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Sam

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  1. Sam
    A regulator overseeing 340,000 professionals breached a psychologist’s human rights by letting their fitness-to-practise case go on for a decade, amid widespread very long delays, it has emerged.
    A judgment from the Health and Care Professions Tribunal said the “lamentable” situation for the registrant was down to the “disgraceful… manner in which the Healthcare Professions Council dealt with their case”.
    The HCPC oversees professional standards for several groups including radiographers, paramedics, physiotherapists, occupational therapists, and operating department practitioners.
    If a complaint is made about a registrant, it can investigate and refer them to the tribunal, which can strike them off.
    The Society of Radiographers said the current speed of cases was “simply unacceptable” and its director of industrial strategy Dean Rogers added: “Our members spend too long working — and living — under the intense scrutiny of their regulator, often under the control of an interim order restricting or even preventing their practise while investigations drag on.”
    Read full story (paywalled)
    Source: HSJ, 17 April 2024
  2. Sam
    In a recent interview in The Times, former Chief Medical Officer, Professor Sir Harry Burns considers the symptoms of the country’s drug deaths epidemic. The total of 1,187 fatalities in 2018 represents 218 drug deaths per million of the population and a 27% year-on-year rise. The death rate is three times higher than in the UK as a whole and worse than that of the United States. Politicians should listen to people working on the front line to tackle rising deaths, according to Sir Harry. The trouble is, he says, “public policy tends to be made because someone has a clever idea which then gets picked up by a politician. Very few outcomes in society are determined by one thing.” He believes that health and social benefit on a national scale comes with incremental change over an extended period of time. 
    When asked what one thing would you do to improve the health of the nation, Sir Harry said "Scotland has made enormous strides in improving patient safety using the concepts of improvement science in which front line staff have tested many different ideas and applied at scale the changes which they have seen work. It’s the principle of marginal gains that has been successful in sport. I would use this approach to improve wellbeing across society."
    Read full interview
    Source: The Times, 20 July 2019
  3. Sam
    ‘Very heavy-handed, laborious and expensive’ inspections ‘have not been the right way’ of regulating hospitals, according to the Care Quality Commission’s (CQC) former chair.
    Speaking at a Royal Society of Medicine event on Wednesday, Lord David Prior, who is now the chair of NHS England, said “very few” physicians will have improved their work after reading a report from the regulator.
    He added that there is a role for the CQC to move in when “things are going wrong” although he is “sceptical” the regulator can actually drive improvement in hospitals.
    Lord Prior said: “I am highly sceptical as to whether or not CQC or any regulator can really drive improvement and drive the top hospitals to make them better.
    “And certainly I think there’ll be very few physicians who will say that their clinical work has improved as a result of reading a CQC report.
    “I think the sadness I have about CQC is that we have not been able, or it has not been able, to develop a series of predictive metrics that could replace these very heavy handed, very laborious and very expensive visits that we used to do.”
    Read full story (paywalled)
    Source: HSJ, 9 September 2021
  4. Sam
    Hundreds of migrants have declined NHS treatment after being presented with upfront charges over the past two years, amid complaints the government’s “hostile environment” on immigration remains firmly in place.
    Data compiled by the Observer under the Freedom of Information Act shows that, since January 2021, 3,545 patients across 68 hospital trusts in England have been told they must pay upfront charges totalling £7.1m. Of those, 905 patients across 58 trusts did not proceed with treatment.
    NHS trusts in England have been required to seek advance payment before providing elective care to certain migrants since October 2017. It covers overseas visitors and migrants ruled ineligible for free healthcare, such as failed asylum seekers and those who have overstayed their visa. The policy is not supposed to cover urgent or “immediately necessary” treatment. However, there have been multiple cases of people wrongly denied treatment.
    Dr Laura-Jane Smith, a consultant respiratory physician and member of the campaign group Medact, said: “I had a patient we diagnosed as an emergency with lung cancer but they were told they would be charged upfront for treatment and then never returned for a follow-up. This was someone who had been in the country for years but who did not have the right official migration status. A cancer diagnosis is devastating. To then be abandoned by the health service is inhumane.”
    Read full story
    Source: The Guardian, 20 August 2023
  5. Sam
    “Frustration with the system was why I went off in the end,” said Conor Calby, 26, a paramedic and Unison rep in southwest England, who was recently off work for a month with burnout. “I felt like I couldn’t do my job and was letting patients down. After a difficult few years it was challenging.”
