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Clive Flashman

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  1. Clive Flashman
    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
  2. Clive Flashman
    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
  3. Clive Flashman
    The safety of maternity services in the NHS are to be investigated by MPs after a string of scandals involving the deaths of mothers and babies highlighted by The Independent.
    The Commons health select committee, chaired by former health secretary Jeremy Hunt, has announced it will hold an inquiry looking at why maternity incidents keep re-occurring and what needs to be done to improve safety.
    The committee will also examine whether the clinical negligence process needs to change and the wider aspects of a “blame culture” in the health service and its affects on medical advice and decision making.
    Read the full article here
  4. 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
  5. Clive Flashman
    There is always a lot happening with patient safety in the NHS (National Health Service) in England. Sadly, all too often patient safety crises events occur. The NHS is also no sloth when it comes to the production of patient safety policies, reports, and publications. These generally provide excellent information and are very well researched and produced. Unfortunately, some of these can be seen to falter at the NHS local hospital implementation stage and some reports get parked or forgotten. This is evident from the failure of the NHS to develop an ingrained patient safety culture over the years. Some patient safety progress has been made, but not enough when the history of NHS policy making in the area is analysed.
    Lessons going unlearnt from previous patient safety event crises is also an acute problem. Patient safety events seem to repeat themselves with the same attendant issues.
    Read full story
    Source: Harvard Law, 17 February 2020
  6. Clive Flashman
    Hospital trust ‘truly sorry that mistakes were made in care’ of Luchii Gavrilescu, who died after being sent home from hospital with undiagnosed tuberculosis.
    An NHS trust investigated over maternity care failings has apologised after a six-week-old child was found to have died due to mistakes at one of its hospitals.
    East Kent Hospitals University Trust was embroiled in a major scandal after The Independent revealed the trust had seen more than 130 babies over a four-year period suffer brain damage as a result of being starved of oxygen during birth. A report into the trust concluded in April that there had been “recurrent safety risks” at its maternity units.
    Read full article here.
  7. Clive Flashman
    All GP appointments should be done remotely by default unless a patient needs to be seen in person, Matt Hancock has said, prompting doctors to warn of the risk of abandoning face-to-face consultations.
    In a speech setting out lessons for the NHS and care sector from the coronavirus pandemic, the health secretary claimed that while some errors were made, “so many things went right” in the response to Covid-19, and new ways of working should continue. He said it was patronising to claim that older patients were not able to handle technology.
    The plan for web-based GP appointments is set to become formal policy, and follows guidance already sent to GPs on having more online consultations. But the Royal College of GPs (RCGP) hit back, saying it would oppose a predominantly online system on the grounds that both doctors and patients benefited from proper contact.
    Read full article here
  8. Clive Flashman
    A new app has been piloted in North East London to help district nurses document chronic wound management more efficiently. The tech has been used in community services and stores a catalogue of photographs to accurately document chronic wounds. 
    District nurses can use the app on a smartphone – making it lightweight, portable and easy to clean. Using two calibration stickers placed either side of the wound, the app can scan it and capture its size and depth to build a 3D image. Nurses can then fill out further characteristics on the software such as colour, pain level, location and smell to give a full picture of the wound’s development.
    Read full story
    Source: Nursing Times,  12 February 2020
  9. Clive Flashman
    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
  10. Clive Flashman
    New analysis from Diabetes UK predicts that, without significant government action, up to 5.5m people in the UK could be living with diabetes by 2030. 
    The prediction is based on analysis of statistics from Public Health England and The Association of Public Health Observatories. It means that as many as 1-in-10 UK adults could be living with diabetes within a decade.  
    Additional analysis carried out shows that up to 17 million people - 1-in-3 UK adults - could be at an increased risk of developing type 2 diabetes by 2030, unless there's commitment from the governments of the UK to urgently invest in diabetes care and prevention. 
    It is known that there's been progress in diabetes care, such as the hundreds of thousands of people who have been supported by the NHS Diabetes Prevention Programme. But we need more action to stop our prediction from coming true. 
