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Clive Flashman

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  1. Clive Flashman
    Covid has created an urgent need, and a unique opportunity, to get the true waiting list out in the open.
    The English waiting list continues to break new records in the aftermath of Covid, and even the Secretary of State says it could reach 13 million patients. But the referral-to-treatment data – bad as it is – doesn’t reveal the full scale of the backlog, partly because not all waiting lists fall under RTT rules, but also because the RTT waiting list data is inaccurate and incomplete.
    The scale of these hidden delays could be vast - millions of patients. Some could wait for years, some indefinitely, always taking second place to the swelling RTT waiting list and the targets that surround it. Some patients who need urgent care will end up with disability or death. Others are already in terrible pain. All deserve better.
    Read full article here
    Source: HSJ (Paywalled). 20 September 2021
  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
    Action must be taken now if the NHS is to avoid an even worse winter crisis next year, the chief inspector of hospitals has warned.
    The Care Quality Commission (CQC) said the use of corridors to treat sick patients in A&E was “becoming normalised”, with departments struggling with a lack of staff, poor leadership and long delays leading to crowding and safety risks. Professor Ted Baker said: “Our inspections are showing that this winter is proving as difficult for emergency departments as was predicted. Managing this remains a challenge but if we do not act now, we can predict that next winter will be a greater challenge still. “We cannot continue this trajectory. A scenario where each winter is worse than the one before has real consequences for both patients and staff.”
    Read full story
    Source: The Independent, 18 February 2020
     
     
  5. Clive Flashman
    A freedom of information request by HSJ has for the first time revealed a complete list of participants in NHS England’s maternity safety support programme, with 28 trusts involved since its inception in 2018.
    London North West University Healthcare Trust, Northern Lincolnshire and Goole Foundation Trust, and Worcestershire Acute Hospitals Trust all entered the scheme at the start, due to pre-existing quality and safety concerns. The trusts were all subsequently removed, having been deemed to have made improvements, but have since been placed back in it following inspections by the Care Quality Commission (see table below).
    HSJ asked the trusts to explain why they had re-entered the scheme, and why it had failed to deliver sustainable improvements the first time, but they declined to comment.
    NHSE said in a statement: “Trusts are placed on the maternity safety support programme according to complex criteria, including local insight and external performance measures, including CQC ratings. “Following the success of the programme since its creation in 2018, its criteria was widened to strengthen its role in proactively improving safety and enabling earlier intervention where there are concerns — this has allowed support to be offered to more trusts than in previous years.” However, it would not provide further details on the new entry criteria.
    Three further trusts — Barts Health, North Devon Healthcare, and the Queen Elizabeth Hospital King’s Lynn — have previously exited the programme and not so far re-entered. Trusts such as Shrewsbury and Telford and East Kent — which have been at the centre of major maternity scandals — have been on the improvement scheme for all four years.
    Peter Walsh, chief executive of the patient safety charity Action against Medical Accidents, said: “The number of NHS maternity services being found to be needing improvement is worrying. We welcome the fact that NHS England is devoting resources to support trusts to improve their maternity services, but there should be much more transparency about this.
    “The criteria for needing this support should be published, and indeed should have been subject to consultation.”
    Helen Hughes, chief executive of patient safety charity Patient Safety Learning, said there should be transparency about resource allocation and the criteria used to make decisions, adding: “It doesn’t appear that this information is easily accessible and in the public domain and rather begs the question, why not?” 
    NHSE said trusts receiving support from the programme detail this in their board papers, although HSJ found this is not always the case. It added trusts are made aware of the rationale for inclusion on an individual basis.
    NHSE and the Department of Health and Social Care last year described the maternity safety support programme as the “highest level of maternity-specific response”. They have said the programme “involves senior clinical leaders providing hands on support to provider trusts, through visits, mentoring, and leadership development”.
    Full article here (paywalled)
    Original source: Health Service Journal
  6. Clive Flashman
    Videos circulating on the social media platform claim that castor oil can help to treat dryness, floaters, cataracts, poor vision and even glaucoma.
    Doctors have issued a warning not to use castor oil as a way to treat vision problems following claims on TikTok.
    Castor oil is a type of vegetable oil traditionally used to treat a range of issues like skin infections. It is even a common ingredient in some over-the-counter eye drops. But dozens of TikTok videos have gone one step further, claiming that by rubbing the oil over eyelids, eyelashes and under the eye, it helps to treat dryness, floaters, cataracts, poor vision and even glaucoma. One woman said that after two weeks of use, she doesn't need to wear reading glasses as often, while another said it prevented an eye infection from progressing.
