Clive Flashman

Almost half of all staff absence linked to coronavirus in parts of northern England Tens of thousands of NHS staff are off sick or self-isolating because of coronavirus, according to data shared with The Independent as the second wave grows. In some parts of northern England, more than 40% – in some cases almost 50% – of all staff absences are linked to COVID-19, heaping pressure on already stretched hospitals trying to cope with a surge in virus patients. The problem has sparked more calls for wider testing of NHS staff from hospital leaders and nursing unions who warned safety was being put at risk because of short staffing on wards. Across England, more than 76,200 NHS staff were absent from work on Friday – equivalent to more than 6% of the total workforce. This included 25,293 nursing staff and 3,575 doctors. Read full article Source: The Independent, 1 November 2020

Thanks @Richard Jones I was doing sentiment analysis on Tweets about 5-6 years ago for a client in the USA. It became evident that people were much more willing to make the effort to post a negative review than they were a positive one. This can of course skew the overall conclusions massively. I am reminded of my sadly departed friend, Michael Seres, who when he wasn't getting the support he needed from clinicians here in the UK, published his test results online via Twitter and received advice from clinicians from all over the world. It completely changed the way his condition was managed. There is always this tension between gaining appropriate context about a patient, and the need for privacy - this is something that has to be decided on a case by case basis.

Thanks for the positive endorsement. Of course that leads to the ethics/ governance question...... if an AI makes an incorrect diagnosis, who takes ownership of that mistake? The clinician, the Trust where they work, the developer/ implementer of the AI??? Still lots of questions to be answered, but as you say, HUGE potential for improvement.

@Richard Jones - what is your take on this?

A qualitative study of Twitter hashtags revealed power hierarchies can damage the patient experience and clinician relationship. In an analysis of a popular Twitter hashtag, researchers found that patients largely take umbrage when they feel their doctor does not believe their ailment or knowledge about their healthcare, and when they perceive a power hierarchy between themselves and their clinician. Although not as many patients are using Twitter to get peer feedback on certain providers (the Binary Fountain poll showed only 21% of patients do this), the social media website still holds a lot of power, researchers from the University of California system explained. Twitter is a large platform that hosts social discourse. Healthcare professionals use Twitter to disseminate public health and patient education messages and to network, while 61% of patients use Twitter to learn more about their health, as well. Read full article Source: Patient Engagement HIT, 29 October 2020

What does whistleblowing in a pandemic look like? Do employers take concerns more seriously – as we would all hope? Does the victimisation of whistleblowers still happen? Does a pandemic compel more people to speak up? We wanted to know, so Protect analysed the data from all the Covid-19 related calls to theirr Advice Line. They found: * 41% of whistleblowers had Covid-19 concerns ignored by employers * 20% of whistleblowers were dismissed * Managers more likely to be dismissed (32% ) than non-managers (21%) They found that too many whistleblowers feel ignored and isolated once they raise their concerns and that these failing are a systematic problem. Protect, which runs an Advice Line for whistleblowers, and supports more than 3,000 whistleblowers each year, has been inundated with Covid-19 whistleblowing concerns, many of an extremely serious nature. Its report, The Best Warning System: Whistleblowing During Covid-19 examines over 600 Covid-19 calls to its Advice Line between March and September. The majority of cases were over furlough fraud and risk to public safety, such as a lack of social distancing and PPE in the workplace.

Hospital hotspots for COVID-19 have been highlighted in a new report by safety investigators. The report by the Healthcare Safety Investigation Branch (HSIB) makes a series of observations to help the health service reduce the spread of coronavirus in healthcare settings. Hospital hotspots for COVID-19 included the central nurses’ stations and areas where computers and medical notes were shared, the HSIB found. The investigation was initiated after a Sage report in May which found that 20% of hospital patients were reporting symptoms of Covid-19 seven days following admission – suggesting that their infection may have been acquired in hospital. In response to the report, NHS England and NHS Improvement confirmed they would publish nosocomial – another term for hospital acquired infections – transmission rates from trusts, the HSIB said. Read full story Source: Express and Star, 28 October 2020

