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Clive Flashman

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  1. Clive Flashman
    The UK's scientists have been trying to trace COVID-19's path through the population ever since the coronavirus arrived on British shores.
    In what is thought to be the largest study of its kind in the world, an app developed by King's College London (KCL) and technology company Zoe, which tracks symptoms of the disease, has been downloaded more than three million times in the UK.
    Not to be confused with the government's contact-tracing app, the COVID-19 Symptom Study app allows users to report daily whether they feel healthy, and record any symptoms. The scientists have been using the data to estimate how the virus may have travelled through the population.
    Read full story
    Source: BBC News, 23 May 2020
  2. Clive Flashman
    Study finds 54 days after discharge, 69% of patients still had fatigue, and 53% were suffering from persistent breathlessness.
    Almost seven out of 10 patients hospitalised due to coronavirus still suffer from debilitating symptoms more than seven weeks after being discharged, according to a new study.
    Researchers from the University College London (UCL) division of medicine, in collaboration with with clinicians at the Royal Free London (RFL) and UCL, followed 384 patients who had tested positive and had been treated at Barnet Hospital, the Royal Free Hospital or UCLH. Collectively the average length of stay in hospital was 6.5 days.
    The team found that 54 days after discharge, 69% of patients were still experiencing fatigue, and 53% were suffering from persistent breathlessness. They also found that 34% still had a cough and 15% reported depression. In addition 38% of chest radiographs (X-rays) remained abnormal and 9% were getting worse.
    Dr Swapna Mandal, an honorary clinical associate professor at UCL division of medicine, said the data shows so-called long COVID is a real phenomenon and that further research is needed to understand how the symptoms of COVID-19 can be treated over an extended period. She said: "Patients whose COVID-19 illness is serious enough for them to require hospital care often continue to suffer significant symptoms for many weeks after their discharge."
    Read full story
    Source: Sky News, 11 November 2020
  3. Clive Flashman
    People are being warned to familiarise themselves with the symptoms of sepsis after a study found that as many as 20,000 COVID-19 survivors could be diagnosed with the condition within a year.
    One in five people who receive hospital treatment for the coronavirus are at risk, according to the UK Sepsis Trust.
    Sepsis is triggered when the body overreacts to an infection, causing the immune system to turn on itself - leading to tissue damage, organ failure and potentially death. If spotted quickly, it can be treated with antibiotics before it turns into septic shock and damages vital organs.
    Read the full article here.
  4. Clive Flashman
    The Care Quality Commission (CQC) has published a report on Stoke Mandeville Hospital, part of Buckinghamshire Healthcare NHS Trust following a recent inspection in June.
    CQC carried out a focused inspection of the trusts children’s emergency department in response to concerns raised about the safety and quality of the service. Inspectors found children and young people received safe care. However, the trust needs to review its systems to make sure potential serious incidents are managed in a way that allows any lessons learned to be shared, to reduce the risk of them happening again.
    Link to the full report  (opens in a new browser window)
  5. Clive Flashman
    Five serious incidents, including the deaths of two children, spark “urgent” investigations at specialist trust Great Ormond Street Hospital FT has linked the incidents partly to what it described as a “faulty” batch of a type of glue used to close wounds during surgery Supplier says it followed the correct recall processes for the product Five serious incidents, including the deaths of two children, have sparked ‘urgent’ investigations into the processes through which clinicians are alerted to potential safety concerns over medical products used on patients.
    Great Ormond Street Hospital Foundation Trust has been investigating the incidents which happened between December 2020 and April 2021. The trust has linked the incidents partly to what it described as a “faulty” batch of a type of glue used to close wounds during surgery. The glue, called Histoacryl, is produced by B. Braun Medical Ltd, and the company issued three separate “field safety notices”, relating to different batches of the product, in March and April this year. The company has stressed that it followed the correct recall processes throughout.
    According to a report to GOSH’s public board meeting on 29 September, Histoacryl has been used for the endovascular treatment of brain arteriovenous malformations for more than 30 years, but earlier this year batches of the product were identified as hardening less rapidly than expected. The trust told HSJ in a statement: “A comprehensive serious incident investigation has been carried out to determine the impact of the faulty glue on all patients treated with it.
    “The investigation found that whilst the passage of glue through the intended vessel may have been contributory in some instances of harm, it was unlikely to be the sole or main factor. “Both patients who died had serious and complex medical conditions and the procedure to correct these always carries a high degree of risk which is discussed extensively with the families before any treatment takes place.”
