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Patient Safety Learning

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  1. Patient Safety Learning
    Women waiting for breast reconstruction surgery on the NHS in England face a “postcode lottery” of care, with some forced to wait more than three years, a damning report warns.
    Two in five women (40%) waiting for breast reconstruction during the pandemic after having their breasts removed due to cancer faced a delay of 24 months or longer, according to research involving 1,246 women who either underwent reconstruction surgery or were waiting for it.
    The report by charity Breast Cancer Now also warned that some breast reconstruction services are still not operating at full capacity after temporarily pausing at the start of the Covid-19 pandemic.
    It says there was a 34% drop in breast reconstruction activity in England in 2021-22 compared with 2018-19. The charity added that on top of the delays, women face a “postcode lottery” of care, with some women offered certain types of reconstruction while others are denied the same operation.
    Breast Cancer Now called on NHS England to develop a plan to address the backlog of breast reconstruction services.
    One woman told the authors of the report she waited for three and a half years for breast reconstruction surgery, while another said she “wants to move on with my life” but has no idea when her surgery will go ahead.
    Baroness Delyth Morgan, the chief executive of Breast Cancer Now, said: “For women who choose breast reconstruction, it is a core component of their recovery – far from a solely aesthetic choice, this is the reconstruction of their body and indeed their identity after they have been unravelled by breast cancer treatment and surgery.
    “We hear of patients affected by delays to reconstruction surgery and the significant emotional impact this has on them, including altered body confidence, loss of self-esteem and identity, anxiety and depression, and hindering their ability to move forward with their lives, knowing their treatment is incomplete."
    Read full story
    Source: The Guardian, 19 October 2022
  2. Patient Safety Learning
    Two out of five maternity units in England are providing substandard care to mothers and babies, the NHS watchdog has warned.
    “The quality of maternity care is not good enough,” the Care Quality Commission (CQC) said in its annual assessment of how health and social care services are performing.
    It published new figures showing it rated 39% of maternity units it inspected in the year to 31 July to “require improvement” or be “inadequate” – the highest proportion on record.
    Ian Trenholm, the CQC’s chief executive, said maternity services were deteriorating, substandard care was unacceptably common and failings were “systemic” across the NHS.
    Its latest state of care report said: “Our ratings as of 31 July 2022 show that the quality of maternity services is getting worse, with 6% of NHS services (nine out of 139) now rated as inadequate and 32% (45 services) rated as require improvement.
    “This means that the care in almost two out of every five maternity units is not good enough.”
    The report said: “The findings of recent reviews and reports … show the same concerns emerging again and again. The quality of staff training, poor working relationships between obstetric and midwifery teams and a lack of robust risk assessment all continue to affect the safety of maternity services. These issues pose a barrier to good care.”
    Staff not listening to women during pregnancy and childbirth is a recurring problem, Trenholm said. Their concerns “are not being heard” by midwives and obstetricians “in the way that they should”.
    Read full story
    Source: The Guardian, 21 October 2022
  3. Patient Safety Learning
    Jeremy Hunt has been told that any cuts to the health budget will in effect “kill” dental services across the UK and deny millions of patients access to a dentist on the NHS.
    The chancellor has told members of the cabinet that “everything is on the table” as he seeks to find tens of billions of pounds in savings after ditching the economic plan of Liz Truss, who said on Thursday she was standing down as prime minister. Health is one key area expected to be hit.
    But in an email to Hunt seen by the Guardian, the head of the British Dental Association (BDA) said in plain terms that because NHS dentistry had already “faced cuts with no parallel anywhere in the health service” over the last decade, any further reduction in funding could trigger its collapse.
    “In blunt terms, NHS dentistry is approaching the end of the road,” Martin Woodrow, the BDA chief executive, wrote in the memo. “There is simply no more fat to trim, short of denying access to an even greater proportion of the population.”