Minority ethnic people in UK were ‘overexposed, under protected, stigmatised and overlooked’, new review finds. Structural racism led to the disproportionate impact of the coronavirus pandemic on black, Asian and minority ethnic (BAME) communities, a review by Doreen Lawrence has concluded. The report, commissioned by Labour, contradicts the government’s adviser on ethnicity, Dr Raghib Ali, who last week dismissed claims that inequalities within government, health, employment and the education system help to explain why COVID-19 killed disproportionately more people from minority ethnic communities. Lady Lawrence’s review found BAME people are over-represented in public-facing industries where they cannot work from home, are more likely to live in overcrowded housing and have been put at risk by the government’s alleged failure to facilitate Covid-secure workplaces. She demanded that the government set out an urgent winter plan to tackle the disproportionate impact of Covid on BAME people and ensure comprehensive ethnicity data is collected across the NHS and social care. The report, entitled An Avoidable Crisis, also criticises politicians for demonising minorities, such as when Donald Trump used the phrase “the Chinese virus”. The report, which is based on submissions and conversations over Zoom featuring “heart-wrenching stories” as well as quantitative data, issued the following 20 recommendations: Set out an urgent plan for tackling the disproportionate impact of Covid on ethnic minorities Implement a national strategy to tackle health inequalities Suspend ‘no recourse to public funds’ during Covid Conduct a review of the impact of NRPF on public health and health inequalities Ensure Covid-19 cases from the workplace are properly recorded Strengthen Covid-19 risk assessments Improve access to PPE in all high-risk workplaces Give targeted support to people who are struggling to self-isolate Ensure protection and an end to discrimination for renters Raise the local housing allowance and address the root causes of homelessness Urgently conduct equality impact assessments on the government’s Covid support schemes Plan to prevent the stigmatisation of communities during Covid-19 Urgently legislate to tackle online harms Collect and publish better ethnicity data Implement a race equality strategy Ensure all policies and programmes help tackle structural inequality Introduce mandatory ethnicity pay gap reporting End the ‘hostile environment’ Reform the curriculum Take action to close the attainment gap Read full story Source: The Guardian, 28 October 2020

In ‘Invisible Women: Exposing Data Bias in a World Designed For Men’ author Caroline Criado Perez writes about Rachael, a woman who suffered years of severe and incapacitating pain during her period. It takes, on average, eight years for women in the UK to obtain a diagnoses of endometriosis. In fact, for over a decade, there has been no improvement in diagnostic times for women living with the debilitating condition. You might think, given the difficulty so many women experience in having their symptoms translated into a diagnosis, that endometriosis is a rare condition that doctors perhaps don’t encounter all that often. Yet it is something that affects one in ten women – so what is going wrong? Read the full article here in The Scotsman

I do often wonder in the hype to join the AI bandwagon, where every new solution seems to have 'AI inside', how much of it really is AI? In the early days of AI (5-7 years ago), new solutions required expert clinicians to spends 6-9 months training them, which of course impacted on the amount of time they could then give to their patients. With ML, is this really changing? Can an AI that improves through ML be as good as one that is 'taught' by clinicians? Is it as safe?

A PS Manager from a Trust told me recently that the investigations they did there were largely driven by the contract with their CCG. They HAD to investigate every serious pressure ulcer. The recommendations were generally the same, and nothing ever changed. Perhaps @Jon Holt the CCGs might change so that there is less emphasis on repeating investigations into an issue ad infinitum, and more emphasis on actual implementation of recommendations and evaluating the impact of them.

@Dominic Claxton

Coronavirus patients who have lived with symptoms for up to five months have spoken about the huge impact it has had on their lives. "Long Covid" support groups have appeared on social media and the government says "tens of thousands" of people have long-term problems after catching the virus, such as extreme fatigue. Daliah, from Borehamwood, Hertfordshire, said: "It's scary because we don't know how permanent this is. There are times where I feel like life will never be normal again, my body will never be normal again." The NHS has launched a Your Covid Recovery website to offer support and advice to people affected. See video here

Five-year survival rates are expected to fall due to delays in getting urgent referrals or treatment at the height of the pandemic. Thousands of lives may be lost to cancer because 250,000 patients were not referred to hospital for urgent checks, says a report to be published this week. Family doctors made 339,242 urgent cancer referrals in England between April and June, down from 594,060 in the same period last year — a drop of 43%. The fall in the number of people seeing their GP with symptoms, and in referrals for scans, is resulting in cancers being spotted too late, according to the research by the Institute for Public Policy Research (IPPR) and Carnall Farrar, a healthcare management consultancy. Full article on The Times website here (paywalled).

Inspectors raise ‘serious concerns’ about medical wards and emergency care at Shropshire NHS trust A patient bled to death on a ward at Shrewsbury and Telford Hospitals Trust after a device used to access his bloodstream became inexplicably disconnected, The Independent has learnt. The incident came to light as new concerns arose about quality of care at the Shropshire trust, with the Care Quality Commission (CQC) warning of “serious concerns” about its medical wards and emergency department following an inspection last month. Although the report from the inspection has not yet been published, it is understood that the trust has been served with a legal notice by the regulator to comply with more than a dozen conditions. It remains in special measures following the inspection and is rated inadequate overall. See full article in The Independent here