    Read full article here (paywalled)
    Original source: Health Service Journal
  6. Clive Flashman
    London doctors are using artificial intelligence to predict which patients with chest pains are at greatest risk of death. 
    A trial at Barts Heart Centre, in Smithfield, and the Royal Free Hospital, in Hampstead, found that poor blood flow was a “strong predictor” of heart attack, stroke and heart failure. Doctors used computer programmes to analyse images of the heart from more than 1,000 patients and cross-referenced the scans with their health over the next two years. The computers were “taught” to search for indicators of future “adverse cardiovascular outcomes” and are now used in a real-time basis to help doctors identify who is most at risk.
    Read full story
    Source: Evening Standard, 15 February 2020
  7. Clive Flashman
    Dr Penny Kechagioglou, Chief Clinical Information Officer and Deputy Chief Medical Officer at University Hospitals Coventry and Warwickshire, kindly shared her thoughts on digitising patient reported outcome measures in a blog for HTN.
    The UK digital transformation wave is mainly characterised by the roll-out of electronic health records and is an opportunity to transform patient care by collecting and analysing patient reported outcome measures digitally.
    A recent study at the European Society of Medical Oncology open journal (Modi, 2022) showed that patient reported outcome measures are predictive of cancer patient treatment response and quality of life for physical and mental parameters. The knowledge of patient reported outcomes (PRO) and experience (PRE) measures can be valuable in the monitoring of individual patient symptoms in clinic or remotely in the community and also for aggregating and interpreting population health data.
    To read the full article, click here
  8. Clive Flashman
    This week, Public Health England (PHE) Chief Executive's message covers the social care sector's management of COVID-19 outbreaks and the exemplary work in Hammersmith and Fulham Council, PHE's Better Health campaign, new reports on greenspaces and global disaster risk reduction, and our studies to support musicians and artists during the pandemic.
    Read full article here.
  9. Clive Flashman
    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
  10. Clive Flashman
    A LACK of capacity is meaning vulnerable kids in England are being put into foster care and children’s homes in Scotland, a new report has revealed. An investigation by the Competition and Markets Authority (CMA) into social care in the UK found that stakeholders are raising concerns about the practice.
    They warned that young people are facing disruption at school after being placed into different legal and educational systems – all due to a lack of spaces near their home area. It could mean some kids from as far away as London are being placed into care in Scotland.
    The investigation also revealed difficulties in Scotland placing children with disabilities or complex needs. And it found Scottish children in the care system were more likely to be separated from their siblings than their counterparts in England. The CMA reported that in England in 2019/20, 1400 (13% of all siblings in care) siblings were not placed according to their plan. In Scotland, there were 200 sibling groups separated after being placed into foster care - more than 20% of all sibling groups in foster care.
    For the full article, click here
    Original source: The National
  12. Clive Flashman
    A team of world-leading medical experts have collaborated to improve patient safety and outcomes following high-risk surgery.
    The endeavour, which includes industry specialists such as anaesthetists, surgeons, and patient representatives, is called the Improving Patient Outcomes (ImPrOve) Think Tank. The ImPrOve team has recently published its European report that highlights and looks to address a severe patient safety and health issue in which death and serious complication rates in the 30-days following high-risk surgery are alarmingly high.
    The insightful report outlines an array of practices and innovations in the health sector that can improve patient safety and outcomes. These include calling for better physician training on the latest guidelines, funding for modern digital monitoring, utilisation of data from current technologies in health policies, and the right for patients to be involved in the discussion of the management of their procedure.
    Perils of high-risk surgery
    Around 2.4 million patients undergo high-risk surgery annually in Europe alone, with UK evidence indicating that 80% of postoperative deaths occur in a 10% sub-population of high-risk patients. If this startling trend continues throughout Europe, it is estimated that a staggering 192,000 people will die within the 30-day period following their surgery, demonstrating the immense dangers posed to patient safety and outcomes. There is an array of challenges during high-risk surgery; however, the ImPrOve Think Tank believes that potentially the most alarming complication is haemodynamic instability, which manifests as drops in blood pressure (known as IOH).
    Mitigating risks and increasing patient safety
    Professor Olivier Huet, the ImPrOve Chair and Professor of Anaesthesia and Intensive Care Medicine, said: “Our mission is to work collaboratively with patient representatives, clinicians and policymakers to improve perioperative patient safety and experience with the help of advanced haemodynamic monitoring technologies.