    In the memo to Hunt, Woodrow wrote: “Recent NHS England board papers confirm officials are euphemistically ‘taking steps to maximise access from existing resources’. We know what that means. Yes, we recognise the unparalleled pressures on public spending. Equally, we cannot escape the hard fact that a service millions depend on materially lacks the resources to underpin any rebuild.
    “You have also spoken of the need for all departments to seek ‘efficiency savings’. Since the financial crash, NHS dentistry has faced cuts with no parallel anywhere in the health service, going into the pandemic with lower government contributions – in cash terms – than it saw a decade ago.
    Read full story
    Source: The Guardian, 21 October 2022
  4. Patient Safety Learning
    Tracey Fletcher, chief executive of East Kent Hospitals, said: "I want to say sorry and apologise unreservedly for the harm and suffering that has been experienced by the women and babies who were within our care, together with their families, as described in today’s report.
    "These families came to us expecting that we would care for them safely, and we failed them.
    "We must now learn from and act on this report; for those who have taken part in the investigation, for those who we will care for in the future, and for our local communities. I know that everyone at the Trust is committed to doing that.
    "In the last few years we have worked hard to improve our services and have invested to increase the numbers of midwives and doctors, in staff training, and in listening to and acting on feedback from the people who receive our care.
    "While we have made progress, we know there is more for us to do and we absolutely accept that. Now that we have received the report, we will read it in full and the Board will use its recommendations to continue to make improvements so that we are providing the safe, high-quality care our patients expect and deserve.
    "I want every family – whether they contributed to the investigation or not – to know I am here to listen to them, to learn and to lead our Trust in acting on this report. 
    "I would like to thank Dr Bill Kirkup and the investigation team for their work. Today, our thoughts remain with those who have shared their experiences. We are grateful to them.”
    Source: NHS East Kent Hospitals, 19 October 2021
  5. Patient Safety Learning
    Russell-Cooke personal injury and clinical negligence partner Grant Incles recently represented Mrs Karen Preater in a clinical negligence case over vaginal mesh surgery performed on her at a hospital in north Wales in 2014. 
    Wrexham County Court found in favour of Mrs Preater, and roundly dismissed allegations made by the defendant in this case, the Betsi Cadwaladr University Health Board, that the claimant had lied in the presentation of her case, as part of a Fundamental Dishonesty defence. 
    Mrs Preater underwent vaginal mesh surgery in January 2014 - to which she had not been properly consented. The surgery itself was performed negligently and as a result she suffered a life-changing chronic pain condition. In late 2020, the defendant carried out intrusive video surveillance of Mrs Preater and trawled through her life on social media, proceeding to launch a defence of Fundamental Dishonesty pursuant to S.57 of the Criminal Justice and Courts Act 2015.
    The defendant alleged that the claimant was seeking to lie to the Court about her ability to work and need for care and assistance which, if found to be correct by the Court, would have meant that Mrs Preater would have lost all of her claimed compensation, and which may well have led to an application by the defendant to have her committed to prison for her alleged dishonesty.
    The case was fought to trial over seven days in July 2022. HHJ Howells found that Mrs Preater had not sought to deceive any party at any time and should be fully compensated for her grave suffering since being injured over eight years ago. 
    Read full story
    Source: Russell-Cooke, 4 August 2022
    Court judgement:
    22081101.Preater v BCUHB approved judgment dated 4 August 2022.pdf
  6. Patient Safety Learning
    The “social prescribing” of gardening, singing and art classes is a waste of NHS money, a study suggests.
    Experts found that sending patients to community activity groups had “little to no impact” on improving health or reducing demand on GP services.
    The research calls into question a major drive from the NHS and Department of Health to increase social prescribing as a solution to the shortage of doctors and medical staff.
    In 2019 the NHS set a target of referring 900,000 patients for such activities via their GP surgeries within five years.
    Projects receiving government funding include football to support mental health, art for dementia, community gardening and singing classes to help patients to recover from Covid.
    However, the study, published in the journal BMJ Open, said there was “scant evidence” to support the mass rollout of so-called “social prescribing link workers”.