Gloucestershire Hospitals FT declares critical incident after ‘relentless demand’ on emergency care Pressure comes two months after trust downgraded one of its A&Es ‘Tired’ staff warned a ’Herculean effort’ is needed to reset emergency system NHS 111 cited as pinch point A trust has declared a critical incident after experiencing “relentless demand” on urgent and emergency care, months after downgrading one of its emergency departments. The internal critical incident was raised by Gloucestershire Hospitals Foundation Trust yesterday. An internal memo said the previous three days “have seen unprecedented demand fall on the Gloucestershire urgent and emergency care system”. Clinicians have been told that early discharges need to be identified on both its Cheltenham General and Gloucestershire Royal hospital sites, to try to free up bed-space, and that all non-essential meetings, besides those at executive level, should be cancelled. The incident comes after the trust decided in June to downgrade the A&E department at Cheltenham General to a minor injuries unit, operating from 8am to 8pm. Previously, the unit offered a full A&E service between 8am and 8pm, with a “nurse-led” minor injuries service outside these hours. The problems appear to be unrelated to covid-19, although infection control measures are known to have reduced capacity in many A&Es and wards. HSJ understands that local managers believe NHS 111, run by Care UK Health Care, has been a particular cause of the problems in recent days, because it has not been directing enough people to alternative services; as well as workforce pressures and the hot weather. Read full (paywalled) article here in the HSJ.

Patients Know Best has launched an education programme which can be used by medical schools. Among the first to use the programme are undergraduate Pharmacy students at Liverpool John Moores University (LJMU). The Patients Know Best platform, which recently became the first personal health record to be fully integrated into the NHS App, has been incorporated into the curriculum to facilitate simulated interactions between patients and pharmacists. This has involved training the students to use Patients Know Best to enable their use of the platform to interact and collaborate with each other. Read the full article here.

Dr Rebecca Fisher gives the lowdown on why maintaining general practice as a ‘front door’ to the NHS that is safe for both GPs and patients is not easy. It’s fair to say that Matt Hancock’s pronouncement that henceforth all consultations should be “teleconsultations unless there’s a compelling reason not to”, has not been universally welcomed in general practice. In my surgery, practicing in a pandemic has seen us change our ways of working beyond imagination. In March, like many other practices, we shifted overnight to a “telephone first” approach. And whilst at peak-pandemic we kept face-to-face consultations to a minimum, we’re now seeing more and more patients in person again. Although many consultations can be safely done over the phone, we’re very clear that there are some patients – and some conditions and circumstances – where a patient needs a face-to-face appointment with a GP. NHS England have also been clear that all practices must offer face-to-face consultations if clinically appropriate. But maintaining general practice as a “front door” to the NHS that is safe for both GPs and patients is not easy. Options to quarantine and pre-test patients set out in national guidance and intended to help protect secondary care cannot be deployed in primary care. Other national guidance – for example regarding wearing masks in clinical sites – often seems to be issued with secondary care in mind, with little or delayed clarity for primary care. Measures like maintaining social distancing are also likely to be harder in general practice, where the ability of a surgery to physically distance staff from each other, and patients from each other and staff, is in part dependent on physical factors. Options to quarantine and pre-test patients set out in national guidance and intended to help protect secondary care cannot be deployed in primary care Things like the size and layout of a practice, or the availability of a car park for patients to wait in are hard to change quickly. Stemming from those challenges are ones related to staffing; how to keep practice staff safe from covid-19? NHS England and the British Medical Association have stated that staff should have rigorous, culturally sensitive risk assessment and consider ceasing direct patient contact where risks from covid-19 are high. The risk of catching COVID-19 – or dying from it – is not equally distributed amongst GPs. Age, sex, ethnicity, and underlying health conditions are all important risk factors. New Health Foundation research finds that not only are a significant proportion of GPs at high or very high risk of death from covid-19 (7.9 per cent), but one in three single-handed practices is likely to be run by a GP at high risk. If those GPs step back from face-to-face consultations we estimate that at least 700,000 patients could be left without access to in-person appointments. Even more concerningly, there’s a marked deprivation gradient. If GPs at high risk from COVID-19 step back from direct face-to-face appointments, and gaps in provision aren’t plugged, the patients likely to be most affected are those in deprived areas – the same people who have already been hardest hit by the pandemic GPs at high risk of death from covid are much more likely to be working in areas of greater socioeconomic deprivation. And single-handed practices run by GPs classed as being at very high risk from covid are more than four times as likely to be located in the most deprived clinical commissioning groups than the most affluent. If GPs at high risk from COVID-19 step back from direct face-to-face appointments, and gaps in provision aren’t plugged, the patients likely to be most affected are those in deprived areas – the same people who have already been hardest hit by the pandemic. Where do solutions lie? Ultimate responsibility for providing core general practice services to populations lies with CCGs. In some areas, collaborations between practices (such as GP federations and primary care networks), may be able to organise cross-cover to surgeries where face-to-face provision is not adequate to meet need. But these collaborations have not developed at equal pace across the country, have many demands on their capacity and may not be sufficiently mature to take on this challenge. These local factors – including the availability of locums – will need to be considered by commissioners. It’s vital that CCGs act quickly to understand the extent to which the concerns around GP supply highlighted by our research apply in their localities. In some cases, additional funding will be needed to enable practices to ‘buy in’ locum support for face-to-face consultations. This should be considered a core part of the NHS covid response. Face-to-face GP appointments remain a crucial NHS service, and must be available to the population in proportion with need. Just as in secondary care, protecting staff, and protecting patients in primary care will require additional investment. Failure to adequately assess the extent of the problem, and to provide sufficient resource to engineer solutions is likely to further exacerbate existing health inequalities. Original Source: The HSJ