    Full article here
    Source: Health Europa
  13. Clive Flashman
    A dedicated team of 32 volunteers are hitting the roads across North Wales assisting the Welsh Ambulance Service in dealing with fallers.
    Based out of the Ambulance headquarters in St Asaph, the Community First Responder Falls Team was launched on 30 April this year and has already assisted almost 250 people.
    The team was created to use the talents and experience of the familiar Community First Responders (CFRs) who had to be stood down from their normal duties at the start of the Covid-19 pandemic.
    Read the full article here.
  14. Clive Flashman
    More than one in five GP partners said they removed practice staff away from face-to-face care due to ethnicity during the pandemic, a Pulse survey has revealed. 
    The survey in June revealed that 84 of the 378 respondents said that ‘ethnicity was a crucial factor in removing anyone in your practice away from face-to-face assessments’.
    Around 70% of respondents said they had been counting ethnicity as a factor when risk assessing staff.
    See full article here
  15. Clive Flashman
    The Nursing Times has just broken a story about the importance of safe nurse staffing levels, which has been underlined in an international white paper that calls on countries around the world to take action to ensure they have enough nurses.

    The paper – launched at the International Council of Nurses’ annual conference – states evidence for a clear link between nurse staffing levels, patient safety and the quality of care is now “overwhelming and compelling”.
  16. Clive Flashman
    In the older European population, men, as well as those with lower socioeconomic status, weak social ties, and poor health, might experience more difficulties getting informal support and are considered to have a higher risk of worsening frailty state and lower quality of life. This reality is shown in a new doctoral thesis at Umeå university.
    Read the full article here
  17. Clive Flashman
    As part of the UK Government’s efforts to tackle health problems, including mental health, earlier in the cycle, the newly-created Office for Health Improvement and Disparities (OHID) has launched the latest Better Health – Every Mind Matters campaign to improve the general public’s mental wellbeing.
    The new campaign aims to empower members of the general public to look after their mental health through tips and practical advice, helping to find what works for them in reducing stress and anxiety, boosting their mood, sleeping better, and feeling in greater control of their lives.
    New research commissioned by OHID revealed nearly half of adults (49%) in England said the Covid-19 pandemic had a negative impact on their mental wellbeing. In the same research, more than a third of all adults in England (34%) said they did not know what to do to improve their mental wellbeing. That equated to 15.1 million people. Younger adults were the most significantly affected group with their mental health, with 57% of 18-34 year olds suggesting the pandemic had negatively impacted their mental health. Just under half (44%) reported not knowing what to do to help improve it.
    This is the first campaign delivered by OHID since being officially launched on October 1, 2021. They have been set up with the aim of tackling health inequalities across the country.
    Minister for Care and Mental Health, Gillian Keegan, said: “The public showed great resilience throughout the pandemic, but it has served as a stark reminder that we all need to look after ourselves not only physically, but mentally. “There are simple steps we can all be taking to improve our mental wellbeing and reduce feelings of stress and anxiety. For anyone who is unsure what they can do, I urge you to visit Every Mind Matters and take advantage of the expert advice and practical tips available to you.”
    Claire Murdoch, NHS National Director for Mental Health, added: “The last year has taken its toll on people’s mental health but NHS staff have responded rapidly to treat more people with mental health issues than ever before – rolling out 24/7 crisis lines across the country and mental health support teams in schools during the pandemic. “The NHS is here for you, so if you’re struggling with anxiety and depression our rapidly expanding talking therapy services are available, while anyone who needs urgent help can access our 24/7 NHS crisis lines – available to people of all ages. “I would encourage everyone to look after their mental health, and by answering 5 simple questions, get a tailored ‘mind plan’ which will give you tips to help boost your mood, sleep better and deal with stress and anxiety.”
    Over 3.4 million individual Mind Plans have already been created since the campaign was first launched in October 2019.
    Original source: National Health Executive
  18. Clive Flashman
    Over-55s are not being recommended useful health technology as GPs presume they cannot use a smartphone, say researchers
    Older patients are being excluded from beneficial health technology because “ageist” doctors presume they cannot work a smartphone, research has suggested. Experts have accused doctors of “stereotyping” older people as being incapable of using technology and warned patient safety was being put at risk by a failure to support them in using appropriate online health tools.