    While he usually manages to keep a distinct divide between work and home life, burnout eroded that line. He also lost his sleep pattern and appetite.
    The final straw came when what should have been a 15-minute call resulted in three hours on the phone trying to persuade the services that were supposed to help a suicidal patient to come out. “I was on a knife edge. That was due to the system being broken. That’s the trigger.”
    Doctors and nurses are struggling under the strain too. After her third time with burnout - the last resulting in her taking six months off work – Amy Attwater, an A&E doctor, considered leaving the profession altogether.
    Attwater, 36, said in the Covid crisis, during which a colleague killed himself, she started having suicidal thoughts and doubting her own abilities. She twice reported that she was being bullied but said no action was taken.
    “The only thing I was left with was to take time off work. I ended up having therapy, seeing a psychiatrist and being on two antidepressants,” said Attwater, the Midlands-based committee member for Doctors’ Association UK.
    Read full story
    Source: The Guardian, 5 February 2023
  6. Sam
    Staff failed to provide kind and compassionate care and did not treat children with respect at a private hospital downgraded from ‘good’ to ‘inadequate’, a report by health inspectors has revealed.
    Huntercombe Hospital Stafford was placed in special measures in 2016, but was rated “good” by the Care Quality Commission two years later.
    Now, its first inspection under provider Huntercombe Young People Ltd in October 2021 has exposed a raft of safety concerns and instances of poor care. Huntercombe Young People Ltd took over the service in February 2021. 
    Heavy reliance on agency staff, workers spotted with their “eyes closed” on observations, and staff not respecting young people’s pronouns were among concerns inspectors flagged.
    Staff observation of patients was also found to be “undermined” by a blind spot where people could self-harm unseen, the CQC report, published today, said.
    Children also told the CQC they felt staff did not always understand their mental health condition or know how to support them, particularly those on the psychiatric intensive care ward with eating disorders or autism.
    Read full story (paywalled)
    Source: HSJ, 10 March 2022
  7. Sam
    Up to £20 million is available for new research projects which aim to understand and address the longer-term physical and mental health effects of COVID-19 in non-hospitalised individuals. 
    Increasing medical evidence and patient testimony has shown that some people who contract and survive COVID-19 may develop longer-lasting symptoms.
    Symptoms can range from breathlessness, chronic fatigue, ‘brain fog’, anxiety and stress and can last for months after initially falling ill. 
    These ongoing problems, commonly termed ‘Long-COVID’, may be experienced by patients regardless of how severe their COVID-19 infection was and irrespective of whether they were hospitalised.
    UK Research and Innovation (UKRI) and the National Institute for Health Research (NIHR) are launching a call to fund two or three ambitious and comprehensive proposals and a small number of study extensions that will address ‘Long-COVID’ in the community. 
    This work will complement other major studies already funded by UKRI and NIHR which focus on long covid in hospitalised patients. Projects are expected to start early in the new year and may be funded for up to three years in the first instance.
    The call will open on 12 November and close on 9 December 2020.
    Further information
  8. Sam
    Junior doctors will take part in what is “thought to be the longest single period of industrial action in the history of the health service” for five days next month.
    The British Medical Association junior doctor committee announced this morning there would be a walkout from 7am on Thursday 13 July and 7am on Tuesday 18 July in its ongoing pay dispute with government.
    It comes amid growing expectation that a Royal College of Nursing ballot on further strike action over the Agenda for Change pay award, which ends this week, is likely to fail to secure a mandate.
    But junior doctors’ strikes are continuing to hit elective recovery, and strain relationships, with workload on other groups increased as they are asked to provide cover. 
    Junior doctors have allowed no “derogations” (exemptions) from the action, as they say other staff groups can cover emergency care, and one move to call them in to a busy hospital in the south west, in an earlier round, was abandoned. 
    Read full story (paywalled)
    Source: HSJ, 23 June 2023
  9. Sam
    A hospital trust has admitted that ‘medically fit’ patients caught covid on its wards while waiting to be discharged, with some of the cases under investigation.
    Bedfordshire Hospitals FT board papers said that a “number” of medically fit patients “acquired [covid] infection while awaiting appropriate and safe discharge”.