Like most women affected by incontinence, 43-year-old Luce Brett has her horror stories. As a 30-year-old first time mum she recalls wetting herself and bursting into tears in the “Mothercare aisle of shame”, where maternity pads and adult nappies sit alongside the baby nappies, wipes and potties. But, she adds, these isolated anecdotes don’t really do justice to what living with incontinence is really like. “It’s every day, it’s all day. People talk about leaking when you sneeze or when you laugh, but for me it was also when I stood up, or walked upstairs. It was always having two different outfits every time I left the house to go to the shops. Incontinence robbed me of my thirties; it made me suicidally depressed,” Luce explains. “Everyone kept telling me it was normal to be leaky after a vaginal birth. It took quite a long time for me to find the courage or the words to stop them and say: ‘Everybody in my NCT (National Childbirth Trust) class can walk around with a sling on, and I can’t do that without wetting myself constantly’,” she adds. Read full article here.

I fell sick on 25 March. Four months later, I’m still dealing with fever, cognitive dysfunction, memory issues and much more I just passed the four-month mark of being sick with Covid. I am young, and I had considered myself healthy. My first symptom was that I couldn’t read a text message. It wasn’t about anything complex – just trying to arrange a video call – but it was a few sentences longer than normal, and I couldn’t wrap my head around it. It was the end of the night so I thought I was tired, but an hour later I took my temperature and realized I had a fever. I had been isolating for 11 days at that point; the only place I had been was the grocery store. My Day 1 – a term people with Long Covid use to mark the first day of symptoms – was 25 March. Four months later, I’m still dealing with a near-daily fever, cognitive dysfunction and memory issues, GI issues, severe headaches, a heart rate of 150+ from minimal activity, severe muscle and joint pain, and a feeling like my body has forgotten how to breathe. Over the past 131 days, I’ve intermittently lost all feeling in my arms and hands, had essential tremors, extreme back, kidney and rib pain, phantom smells (like someone BBQing bad meat), tinnitus, difficulty reading text, difficulty understanding people in conversations, difficulty following movie and TV plots, sensitivity to noise and light, bruising, and petechiae – a rash that shows up with Covid. These on top of the CDC-listed symptoms of cough, chills and difficulty breathing. Read the full article here.

Doctors and surgeons’ leaders have issued a warning that the NHS must not shut down normal care again if a second wave of Covid-19 hits as that would risk patients dying from lack of treatment. Here, one patient tells her story. Marie Temple (not her real name) was distraught when her MRI was cancelled in March, shortly after the UK went into lockdown and Boris Johnson ordered the NHS to cancel all non-urgent treatment. Temple, who lives in the north of England, was diagnosed with a benign brain tumour last year after suffering seizures and shortly afterwards had surgery to remove it. She had been promised a follow-up MRI scan in late March to see if the surgery had been a success, but she received a letter saying her hospital was dealing only with emergency cases and she didn’t qualify. Read the full article here.

Up to half a million Britons are suffering the effects of "long Covid", MPs have been told, with some doctors dismissing many of the long-term symptoms suffered in the wake of coronavirus as ME.... Paywalled article in The Telegraph.

A healthy population is one of any nation’s most important assets. We have known for a long time that not everyone has the same opportunity to access the things they need to lead a healthy life, such as good quality work and safe secure stable housing. Now we can see that the COVID-19 pandemic is replicating and exacerbating deep-rooted health inequalities. Without concerted action, this health crisis will also become a health inequalities crisis. The COVID-19 pandemic has brought health inequalities into sharp focus. While every part of the population has been affected by the current crisis, some communities have been hit much harder both by the virus itself and by the measures taken to control its spread. Evidence is starting to emerge, for example, of the unequal impact of the shutdown of the economy. For example a recent survey of UK households found that the lowest earners have been worst hit by loss of earnings, with the most severe losses for single parents. The uneven impact of COVID-19 has also highlighted the inequalities faced by Black, Asian and minority ethnic communities. Recent data shows that some ethnic groups are at much higher risk of dying from COVID-19 than the rest of the population (e.g. Black men are four times more likely to have died of COVID-19 than their White peers). Read full article here.