    Read full story (paywalled)
    Source: The Times, 18 October 2022
  7. Patient Safety Learning
    A quarter of services the Care Quality Commission has recently inspected required enforcement action from the regulator, its chief executive has revealed. 
    Speaking at the launch of the regulator’s annual State of Care report, Ian Trenholm called for a “long-term, sustainable funding solution” from the government to aid a service that was ”genuinely struggling to cope”.
    Mr Trenholm said “about a quarter of the services” the CQC has inspected in 2022 had resulted in it having to take “enforcement action”.
    Examples of action taken against NHS trusts in the last year included enforcement measures placed on Nottingham University Hospitals, University Hospitals Sussex, and Princess Alexandra Hospital.
    In response to a question from HSJ about the robustness of the CQC’s inspection regime following further care quality and safety scandals, Mr Trenholm said observers should not focus solely on the ratings given to trusts by the CQC as there was a lot ”work going on in the background, whether that’s enforcement or otherwise”.
    He added the CQC had significantly increased the amount of information it was gathering in relation to concerns about services.
    Read full story
    Source: HSJ, 21 October 2022
     
  8. Patient Safety Learning
    Parents are being told to urgently bring their children forward for flu vaccinations as new data reveals the rate of hospitalisation and ICU admission for people with the virus is rising fastest among those under five years old.
    New figures published in the UK Health Security Agency’s (UKHSA) National flu and Covid-19 surveillance report show that cases of flu have climbed quickly in the past week, indicating that the season has begun earlier than normal.
    According to the UKHSA, vaccination for flu is currently behind last season for pre-schoolers (12.1% from 17.4% in all two-year-olds and 12.8% from 18.6% in all three-year-olds).
    It has also fallen behind in pregnant women (12.4% from 15.7%) and under 65s in a clinical risk group (18.2% from 20.7%).
    Dr Mary Ramsay, director of public health programmes at the UK Health Security Agency, said: “Our latest data shows early signs of the anticipated threat we expected to face from flu this season.
    “We’re urging parents in particular not to be caught out as rates of hospitalisations and ICU admissions are currently rising fastest in children under 5.
    “This will be a concern for many parents and carers of young children, and we urge them to take up the offer of vaccination for eligible children as soon as possible.”
    Read full story
    Source: The Independent, 20 October 2022
  9. Patient Safety Learning
    The families of three patients who all died after undergoing the same specialised endoscopy procedure have accepted damages from an NHS trust.
    The patients all died after a procedure called an endoscopic retrograde cholangiopancreatography (ERCP) at Nottingham University Hospitals NHS Trust.
    Following their deaths, a coroner issued a report calling for changes. The trust said improvements had been made.
    William - known as Bill - Doleman, 76, Anita Burkey, 85, Peter Sellars, 72, and Carol Cole, 53, died in the space of about six months after undergoing the procedures.
    An inquest found they died as a result of complications of the ERCP - where a tube is passed through a patient's throat to examine and treat possible gallstones and other conditions.
    The families said they had accepted undisclosed damages from the trust over the deaths.
    Read full story
    Source: BBC News, 21 October 2022
  10. Patient Safety Learning
    Indonesia has temporarily banned all syrup-based and liquid cough medicines after the death of nearly 100 children from acute kidney failure since the start of this year.
    Most of those affected are said to be below the age of six.
    Muhammad Syahril Mansyur, the country’s health ministry spokesman, said: “Until today, we have received 206 reported cases from 20 provinces with 99 deaths.”
    He added: “As a precaution, the ministry has asked all health workers in health facilities not to prescribe liquid medicine or syrup temporarily … we also asked drug stores to temporarily stop non-prescription liquid medicine or syrup sales until the investigation is completed.”
    The ban, announced by the health ministry on Wednesday, applies to prescription and over-the-counter medicines. It comes after nearly 70 children died of acute kidney failure this year in the Gambia, linked to four brands of paracetamol cough syrup manufactured by India’s Maiden Pharmaceuticals.