    Trusts nationwide have struggled to discharge patients as quickly as they wanted, the reasons including a Department of Health and Social Care mandate to only allow designated care homes to accept covid patients; the resumption of NHS Continuing Healthcare tests; shortages of community beds; and capacity in the care sector.
    The trust, formed in April by the merger of Luton and Dunstable University Hospital FT and Bedford Hospital FT, said a “significant proportion of [its covid] cases [were] due to acquisition in the hospital”.
    It continued: “A significant additional factor was the length of stay for many patients who were medically fit for discharge but were unable to return to their place of residence. Case reviews have shown that a number of these patients acquired infection while waiting appropriate and safe discharge.”
    The board papers said its covid serious incident reviews covered “some deaths on both sites… and the majority [were] patients with very severe co-morbidity”. It said six out of 15 serious incidents being investigated at its Bedford hospital site were “of potentially avoidable nosocomial covid infection (hospital acquired)”.
    Read full story (paywalled)
    Source: HSJ, 4 Februrary 2021
  10. Sam
    NHS bosses are using misleading figures to hide dangerously poor performance by A&E units in England against the four-hour treatment target, emergency department doctors claim.
    Some A&Es treat and admit, transfer or discharge as few as one in three patients within four hours, although the NHS constitution says they should deal with 95% of arrivals within that timeframe.
    How well or poorly A&Es are doing in meeting the 95% target is not in the public domain because the data that NHS England publishes is for NHS trusts overall, not individual hospitals.
    That means official figures are an aggregate of performance at sometimes two A&Es run by the same trust or include data for any walk-in centres, minor injuries units or urgent treatment centres that a trust also operates. Forty-eight trusts have two A&Es and many also run at least one of the latter.
    The Royal College of Emergency Medicine (RCEM), which represents A&E doctors, wants that system scrapped. It is urging NHS England to start publishing data that shows the true performance of every individual emergency department against the 95% standard.
    “The current data is misleading,” Dr Adrian Boyle, the college’s president, told the Guardian. “It’s a good example of a lack of transparency and also of performance incentives. Being open about the long delays in some A&Es would shine a light in some dark places.”
    Read full story
    Source: The Guardian. 28 October 2023
  11. Sam
    Multiple problems have been highlighted with the leadership and governance of a much-vaunted integrated care system, including a lack of trust between organisations which often hide information that could weaken their position.
    HSJ has seen an executive summary of the review of Greater Manchester ICS, which cited widespread concerns around the allocation of resources, confusion about the role of commissioning, and “muddled” governance, including:
    a lack of transparency and trust between partners, with some only sharing a “partial overview” of performance and finances which drives choices likely to “bias” some organisations;
    complex architecture of system boards, committees and forums, with “muddled” governance, unclear paths for critical decisions to be made, and unclear delegations to localities;
    frustration at the quantum of meetings that take place at system, locality and provider level.
    Read full story (paywalled)
    Source: HSJ, 2 June 2023
  12. Sam
    An ‘outstanding’ trust’s Care Quality Commission rating has been dropped to ‘requires improvement’, after inspectors found potential safety risks and a disconnect between board and ward.
    A highly critical report on University Hospitals Sussex Foundation Trust also downgraded its well-led rating to “inadequate” and recommended the trust be placed in segment four – the bottom tier – of NHS England’s system oversight framework. Its main tertiary centre – the Royal Sussex County Hospital – was also rated “inadequate”, including for safety.
    Deanna Westwood, Care Quality Commission’s director of operations in the South, said “staff and patients were being let down by senior leaders, especially the board, who often appeared out of touch with what was happening on the wards and clinical areas and it was affecting people’s care and treatment”.
    Read full story (paywalled)
    Source: HSJ,12 May 2023
  13. Sam
    Pregnant women and new mothers are facing wide variation in access to mental health support, new figures suggest, as NHS England admits national performance on a key long-term plan goal to expand services is ‘over a year behind trajectory’.
    Analysis of access rates for perinatal mental health services from NHS Digital shows the rates of women accessing support within the past 12 months range from 3.7 per cent in Humber and North Yorkshire to 15 per cent in Shropshire, Telford and Wrekin ICS.
    The long-term plan target is for 66,000 women per year to be accessing specialist perinatal services, which can help with conditions such as post-partum psychosis, by March 2024. NHSE admitted in its papers that “although access is increasing, performance remains over a year behind trajectory”.