      GPs typically recommend NHS-approved health apps to about one in 10 patients aged under 35 to help them manage their conditions between appointments, such as by reminding them to take medications or monitoring their symptoms. However, doctors recommend the same apps to just one in 25 patients over 55 and one in 50 patients over 65, according to research by the Organisation for the Review of Care and Health Apps (ORCHA), which assesses apps for the health service. The same research found 55 per cent of over-55s would be happy to try using a health app if it was recommended, while nine in 10 over-55s and eight in 10 over-65s who have used a health app felt satisfied or very satisfied with the experience.
      The NHS Long Term Plan states that patients should have access to “digital tools” to manage their health and studies have shown NHS-approved health apps can have clinical benefits. Older people ‘will benefit from digital products’
    However, Helen Hughes, the chief executive of the charity Patient Safety Learning, suggested ageist assumptions about older people’s technological ability meant they were missing out.
      “The data suggests that older people maybe being stereotyped, with assumptions they won’t be computer literate,” she said. “Plenty of older people are tech savvy – or at least willing to learn – and will really benefit from being able to manage their health from home, using digital products. Older patients need to be offered technology solutions with support on how best to use them, if this is needed.”
      She warned there was also “a significant patient safety issue” with the failure to advise patients about NHS-approved apps, as it left older patients at risk of inadvertently downloading one of the thousands of unreliable health apps available. To read the full article (paywalled), click here
    Original Source: The Telegraph
  19. Clive Flashman
    GP practices will be included in the remit of a new patient safety watchdog, due to come in from 2023 under the new Health and Care Bill, the Department of Health and Social Care (DHSC) has said. DHSC said that it expects the new Health Services Safety Investigations Body (HSSIB) to be ‘fully operational’ in England from April 2023 – ‘subject to parliamentary clearances’. 
    It confirmed that the statutory independent body will investigate NHS care in GP practices, although it said that the HSSIB’s ‘focus is likely to be predominantly on investigating patient safety incidents in NHS trusts’. The body will also investigate care provided by the independent healthcare sector.
    RCGP vice-chair Dr Gary Howsam said: ‘It is important that we have further details about how this regulator will interact with general practice, and the expectations it will have of GPs and our teams, including ensuring GPs are not implicated for systemic issues out of their control.’
    Read the full article here
  21. Clive Flashman
    Steve Gulati, Associate Professor and Director of Healthcare Leadership at HSMC (University of Birmingham) discusses the concept of "time to care" within healthcare.
    A UK-wide poll of healthcare workers revealed that most NHS staff think they have too little time to help patients and the quality of care that services provide is falling. This reported reduction in the time to care is perhaps inevitable after almost a decade of health funding failing to keep up with increases in demand, and is a cause for concern for all of us – patients, carers or those working in the NHS. Where does this fit in to the wider picture – and can anything be done about it?
    It is not just NHS workers who are feeling the pinch – levels of public satisfaction with the NHS are at an all-time low. Interestingly, the two most cited reasons relate to access (difficulties or delays in getting appointments) and, tellingly, to staff shortages. Even against this gloomy backdrop, the collectivised funding model upon which the NHS is founded continues to find significant public support. All of this points towards a painful congruence – NHS staff feel that they do not have enough time to care, and the public is noticing.
    Is ‘time to care’ an outdated concept, harking back to an age of long patient stays, a paternalistic bedside manner and unrealistic expectations? Both staff and patient experience suggest not. Although technology plays an increasing role in healthcare diagnostics, treatment and recovery, delivering care remains a deeply human phenomenon and is essentially a relational and personal task. Recognising that frontline healthcare workers need time to care is not a new phenomenon. Influenced by service improvement methodologies, the ‘productive ward’ initiative in the mid-2000s placed an explicit emphasis on using efficiency techniques for the express purpose of releasing nursing staff to have “time to care”. It was acknowledged that productivity was more than metrics around bed occupancy and throughput, for example, and that the driving purpose of service improvement was to time to care. Whilst research indicated a nuanced impact, the principle is long recognised.
    If solutions to these problems were easy, they would have been implemented by now. There is no doubt that on one level, it really is a matter of resources – no system can carry a vacancy factor of around 10% for any length of time without there being an evident impact. However, even within an environment of constrained resources, choices are made every day by caregivers and leaders alike about what receives attention and what is allowed to move into the ‘important but not urgent’ category. That is in no way to blame the hard-pressed caregivers, but instead to indicate that even when it really does not feel like it, every individual has a level of agency.
