre site were still recovering in hospitals across London.
    Johanna Cade, a nurse at Guy’s and St Thomas’ NHS trust and who worked at the Nightingale, said: “We had quite high incident reporting at 144 incidents reported and I think that demonstrates that Nightingale really did well at building a no blame safety culture for resolution and learning. This system manifested itself and staff were really striving to make things better continually. We knew who to report to and how to escalate things.”
    She showed data revealing the largest number of safety incidents involved medical devices.
    There were 25 incidents that included the ventilators used to keep patients alive. Staffing issues and medication, as well as pressure ulcer and communication incidents, were also among the highest numbers.
    Read full story
    Source: The Independent, 27 June 2020
  24. Patient Safety Learning
    People who were seriously ill in hospital with coronavirus need to be urgently screened for post-traumatic stress disorder (PTSD), leading doctors say.
    The Covid Trauma Response Working Group, led by University College London and involving experts from south-east England, said those who had been in intensive care were most at risk.
    The experts said regular check ups should last at least a year.
    More than 100,000 people have been treated in hospital for the virus. The experts say tens of thousands of these would have been seriously ill enough to be at risk of PTSD.
    The working group highlighted research which showed 30% of patients who had suffered severe illnesses in infectious disease outbreaks in the past had gone on to develop PTSD, while depression and anxiety problems were also common.
    Tracy is just one of many people who has been left with psychological scars from her coronavirus experience. She was admitted to Whittington Hospital in north London in March and spent more than three weeks there - one of which was in intensive care.
    "It was like being in hell. I saw people dying, people with the life being sucked from them. The staff all have masks on and all you saw was eyes - it was so lonely and frightening."
    Since being discharged in April the 59-year-old has been struggling to sleep because of the thought she will die and she has constantly suffered flashbacks. She is now receiving counselling.
    Read full story
    Source: BBC News, 29 June 2020
  25. Patient Safety Learning
    Brain complications, including stroke and psychosis, have been linked to COVID-19 in a study that raises concerns about the potentially extensive impact of the disease in some patients.
    The study, published in Lancet Psychiatry, is small and based on doctors’ observations, so cannot provide a clear overall picture about the rate of such complications. However, medical experts say the findings highlight the need to investigate the possible effects of COVID-19 in the brain and studies to explore potential treatments.
    “There have been growing reports of an association between COVID-19 infection and possible neurological or psychiatric complications, but until now these have typically been limited to studies of 10 patients or fewer,” said Benedict Michael, the lead author of the study, from the University of Liverpool. “Ours is the first nationwide study of neurological complications associated with Covid-19, but it is important to note that it is focused on cases that are severe enough to require hospitalisation.”
    Scientists said the findings were an important snapshot of potential complications, but should be treated with caution as it is not possible to draw any conclusions from the data about the prevalence of such complications.
    Read full story
    Source: The Guardian, 26 June 2020

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