    That's why Diabetes UK are calling on the UK Government to: 
    Make more funding available to enable more people to avoid a diagnosis of type 2 diabetes through increasing access to proven preventative measures, such as the NHS Diabetes Prevention Programme  Support far more people diagnosed with type 2 diabetes to go into remission where possible  Improve access to weight management services   Ensure that everyone has the access to the care and diabetes checks they need – including tackling the backlog – as we move out of the pandemic.  The effects of the pandemic are still being felt in diabetes care. Millions of people with type 1 and type 2 diabetes haven't had vital health checks when they needed them, and thousands of diagnoses of type 2 diabetes have been delayed or missed. 
    Read full article here
    Original source: Diabetes UK
  11. Clive Flashman
    "I'm not sure I want to be a nurse anymore," she tells me. "I've seen more people die in the past two months than in the whole six years."
    Some 70% of health workers dealing with COVID-19 in Italy's hardest-hit areas are suffering from burnout, a recent study shows. "This is actually the hardest moment for doctors and nurses," says Serena Barello, the author of the study.
    Read story
    Source: BBC News, 26 May 2020
  12. Clive Flashman
    Staffing shortages remain a pervasive challenge for the NHS, risking patient safety, care standards and the pursuit of innovation. 
    There are now 106,000 vacancies across the NHS in England, with over 44,000 vacancies in nursing. Overseas staff are a crucial way of filling those vacancies, but the message to potential workers is confused to say the least.
    Read full story
    Source: Health Europa, 14 February 2020
  13. 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
  14. Clive Flashman
    Three quarters of patients surveyed at Jinyintan Hospital in Wuhan, China had at least one ongoing symptom
    The majority of people admitted to hospital with coronavirus still had symptoms six months after getting ill, a new study has revealed.
    Over three quarters of Covid patients surveyed at Jinyintan Hospital in Wuhan, China had at least one ongoing symptom – with the most commonly reported being fatigue or muscle weakness. A total of 1,733 patients, with a median age of 57, were examined for the study between 7 January and 29 May last year. At a follow-up, 76% of patients reported at least one ongoing symptom.
    Read the full article here
  15. 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
  16. Clive Flashman
    Lego could be used as a practical tool to train doctors in anesthetic skills according to new research that has shown a simple task using the building bricks can help improve technical skills—a finding that could improve medical training and patient safety.
    Scientists from the University of Nottingham's School of Psychology and School of Medicine developed a task where people copied shapes using bricks that they could see in a mirror. They found this simple training improved student performance in an ultrasound-guided regional anesthesia task. The results of the study have been published in British Journal of Anesthesia
    Read the full article here
  17. Clive Flashman
    In the largest independent randomized controlled trial (RCT) of its type, a multimodal digital therapy program for patients with non-specific chronic low back pain has outperformed standard-of-care treatment across all medical outcomes.
    Results of the study, published in the Journal of Pain Research, show that patients using Kaia, the back pain management app developed by leading digital therapeutics company Kaia Health, reduced pain levels, anxiety, depression, stress, and improved wellbeing and body functionality significantly more compared to standard-of-care treatments, e.g. pain killers, surgeries, physical therapy.
    “This large-scale study demonstrates the significant benefits for people managing low back pain when using Kaia to deliver a multimodal treatment through a digital device, such as a smartphone,” says Thomas R. Toelle, M.D., Ph.D., Head of the Pain Center of the Technical University Munich, Germany. “These results add to the growing body of medical evidence that supports the use of digital multimodal treatments for chronic conditions, such as back pain.”
    Low back pain is one of the leading causes of global disability, with an enormous cost for healthcare systems worldwide. 1,2 According to a 2018 report on the impact of musculoskeletal pain on employers, chronic pain, including back pain, accounts for 188.7 million lost work days, and $62,4 billion in lost productivity cost.3
    Kaia is an app-based, multimodal digital therapy program for chronic back pain, which focuses on Physical therapy, Relaxation exercises, and Medical education.