    Feeling as though one does not have time to do one’s job is, put simply, unpleasant for all workers but should especially concern us in care environments. The impact on clinical safety and quality is an obvious starting point, but it is also important to recognise the impacts on care workers themselves with regard to emotional labour and the impact on the psychological contract that working in a caring profession, when people feel that they don’t have enough time to care, must have. As eloquently stated by the Vice-President of the Royal College of Physicians in Wales, it is “…very clear that good clinicians, be they nurses, doctors, therapists or pharmacists, need time to train, time to care and time to rest”. Even in challenging times, self-care and compassionate, values driven leadership can make a difference. Caring is everyone’s business.
    Link to original article: https://www.birmingham.ac.uk/news/2023/healthcare-workers-need-more-time-to-care
  22. Clive Flashman
    The Care Quality Commission (CQC) has published State of Care. The report, which draws on the experiences of care people have shared with Healthwatch England, has found that health and social care services face some highly concerning challenges, including:
    A workforce drained in terms of resilience and capacity, especially in social care, where the staff vacancy rate has risen; A rising number of people seeking emergency care, leading to unacceptable waiting times; and Tackling the health inequalities that the COVID-19 pandemic has exacerbated. The report welcomes the additional funding that the Government has allocated to help the NHS and social care address their challenges. However, CQC has called for the extra investment to be used to:
    Develop new ways of working and don’t just prop up existing approaches and plug demand in acute care; and Improve the training, career development and terms and conditions of social care workers to help attract and retain more staff. CQC has also recommended that the short-term funding - currently in place to help discharge patients who are no longer in need of hospital care but may still require care services - be extended. 
    The HealthWatch response
    Responding, Sir Robert Francis QC, Chair of Healthwatch England said:
    “During the pandemic, people have told us about the challenges they have faced. Whether this not being able to access dental care, problems using online GP services or being discharged from the hospital without the proper support. It’s great to see this report drawing so much on the experiences people have shared with us. 
    “We urge Government to act on this report. The health and care system upon which we all depend is facing a hard winter, but, as this report makes clear, the longer-term picture is also challenging.
    “The steps the CQC are recommending, like extending the extra funding to help people leave hospital safely and ensuring there is enough dental capacity, will help give services the breathing space they need to get through this winter.
    “However, come spring we need to grasp the opportunity to build a better NHS and social care system. A system that tackles heath inequalities head-on, ensuring that no matter who you are or where you live, you can access high-quality care that meets your needs. A system that is sustainable, is designed round the needs of people and breaks perennial cycle of winter crises.”
    Original source: HealthWatch
    CQC report here
  23. Clive Flashman
    Monitoring heart patients via a smartphone app prevented readmissions and sped up discharges in a pilot scheme that its developers hope will be introduced across the country.
    Patients sent data including their blood pressure, heart rate, oxygen levels and details of developing symptoms to their clinical team on an app.
    The figures were collated on a “dashboard”, which flagged any signs that a patient might need medical help, allowing doctors and nurses to bring them into hospital or alter their medication as required.
    The 12-week pilot by Huma, a healthcare technology company based in London, involved 40 patients at Cwm Taf Morgannwg University Health Board in south Wales and Betsi Cadwaladr University Health Board in north Wales.
    Click here to read full article (paywalled)
     
  24. Clive Flashman
    Health Education England (HEE) has announced that its new £10 million training programme, intended to ‘boost’ the critical care workforce, will be rolled out this autumn.
    According to HEE, the funds it secured earlier this year will provide nurses and Allied Health Professionals with a ‘nationally recognised pathway’ to further their careers in Adult Intensive Care Units (ICUs).
    Specialist training, delivered through a ‘blended learning package’ could help to strengthen the ICU workforce across England and will offer around 10,500 nursing staff the chance to undertake courses and ‘further their careers’.
    There will be a focus on flexible training – enabling participants to balance family and caring commitments, as well as taking into account those who are unable to travel, when the roll-out of the programme begins.
    The learning will be delivered by higher education institutions, Critical Care Skills Networks and acute trusts, and it is expected to take participants up to 12 months to receive the standardised qualification. It’s hoped that the programme could lead staff to career opportunities such as becoming a shift leader or clinical educator, or to lead on research.
    Read full article here
    Original source: Leading Healthcare News
  25. Clive Flashman
    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
     
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