    Read full story (paywalled)
    Source: The Times, 20 October 2022
  11. Patient Safety Learning
    A Harley Street doctor suspended for working while testing positive for Covid at the height of the pandemic has said that his patient’s cancer treatment took priority.
    Dr Andrew Gaya was found to have “blatantly disregarded” the rules by going to work at a centre for patients with brain tumours after he tested positive for the disease.
    The “highly regarded” consultant oncologist “dishonestly” misled colleagues that he was safe to work by keeping his positive test secret, a tribunal found.
    Dr Gaya, whose work is at the forefront of tumour care and has been described as “world class”, said he defied Covid-19 rules because he believed “the risk of harm to his patient” in delaying treatment was “greater than the risk he posed”.
    Now, the doctor of 27 years has been suspended for three months at a Medical Practitioners’ Tribunal.
    Read full story (paywalled)
    Source: The Times, 20 Ocotober 2022
  12. Patient Safety Learning
    A medical expert has told the trial of nurse Lucy Letby how he noticed a "quite disturbing and quite unusual" pattern in the deaths of babies she is accused of murdering.
    Ms Letby is charged with killing seven babies and attempting to murder 10 others at the Countess of Chester Hospital in 2015 and 2016.
    Expert Dr Dewi Evans was approached by the National Crime Agency to review the case in 2017.
    Giving evidence at Manchester Crown Court, Dr Evans said: "The concern was that there had been a number of deaths in the Countess of Chester that had been unusual.
    "There were far more deaths than they would expect. There was collapses in babies that were otherwise quite stable, but in many of the cases resuscitation was not successful."
    It is alleged Ms Letby injected air into the bloodstream of a baby referred to in court as Child A, shortly after she came on shift in June 2015, just over 24 hours after his premature birth.
    The prosecution alleges she used the same method to attack his sister, Child B, on the following night shift.
    Dr Evans told the court that a review of Child A's records showed that the baby boy was in a "stable condition" before his collapse.
    He said: "He was as well as could be expected, all the markers of wellbeing were very satisfactory.
    Read full story
    Source: BBC News, 25 October 2022
     
  13. Patient Safety Learning
    A trust chief executive says the Care Quality Commission’s (CQC) inspection regime is still overly focussed on individual organisations, rather than systems, and this is driving the “risk aversion” which is partly responsible for the emergency care crisis.
    Mid Yorkshire Hospitals Trust CEO Len Richards acknowledged the CQC has started to scrutinise system-wide issues but suggested the “heat” of its regulation is still on individual providers.
    Mr Richards told the House of Lords’ public services committee on Wednesday that care homes and nursing homes in his area have declined to take patients ready to be discharged from hospital, due to concerns it would put their CQC accreditation at risk.
    He said: “[Last winter] we asked nursing homes and care homes to take patients and they couldn’t take them beyond a certain limit because it would put their accreditation at risk.
    “We went to the CQC to try and create some flexibility. Their perspective was very much of an independent regulatory body that would look at the organisation and not look at the system. I think we’ve got an awful long way to go there.
    “I think regulation does drive risk aversion… [and] the heat of regulation right at the moment is on individual organisations.
    “Therefore, when the CQC come and look at my organisation, they will talk about congestion in the A&E department. They won’t talk about the assessment that we made around there being a greater risk in the community if we didn’t offload ambulances.”
    Read full story (paywalled)
    Source: HSJ, 28 October 2022
  14. Patient Safety Learning
    Scotland's NHS is in "a perilous situation" amid a staffing and funding crisis, according to the chairman of the doctors' union.
    Dr Iain Kennedy said urgent action was needed to tackle workload pressures ahead of a potentially "terrifying" winter period.
    It comes after Scotland's health secretary Humza Yousaf admitted NHS Scotland was not performing well. Mr Yousaf told BBC Scotland it would take at least five years to fix.
    Dr Kennedy, who is chairman of the industry body BMA Scotland, said it was good to hear Mr Yousaf being honest about the scale of the problems, but added that "frankly we cannot wait five years" for things to improve.