    Now, doctors in the US have said the oil is "not going to seep in and dissolve or fix anything". They warned that some unsterilised bottles on shop shelves may even cause irritation or infection if put directly into the eye. "Castor oil is not a cure-all. If you have concerns about your eyes, you need to see an optician," Dr Ashley Brissette, a spokesperson for the American Academy of Ophthalmology. She said they cannot make recommendations as studies that look at the effects of eye drops which contain castor oil on dry eyes and blepharitis are of low quality, involving small sample sizes and no control groups.
    Dr Vicki Chan, a practising optician in Los Angeles added that castor oil has no effect on conditions that affect the inside of the eyeball. These include cataracts - an age-related condition that causes cloudy vision - floaters, and glaucoma, which occurs when fluid accumulates and damages the optic nerve. Dr Brissette added that ignoring early symptoms of glaucoma, or waiting to see it castor oil improves conditions such as cataract, can lead to permanent vision loss or complications with surgery. Instead, eating a healthy balanced diet; removing all make up before bed; wearing sunglasses outdoors and attending regular eye examinations are alternative ways to maintain eye health.
  7. Clive Flashman
    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.
  8. Clive Flashman
    A mental health trust ‘scapegoated’ a psychiatrist over the death of a patient amid systemic issues, an employment tribunal has found.
    Judges called the conduct of two senior directors — one of whom is a current NHS trust medical director — into question after ruling they had colluded to scapegoat Bernadette McInerney for issues that would have damaged the trust’s reputation.
    Nottinghamshire Healthcare Foundation Trust was found unanimously to have unfairly sacked and victimised Dr McInerney, a former consultant forensic psychiatrist at Rampton secure hospital, in a decision published last week.
    The judgement was critical of both Chris Packham, a GP at Rampton hospital, and NHFT’s then-executive medical director Julie Hankin, but it also strongly condemned the trust’s former executive director for forensic services Peter Wright. Dr Hankin is now medical director at Cambridgeshire and Peterborough FT.
    Read full article here (paywalled)
    Original source: Health Service Journal
  9. Clive Flashman
    Researchers at UCL-led collaboration i-sense, have published a dashboard to collate data on five stages, Find, Test, Track, Isolate and Support, with an aim to provide a complete picture of the pandemic.
    The i-sense COVID Response Evaluation Dashboard (COVID RED) collates and presents data from the Office of National Statistics, Public Health England, and the NHS under five categories; Find, Test, Track, Isolate and Support for those asked to Isolate (FTTIS). It presents indicators of performance under each of these headings, and identifies areas where more data is needed.
    Co-developer Professor Christina Pagel, UCL Mathematics & Physical Sciences, said: “Increasing volumes of data are being shown in the media and in government press conferences as a basis for local tightening of restrictions.”
    “However, these data are often from disparate sources, and are not linked together to give a more complete picture of how we are doing. This was the motivation behind our dashboard development. We wish to contribute to the public understanding of COVID-19’s spread, and support policymakers in identifying current areas of the Find, Test, Trace, Isolate and Support structure requiring strengthening.”
    Read full article
    Source: Health Tech Newspaper, 30 October 2020
    To access the dashboard, click here
  10. Clive Flashman
    Many feared that the UK leaving the EU would cause shortages and limitations to the medicine supply throughout England, Scotland, Wales and Northern Ireland. Now ten months on from Brexit are we finally seeing the short fallings?
    Ninety percent of the UK's medicines are imported from abroad meaning disruptions caused by the outcomes of Brexit and a lack of HGV drivers has caused a significant problem in transporting drugs into the country.
    Leaked Department of Health and Social Care documents revealed two hundred and nine medicines had supply “issues” in 2019, more than half of these remained in short supply for over three months. Drugs such as hepatitis vaccines and anti-epileptic drugs, faced “extended” problems.
    A document published by the NHS Nottinghamshire Shared Medicines Management Team compiled a list of shortages and disruptions to supply due to COVID.
    The following 5 products had long-term manufacturing issues:
    AstraZeneca’s Zyban (bupropion, anti-smoking drug) Par’s Questran (colestyramine, a bile acid sequestrant) Diamorphine (a painkiller, used for cancer patients) Metoprolol (used for high blood pressure) Co-Careldopa (given to people with Parkinson’s disease) A further thirty medicines had short-term manufacturing issues, including end of life medicines such as morphine and anti-vomiting drug, levomepromazine.
    NHS Scotland and NHS Wales have published lists of drugs in low supply which are available to view on their NHS websites. NHS England consider this to be ‘sensitive information’ and have not published any shortfalls.
    An amendment to The Human Medicines Regulations 2019 legislation has added a ‘Serious Shortage Protocol’ (SSP). This allows for pharmacists and contractors to supply patients with a ‘reasonable and appropriate substitute’ if their prescription has an active SSP.
    Currently, shortages on Fluxoetine, (anti-depressive drug) and Estradot patches, (hormonal replacement therapy) have active SSP’s according to the NHS Business Service Authority.