  18. Clive Flashman
    To help stop the spread of the coronavirus that causes COVID-19, the majority of hospitals have stopped or severely restricted visits. This article explains how you can still help a loved one even when you can't see them face to face.
    During the coronavirus crisis, most hospitals and care homes in the UK have stopped visits. If you have a loved one in a healthcare setting, not being able to go to see them will be incredibly difficult. But these temporary measures have not been taken lightly. Restricting visits to hospitals and care homes is important to reduce the spread of the virus that causes COVID-19 as much as possible. This way hospital and care home residents, and healthcare staff, can be better protected during the pandemic.
    Read the full article here
  19. Clive Flashman
    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
  20. 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
  21. Clive Flashman
    New analysis published by the Health Foundation shows that while the waiting list for hospital care continues to grow, so too does the number of ‘missing' patients who have not yet been added to the list. There were 7.5 million fewer people referred for routine hospital care between January 2020 and July 2021 than would have been expected based on numbers prior to the pandemic. These ‘missing patients’ are in addition to the record 5.6 million people already on the waiting list.  
    This lower than expected number of people referred for hospital care, including for routine procedures such as hip or knee surgery, is likely to be due to a number of reasons. Some people may not have sought treatment for health concerns during the pandemic, while others may have seen their GP but not yet been referred due to the pressure on hospital services during the pandemic. In some instances, care may no longer be needed. 
    The analysis comes alongside a BBC Panorama documentary (Monday 27 September) revealing the scale of the elective care backlog and the impact delays are having on people’s lives. The Health Foundation analysis, shared with Panorama, also shows that the pandemic had a much worse effect on the hospital care provided in some areas of England than it did in others. The analysis of 42 local integrated care systems (ICSs) shows that the pandemic significantly reduced the level of routine hospital care performed across the country – in the worst affected area routine hospital care dropped by 37% while in the least affected area there was a 13% reduction.  
    Read the full article here
    Source: The Health Foundation
  22. Clive Flashman
    One of the world’s foremost virus experts has said survivors will be living with the effects of Covid-19 for “years to come” after he was struck down by a severe infection, and called for added support for those who have recovered from the disease. 
    Professor Peter Piot, who as director of the London School of Hygiene and Tropical Medicine has been at the forefront of the academic response to the pandemic, has spent his entire career studying viruses such as Ebola and HIV. 
    Prof Piot spent a week at the Royal Free Hospital in London in early April after contracting the disease. “I spent a week in isolation on a ward with three other men. I couldn’t leave the room. When I came out the thing I remember most is seeing the sky. London was deserted - it was in acute lockdown,” he said.
    The fever and splitting headache he had felt before being admitted were gone and apart from chronic exhaustion he was feeling better, he said. Getting out of bed was a struggle and he had to take rests when going up the many flights of stairs of his tall Georgian townhouse. But a week later he took a turn for the worse - he became breathless and his heart rate shot up to over 100. 
    Read the full article here
  23. Clive Flashman
    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.
  24. Clive Flashman
    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.
     
  25. Clive Flashman
    NHSX have revealed that they will fund and support 14 new projects across the country to help half a million people receive care at home using digital technology. This will include remote cardiac rehabilitation services and digital self-management systems, as well as parental support services for families of children with eating disorders.
    Tara Donnelly, Chief Digital Officer at NHSX, said: “Through our Digital Health Partnership Award, these organisations will have access to the expertise and support they need to adopt or expand their digital capabilities safely and effectively, allowing many more patients with long term conditions to receive their care from the comfort of their homes rather than always having to attend primary and acute settings.”
    In addition to innovation in digital technology, a number of the projects build on existing services to ensure more patients can benefit from remote services.
    One of the projects also includes the expansion of secure video services at Great Ormond Street Hospital for Children, which will make it possible for patients and carers, as well as their doctors, to share seizure videos across their neurology service. Cambridgeshire Community Services are also expanding their remote health monitoring service.
    Read the full article here
    Source: National Health Executive
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