    He told BBC Radio's Good Morning Scotland programme: "The NHS in Scotland is in a perilous situation and we have a particular crisis around the workforce - we simply do not have enough doctors in general practice and in hospitals.
    "We need more urgent action because the pressures and the workload have really shot up."
    Dr Kennedy has called on the government to publish a "heat map" showing where NHS vacancies are unfilled across Scotland.
    He said: "The public need to see transparency on where the vacancies are. We think that there are probably 15% vacancies across hospital consultant posts across Scotland.
    "Even the government admits to 7% and that we are at least 800 GPs short in Scotland - and I, and others, suspect we are probably well over that figure now."
    Read full story
    Source: BBC News, 31 October 2022
  15. Patient Safety Learning
    A case of MRSA has been reported at the congested asylum processing centre at Manston in Kent, the Guardian has learned, after it emerged that Suella Braverman ignored advice that people were being kept at the centre unlawfully.
    The antibiotic-resistant bacteria was identified in an asylum seeker who initially tested positive for diphtheria. But the asylum seeker was moved out of the site in Ramsgate to a hotel hundreds of miles away before the positive test result was received, raising concerns about the spread of the infection.
    The Manston site is understood to now have at least eight confirmed cases of diphtheria, a highly contagious and potentially serious bacterial infection.
    Migrants are meant to be held at the short-term holding facility, which opened in January, for 24 hours while they undergo checks before being moved into immigration detention centres or asylum accommodation such as a hotel.
    But giving evidence to a committee of MPs last week, David Neal, the independent chief inspector of borders and immigration, said he had spoken to a family from Afghanistan living in a marquee for 32 days, and two families from Iraq and Syria sleeping on mats with blankets for two weeks. Conditions at the site left him “speechless”, he said.
    On a visit to the site on 24 October, Neal was told there were four confirmed cases of diphtheria. 
    Protective medical equipment for staff has now been brought on to the site. Although diphtheria is a notifiable disease, meaning cases must be reported to authorities, those at Manston have not appeared on weekly public health reports.
    A Home Office spokesperson said it was “aware of a very small number of cases of diphtheria reported at Manston”, and that proper medical guidance and protocols were being followed.
    Read full story
    Source: The Guardian, 30 October 2022
  16. Patient Safety Learning
    Results from the recently published Community Mental Health Survey highlight that issues with access to services and support, as evidenced in the 2020 and 2021 surveys, continue to persist. 
    The 2022 Community Mental Health Survey – coordinated by Picker for the Care Quality Commission – collected feedback from more than 13,400 people in contact with services between September and November 2021. The survey is an important source of information to help us understand the quality of person-centred care provided to mental health service users.
    A key feature of a high-quality person centred mental health service is timely access to care. The survey shows that there is more to be done here to ensure that service users have a good experience as nearly a third (31%) reported not being told who was in charge of organising their care and services – up from 28% in 2021. In parallel with this, 30% of service users said that they had not seen NHS mental health services enough in the last 12 months (compared to 27% in 2021 and 24% in 2020) and only 55% said they were given enough time to discuss their needs and treatment.
    Just over half of service users (51%) said that they did not receive any help or advice with finding support for financial advice or benefits – a 3% point increase from last year’s survey. When asked a similar question regarding support for finding or keeping work, 50% said they did not receive help or advice but would have liked it. With the financial worries that the increased cost of living is causing for many people, signposting support and advice for employment, managing money, and claiming benefits are vital for helping people maintain good mental health.
    Commenting on the results, Jenny King, Picker’s Chief Research Officer, said:
    “On the 22nd September 2022, the Secretary of State for Health and Social Care and Deputy Prime Minister at the time, Thérèse Coffey, announced the UK government’s Our plan for patients. Whilst it notes that work will continue to improve the availability of mental health support through expansion of services, there was little detail on how this would be achieved and how backlogs of care in mental health services would be resolved.