    Original source: National Health Executive
  11. Clive Flashman
    The Office for Health Improvement and Disparities (OHID) has been officially launched by the UK Government, aimed at preventing health disparities across the country and supporting people to live longer, healthier, and happier lives.
    OHID will focus on stopping debilitating health conditions before they develop and represents a distinct step-change in focus from the Government towards a more preventative, rather than reactionary, approach to health.
    One of the key intentions of this is to reduce the backlog and also put social care on a long-term sustainable footing, tackling health issues much earlier in their presentation, tackling the underlying causes of many of these, or preventing them altogether.
    The new government office will see Professor Chris Whitty, Chief Medical Officer, provide professional leadership to the organisation.
    Announcing the official launch of OHID, the Government pointed to some of the clear trends shown in recent figures, which highlight how geographical location can play a significant role in a person’s life expectancy and the years that they can expect to live a healthy life. For example:
    men in the most deprived areas in England are expected to live nearly 10 years fewer than those in the least deprived. Women in the same areas can expect to live 7 years fewer smoking is more prevalent in more deprived areas and one of the leading causes of inequalities in life expectancy; an international study found it accounts for half the difference in mortality between the least and most deprived men aged 35 to 69 obesity is widespread but more prevalent among the most deprived areas; prevalence is almost 8% higher among those living in the most deprived decile of local authorities (66.6%) compared to those in the least deprived areas (58.8%) Under its new remit, OHID will work to coordinate across local and central government, the NHS and wider society – utilising expert advice, analysis, and evidence – to drive improvements in the public’s health which may be able to have preventative roles and level up health across the UK.
    Preventative approaches to health can, it is intended, reduce the pressure on existing healthcare services, saving significant resource and money, and ensure that record investments into health and social care services can go further.
    Source: National Health Executive
    Health and Social Care Secretary, Sajid Javid said: “The pandemic has laid bare the health disparities we face not only as a country, but as communities and individuals.
    “This must change, and this body marks a new era of preventative healthcare to help people live healthier, happier and longer lives.
    “The Office for Health Improvement and Disparities will be the driving force across government, supported by communities, academics, industry and employers, to level up the health of our nation, which will reduce the pressure on our NHS and care services.”
  12. Clive Flashman
    U.S. News has just released its list of the best hospitals with associated rankings and ratings.
    Scores are based on several factors, including survival, patient safety, nurse staffing and more. U.S. News reviews hospitals performance in 15 adult specialties, 10 pediatric specialties and 17 surgical procedures and medical conditions affecting millions of people across the country.
    Find all of the rankings and ratings here
     
  13. Clive Flashman
    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
  14. Clive Flashman
    A hospice is using virtual reality (VR) to help patients relax and transport them away from their beds.
    St Giles Hospice, which has bases in Lichfield and Sutton Coldfield, said the headsets allowed patients "to escape the realities of their present situation".
    "I've never experienced anything quite like it in my life - I was totally lost in the moment," Janet, 71, said.
    The VR experiences include cities of the world, space, and wildlife.
    Beth Robinson, Occupational Therapist at St Giles Hospice, said the VR headsets helped patients "immerse themselves into a calming space".
    To read the full article, click here
  15. Clive Flashman
    No single solution will stop the virus’s spread, but combining different layers of public measures and personal actions can make a big difference.
    It’s im­por­tant to un­der­stand that a vac­cine, on its own, won’t be enough to rapidly ex­tin­guish a pan­demic as per­ni­cious as Covid-19. The pan­demic can­not be stopped through just one in­ter­ven­tion, be­cause even vac­cines are im­per­fect. Once in­tro­duced into the hu­man pop­u­la­tion, viruses con­tinue to cir­cu­late among us for a long time. Fur­ther­more, it’s likely to be as long as a year be­fore a Covid-19 vac­cine is in wide-spread use, given in­evitable dif­fi­cul­ties with man­u­fac­tur­ing, dis­tri­b­u­tion and pub­lic ac­ceptance.
     Con­trol­ling Covid-19 will take a good deal more than a vac­cine. For at least an­other year, the world will have to rely on a mul­ti­pronged ap­proach, one that goes be­yond sim­plis­tic bro­mides and all-or-noth­ing re­sponses. In­di­vid­u­als, work-places and gov­ern­ments will need to con­sider a di­verse and some­times dis­rup­tive range of in­ter­ven­tions. It helps to think of these in terms of lay­ers of de­fence, with each layer pro­vid­ing a bar­rier that isn’t fully im­per­vi­ous, like slices of Swiss cheese in a stack.
     The ‘Swiss cheese model’ is a clas­sic way to con­cep­tu­al­ize deal­ing with a haz­ard that in­volves a mix­ture of hu­man, tech­no­log­i­cal and nat­ural el­e­ments.