    Read full story (paywalled)
    Source: HSJ, 25 May 2023
  14. Sam
    The health service in England is returning to a payment-by-results-style system for elective activity, new guidance confirms.
    Providers struggled to hit elective targets in 2022-23, in large part due to ongoing covid, emergency care and staffing pressures, but some have argued that incentives to carry out more activity are too weak.
    Proposals for the NHS payment system for 2023-24 issued state: “The large backlog in elective care is a significant issue for the NHS and the patients who rely on it. We want the NHSPS to include an elective funding mechanism which means that providers are paid based on the level of activity they deliver.”
    The plans add: “The approach we are proposing gives providers maximum financial incentive to deliver the elective activity targets they are being set.”
    Read full story (paywalled)
    Source: HSJ, 23 December 2022
  15. Sam
    Dr Katherine Henderson, a senior A&E consultant in London and President of the Royal College of Emergency Medicine, says physical and verbal attacks have increased in recent months.
    Speaking to the Guardian, she says: “It is a sad reality that in recent months there has been a rise in abuse directed towards healthcare workers, but this abuse is not something new to frontline staff or emergency departments. It was bad before the pandemic, but there’s a changed atmosphere now.
    “During the pandemic people were being very positive about healthcare workers. But now the public are frustrated that services aren’t getting back to normal. Maybe people who weren’t the source of abuse before are now being the source of abuse. Abuse may be physical or verbal, it may be through social media, or it may be racial or misogynistic.
    “People are being angry – very angry – with us. They are angry about long waits, about having to stand outside emergency departments in queues, about delays in ambulances coming, including to take their relative home from hospital. The public haven’t really caught up with how struggling the whole NHS is."
    Read full story
    Source: The Guardian, 10 October 2021
  16. Sam
    Ministers have denied care home inspectors access to weekly testing for coronavirus – despite fears they could contribute to the spread of COVID-19 as cases rise across the country, The Independent can reveal.
    The Care Quality Commission (CQC) was told by the Department of Health and Social Care last month it could not have access to regular testing for inspection teams as the watchdog prepares for 500 inspections of care homes during the next six weeks.
    Officials said the teams, who are assessing care conditions for the vulnerable and elderly, did not get close enough to people to present a risk.
    During the first wave of the virus, after Public Health England initially said there was no risk to care homes, an estimated 16,000 residents died from the virus.  At the height of the crisis up to 25,000 NHS patients were discharged to care homes by the NHS, with many not having been tested for the virus.
    Labour MP Barbara Keeley said: “The refusal of the Department of Health and Social Care to treat CQC inspectors in the same way as other staff going into care homes puts lives at risk.”
    Read full story
    Source: The Independent, 20 October 2020
  17. Sam
    The Care Quality Commission may in future be notified when ‘secretive’ external reviews have looked at patient safety issues within trusts.
    Last summer, HSJ revealed guidance for trusts to publish summaries of royal colleges’ reviews was being widely ignored, with some even failing to inform the CQC.
    A recent BBC Panorama programme has again raised the issue, with Academy of Medical Royal Colleges chair Helen Stokes-Lampard saying she was “dismayed” the body’s guidance was not being followed.
    But she has now told HSJ of “advanced discussions” with the CQC about changes which would see the royal colleges routinely inform the regulator when reviews raise patient safety issues.
    Read full story (paywalled)
    Source: HSJ, 3 June 2021
  18. Sam
    Health professionals should not let fears about sharing personal data “stand in the way” of reporting patients at risk of ”being groomed into terrorist activity”, new government guidance has stressed.
    New guidance has been developed in response to concerns raised by clinicians about information sharing without consent for the purposes of the anti-terror Prevent and Channel programmes.
    It stresses that “fears about sharing personal data should not be allowed to stand in the way of the need to safeguard and promote the welfare of children and adults at risk of abuse or exploitation”.
    However, despite the need for clarity it describes how the decision for making a referral without someone’s informed consent should be subject to a “case-by-case” basis assessment, which considers whether the informed consent of the individual can be obtained, and if the proposed data sharing is legitimate, necessary, proportionate and lawful.
    It said: “This assessment should be based on your professional opinion that there is tangible public interest or best interest considerations involved.”