    With the backdrop of the cost of living crisis and its impact on people’s mental health, the findings from this survey highlight the urgent need for more to be done to address accessibility issues. And not just in mental health services but across health and social care where, as highlighted by CQC’s 2021/22 State of Care report, people are waiting too long for appointments, assessments, and treatment. Without a plan for tackling the NHS’s workforce crisis, the ability to make sustainable service improvements to address the unmet need is severely restricted.”
    Read full story
    Source: Picker, 27 October 2022
  17. Patient Safety Learning
    Surgeons in a London hospital have performed a week’s worth of operations in a single day, pioneering a technique that could be used to help reduce the NHS backlog.
    The team at Guy’s and St Thomas’ hospital performed eight robot assisted radical prostatectomy operations in under ten hours, the highest number performed in a single day in the UK in one hospital.
    High Intensity Theatre lists (HIT) focus on one procedure at a time and seek to minimise the turnaround time between operations. Using two theatres, the surgeon can go between cases without having to wait for a patient to come in. This helps to cut the significant amount of time it takes for medics to anaesthetise a patient, set up equipment in the theatre and help them to recover – a process which sometimes takes longer than the operation itself.
    The team at Guy’s assembled a large team for the HIT list, which took place on 8 October. Each theatre had a team of around 1.5 times its usual size and staff were given very specific roles.
    By the time the list had reached the third patient, the turnaround time between operations had dropped as low as 32 seconds. Behind the scenes, staff in the control room used Proximie software to monitor activity in the theatre in real time.
    Dr Ben Challacombe, a consultant urological surgeon who performed the operations with his surgical consultant colleagues Paul Cathcart, Christian Brown, and Prokar Dasgupta, told the Standard that the success of the HIT list had given staff a “huge” morale boost.
    “Everyone pulled together to do the job, it really helped to energise the team. Morale has been hit by Covid and other issues, but people feel galvanised by doing something different.”
    Read full story
    Source: Evening Standard, 29 October 2022
  18. Patient Safety Learning
    Steve Barclay is back as England's health secretary, just as the NHS prepares for what its chief executive Amanda Pritchard says could be a "very, very challenging winter".
    The government has said "intensive work" is under way in the 15 most under-pressure hospital trusts in England, to speed up ambulance delays, free up beds and reduce waiting times in A&E.
    Emergency departments across the UK are struggling to quickly treat patients.
    Only 57% of people who turned up at major A&E departments in England last month were seen, admitted or discharged within four hours, well below the 95% national target.
    The latest figures from Gloucestershire Royal show it performs slightly worse than average, with 55% dealt with in four hours.
    One medic, speaking anonymously to the BBC, said: "I wouldn't bring a member of my family to this hospital. And winter is going to be worse unless something changes fast."
    Read full story
    Source: BBC News, 28 October 2022
  19. Patient Safety Learning
    A surge in Covid cases over winter could lead to harsh visiting restrictions being reimposed in care homes and hospitals, MPs and campaigners have warned.
    Families are still facing a “postcode lottery” of Covid restrictions in care homes, with visiting times restricted and personal protective equipment (PPE) obligatory.
    However MPs are worried that some will reimpose even harsher measures if Covid cases rise this winter.
    Daily global Covid infections are projected to rise slowly to around 18.7 million by February, up from the current 16.7 million average daily cases this October.
    MPs are calling for the government to enact legislation that would enshrine the right for an essential care giver to be present with their loved ones in care settings.
    Liberal Democrat MP Daisy Cooper said that one of her constituents, Lynn, was not allowed into a hospital A&E ward to see her husband Andy when his dementia deteriorated over Christmas last year.
    The hospital refused to let Andy have any visitors for two weeks until Ms Cooper intervened. When she was allowed in, Lynn was distraught to find that Andy had lost a significant amount of weight in the weeks he was isolated.
    Ms Cooper continued: “We have come a long way since last Christmas, and since the start of the pandemic, but as winter approaches the NHS and care settings are once again expected to struggle with a surge in Covid cases.
    “It is not inconceivable that what happened to Lynn and Andy could happen again to them and to many others.”