    This article can be read in full on the WSJ website, but is paywalled. 
    The illustration showing the swiss cheese pandemic model is hyperlinked to this hub Learn post.
  16. Clive Flashman
    Making data on medical interventions easier to collect and collate would increase the odds of spotting patterns of harm, according to the panel of a recent HSJ webinar
    When Baroness Julia Cumberlege was asked to review the avoidable harm caused by two medicines and one medical device, she encountered no shortage of data.
    “We found that the NHS is awash with data, but it’s very fractured,” says Baroness Cumberlege, who chaired the Independent Medicines and Medical Devices Safety Review and now co-chairs the All-Party Parliamentary Group which raises awareness of and support for its findings.
    And it is that fracturing that can make patterns of harm difficult to spot. The report concluded that many women and children experienced avoidable harm through use of the hormone pregnancy test Primodos, the epilepsy drug sodium valproate, and the medical device pelvic mesh – simply because it hadn’t been possible to connect the dots.
    “It’s very hard to collect things together and to get an overall picture. And one of the things that we felt very strongly about was that data should be collected once, but used often,” said Baroness Cumberlege at a recent HSJ webinar. Run in association with GS1 UK, the event brought together a panel to consider how better data might help address patient safety challenges such as problems with implants.
    “But the big problem was they couldn’t identify who had which implants. No doubt somebody somewhere had written this down with a fountain pen and then someone spilt the tea over it and the unique information was lost,” recalled Sir Terence Stephenson , now Nuffield professor of child health at Great Ormond Street Institute of Child Health and chair of the Health Research Authority for England.
    The review he chaired therefore suggested establishing a concept of person, product place – “for everybody who had something implanted in them, we should have their name, the identifier of what had been put in, and where it had been put in. And one of my panel members said: ‘Well, how are we going to record this? We don’t want the fountain pen and the teacup.’”
    Ultimately the answer suggested was barcode scanning. By scanning the wristband of a patient, that on the product being implanted, and one for the hospital theatre or department at which it was being implanted, the idea was to create an immediate and easy-to-create record.
    For those long convinced of the virtues of barcode scanning in health, it is a welcome development
    Two years later, the then Department of Health launched the Scan4Safety programme, in which six “demonstrator sites” implemented the use of scanning across the patient journey. At these organisations, barcodes produced to GS1 standards – meaning they are globally unique – are present on patient wristbands; on equipment used for care, including implantable medical devices; in locations; and sometimes on staff badges.
    Link to full article here (paywalled)
  17. Clive Flashman
    Lawyers acting for whistleblowers have told MPs and peers that they can feel intimidated to raise concerns over non-disclosure agreements (NDAs) because of the threat of retaliation.
    Whistleblowers themselves have also accused employers’ law firms of using underhand tactics in employment tribunal cases, and the All-Party Parliamentary Group on Whistleblowing said it would move on to look in more detail at the role of lawyers.
    The findings came in the group’s first report – focusing on ‘the voice of the whistleblower’ – which found that, although the UK “remains a leading authority on whistleblowing legislation”, the Public Interest Disclosure Act 1998 (PIDA) needed “a radical overhaul”.
    Read the full article here.
  18. Clive Flashman
    A senior district nurse who was unfairly dismissed after blowing the whistle over valid safety concerns has told how the ordeal has left her life in "chaos" and she feels forced to quit the profession for good. 
    Linda Fairhall, who had worked at North Tees and Hartlepool NHS Foundation Trust for 38 years, has spoken to Nursing Times about her experiences after she successfully challenged her employer's decision to sack her. Between December 2015 to October 2016, Ms Fairhall raised 13 concerns to the trust regarding staff and patient safety. At the time, she was managing a team of around 50 district nurses in her role of clinical care co-ordinator.
    Read full story (paywalled)
    Source: Nursing Times, 17 February 2020
  19. Clive Flashman
    Despite regular MRI scans at the Royal Preston Hospital showing that the tumour was growing, May Ashford was not offered surgery until five years later.
    A woman died unnecessarily after doctors failed to operate soon enough on a growing brain tumour, according to the health complaints service.
    May Ashford, from Blackpool, was diagnosed with a brain tumour in 2010 after experiencing headaches and seizures.
    Despite regular MRI scans at the Royal Preston Hospital showing that the tumour was growing, she was not offered surgery until five years later.
    An investigation by the Parliamentary and Health Service Ombudsman (PHSO) said the treatment was too late as medical staff had failed to monitor the scan results properly.
    Medical experts said Mrs Ashford should have been operated on at least three years earlier, before the tumour had time to grow and affect the surrounding area of the brain.
    She tragically died aged 71 from a stroke following surgery.
    Link to full article here
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