    Read full story
    Source: Independent, 30 October 2022
    Further hub reading
    Visiting restrictions and the impact on patients and their families: a relative's perspective It’s time to rename the ‘visitor’: reflections from a relative Mother knows best – a blog by Dr Abha Agrawal
  20. Patient Safety Learning
    Eighteen people died at two Teesside hospital trusts following patient safety lapses over a 12-month period.
    Sixteen such deaths were recorded at the South Tees Hospitals NHS Foundation Trust, with two at the North Tees and Hartlepool NHS Foundation Trust.
    Examples of patient safety lapses include a failure to provide or monitor care, a breakdown in communication, an out-of-control infection in a hospital, insufficient staffing or a missed diagnosis.
    NHS England figures show that, between April 2021 and March this year, there were 16,557 incidents at the South Tees Trust, which operates James Cook University Hospital in Middlesbrough, and Northallerton's Friarage Hospital. Thirty-four resulted in "severe" harm.
    Middlesbrough MP Andy McDonald told the Local Democracy Reporting Service the figures were a concern and that he planned to take them up with the South Tees Trust's chief executive.
    He said NHS staff worked under "the most demanding of conditions" but added: "Every person going into hospital rightly expects to receive the best treatment. Patient safety is paramount and no family wants to see a loved one suffer."
    Dr Mike Stewart, the trust's chief medical officer, said: "We encourage an open and transparent culture and promote the reporting of all patient safety incidents, even when there is uncertainty over a direct link between any problems in care and incidents of severe harm or death.
    "In the last year there were no deaths graded as definitely preventable due to a problem in the care delivered by the trust.
    "While our reporting has increased consistently over the last three years, the number of serious incidents has not risen, which is strong evidence of a positive safety culture."
    Read full story
    Source: BBC News, 30 October 2022
  21. Patient Safety Learning
    Hospitals and care homes have not received a single penny of a £500m emergency fund promised by the government to prevent the NHS becoming overwhelmed this winter, the Guardian has learned.
    Ministers announced they were injecting the cash into the health and social care system last month, to help get thousands of medically fit patients out of hospital into either their own home or a care home as soon as possible in an effort to better prepare the NHS for the coming months.
    “At the moment, one of the key challenges is discharging patients from hospital into more appropriate care settings to free up beds and help improve ambulance response times,” Thérèse Coffey, the then health and social care secretary, said on 22 September. “To tackle that, I can announce today that we are launching a £500m adult social care discharge fund for this winter.”
    However, the Guardian has been told that none of the funding has materialised. Senior health and social care sources described the government’s failure to release the promised cash as “inexplicable” and “outrageous”.
    More than 13,000 of the 100,000 NHS hospital beds in England currently contain “delayed discharge” patients, which has led to A&E units becoming heavily congested and long delays in ambulance handovers. As a direct result, thousands of 999 patients are suffering potential “severe harm” every month because ambulances are stuck outside hospitals.
    “Leaders across the NHS and local authorities are yet to see a single penny of this investment or any official detail on how it will be allocated,” said Matthew Taylor, the chief executive of the NHS Confederation.
    “Currently, only two-fifths of patients in hospital are able to leave when they are ready to do so, including due to problems accessing social care, yet health leaders still do not know how and when the £500m will be released to the system. So close to winter, this is unbelievable.
    Read full story
    Source: The Guardian, 31 October 2022
  22. Patient Safety Learning
    NHS England has launched the first substantive consultation on changes to the NHS provider licence since 2013. 
    Licences set out the requirements providers must meet and are the legal mechanism NHS England can use to take enforcement action. Having a licence has long been mandatory for foundation trusts and independent providers, and will become so for trusts. The intention is for the proposals to take effect from next year.  
    Most of the changes to the licence regime have been made to bring it into line with this year’s Health and Care Act and accompanying policy changes. For example, trusts will be required to collaborate with other providers and work effectively as part of their integrated care system. 
    This extends to trusts delivering agreed financial plans decided at a system level. The aim is to provide “mutual accountability” and ensure each provider does not use “more than their fair share of NHS resources”.'
    Read full story (paywalled)
    Source: HSJ, 28 October 2022
  23. Patient Safety Learning
    Children say they were "treated like animals" and left traumatised as part of a decade of “systemic abuse” by a group of mental health hospitals, an investigation by The Independent and Sky News has found.
    The Department of Health and Social Care has now launched a probe into the allegations of 22 young women who were patients in units run by The Huntercombe Group, which has run at least six children’s mental health hospitals, between 2012 and this year.
    They say they suffered treatment including the use of “painful” restraints and being held down for hours by male nurses, being stopped from going outside for months and living in wards with blood-stained walls. They also allege they were given so much medication they had become “zombies” and were force-fed.
    But despite reports to police and regulators dating back seven years, and findings by the Care Quality Commission (CQC) that the units were inadequate, the NHS has still handed Huntercombe nearly £190m since 2015-16 to admit children to its mental health beds.
    Through witness testimony, documents obtained by Freedom of Information request and leaked reports, the investigation has uncovered:
    The CQC has received more than 700 whistleblowing and safeguarding reports, including “incidents of concern” and several “sexual safety” concerns. NHS England was notified of 195 safeguarding reports between 2020 and 2021. A 2018 internal report at Meadow Lodge hospital in Newton Abbot (now closed) found staff members using sexually inappropriate language in front of patients. 160 reports investigated by Staffordshire police about Huntercombe Staffordshire between 2015 and 2022. Between March 2021 and 2022, the CQC gave permission for 29 patients to be admitted to Maidenhead hospital after it was placed in special measures. Read full story
    Source: The Independent, 27 October 2022
  24. Patient Safety Learning
    Regulators have told the agency that supplies blood to the NHS to develop a more inclusive culture, after hearing multiple reports of ethnic minority staff being ‘disrespected’ and discriminated against.
    “Many staff” at NHS Blood and Transplant also expressed fear of reprisal for raising issues and concerns, the Care Quality Commission (CQC) said.
    The CQC carried out a “well-led” inspection of the agency over the summer, after receiving concerns about its culture and the behaviour of some senior leaders.
    Chief executive Betsy Bassis resigned after the inspection, although the CQC report does not refer to any specific allegations made against her.
    NHSBT has acknowledged it needs to improve its culture, particularly around diversity and inclusion issues. An internal memo sent to staff last week, seen by HSJ, said executives and board members would receive one-to-one training in “inclusive leadership and understanding racism”.
    Read full story (paywalled)
    Source: HSJ, 27 October 2022
  25. Patient Safety Learning
    A hospital trust has been fined £200,000 for putting four babies at "serious risk"of harm.
    Staff at Rotherham Hospital failed to spot non-accidental injuries during admissions, Sheffield Magistrates' Court heard.
    District Judge Naomi Redhouse criticised failures in the hospital's systems and processes.
    Health watchdog, the Care Quality Commission (CQC), had earlier highlighted problems with safeguarding training at the trust prior to the babies' admissions between January 2019 and February 2020.
    The court was told how one eight-day-old baby was brought into the hospital on 23 December 2019 suffering from breathing difficulties and bleeding from the nose and mouth.
    It was only on the child's fifth visit to hospital - after a GP raised concerns - that a child safety examination took place, revealing rib and leg fractures that were deemed non-accidental.
    Ms Redhouse also heard how a month-old baby brought in with a mouth injury on 20 January 2019 was on a child protection plan but this was not spotted by the paediatric nurse who examined the baby.
    This child was twice released from hospital, with no safeguarding concerns, before a scan and other examinations revealed multiple fractures, the court heard.
    Prosecutor Ryan Donohue said failings had been identified in areas including policy implementation, training, reporting, auditing and governance.
    Eleanor Sanderson, mitigating for the trust, said: "The trust wishes to express to the court its deep regret for the circumstances which gave rise to these offences and the risk posed to those who required safeguarding."
    Read full story
    Source: BBC News, 26 October 2022
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