    Read full story (paywalled)
    Source: HSJ, 29 September 2022
  20. Sam
    A patient flow model which involves moving A&E patients to wards “irrespective” of whether there are beds available, is under review for wider rollout by NHS England and is being endorsed by senior clinicians, despite safety fears, HSJ has learned. 
    The Royal College of Emergency Medicine has said it would be “unethical” for leaders not to at least consider implementing some form of “continuous flow” model for emergency patients.
    The approach has been been trialled recently by North Bristol Trust and at several London trusts. HSJ understands NHS England is considering the wider implementation of the continuous flow model, although no final decision has yet been made.
    The calls come despite patient safety concerns about the model being raised by the Nuffield Trust think tank, who said the evidence for the model is “poor” and could spread risk to other parts of the hospital.
    Read full story (paywalled)
    Source: HSJ, 21 October 2022
  21. Sam
    Hospitals have been accused of “unnecessary secrecy” for refusing to disclose how many of their patients died after catching Covid on their wards.
    The Patients Association, doctors’ leaders and the campaign group Transparency International have criticised the 42 NHS acute trusts in England that did not comply fully with freedom of information request for hospital-acquired Covid infections and deaths.
    The Guardian revealed on Monday that up to 8,700 patients lost their lives after probably or definitely becoming infected during the pandemic while in hospital for surgery or other treatment. That was based on responses from 81 of the 126 trusts from which it sought figures.
    The British Medical Association, the main doctors’ trade union, said the 42 trusts that did not reveal how many such deaths had occurred in their hospitals were denying the bereaved crucial information.
    “No one should come into hospital with one condition, only to be made incredibly ill with, or even die from, a dangerous infectious disease,” Dr Rob Harwood, chair of the BMA’s hospital consultants committee, said.
    “Families, including those of our own colleagues who died fighting this virus on the frontline, deserve answers. We will only get that if there is full transparency."
    Read full story
    Source: The Guardian, 25 May 2021
  22. Sam
    A director at a major acute trust said it needs to stop “caving in” to demand pressures by opening extra escalation beds.
    Board members at Mid and South Essex were discussing a recent report from the Care Quality Commission (CQC), which rated medical services as “inadequate”.
    The CQC flagged significant staffing shortages and repeated failures to maintain patient records, among other issues.
    Deputy chair Alan Tobias told yesterday’s public board meeting: “We have just got to hold the line on these [escalation] beds. We never do. Every year we cave in…
    “We have just got to hold the line with this… Do what some other hospitals do, they shut the doors then. We have never had the bottle to do that.”
    Barbara Stuttle, another non-executive director, said: “Our staff are exhausted… We don’t have the staff to give the appropriate care to our patients when we have got extra beds. To have extra beds on wards, I know we have had to do it and I know why, [but] you are expecting an already stretched workforce to stretch even further.
    “And when that happens, something gives. Record keeping, that’s usually the last thing that gets done because they’d much rather give the care to patients.”
    Read full story (paywalled)
    Source: HSJ, 28 July 2023
  23. Sam
    The United States is now in its fourth-biggest Covid surge, according to official case counts – but experts believe the actual current rate is much higher.
    America is averaging about 94,000 new cases every day, and hospitalizations have been ticking upward since April, though they remain much lower than previous peaks.
    But Covid cases could be undercounted by a factor of 30, an early survey of the surge in New York City indicates.
    “It would appear official case counts are under-estimating the true burden of infection by about 30-fold, which is a huge surprise,” said Denis Nash, an author of the study and a distinguished professor of epidemiology at the City University of New York School of Public Health.
    While the study focused on New York, these findings may be true throughout the rest of the country, Nash said. In fact, New Yorkers likely have better access to testing than most of the country, which means undercounting could be even worse elsewhere.
    “It’s very worrisome. To me, it means that our ability to really understand and get ahead of the virus is undermined,” Nash said.
    Read full story
    Source: The Guardian, 2 June 2022
  24. Sam
    The national director for patient safety in England has cautioned against the ‘false hope’ of trying to achieve ‘zero harm’ from healthcare, describing it as unachievable.
    Speaking at HSJ’s Patient Safety Congress earlier this week Aidan Fowler told delegates: “The dream of zero harm is appealing. It’s what we all want. But it’s unachievable in reality, it’s unmeasurable [and] it carries risk.”
    Mr Fowler said what is really meant is eliminating “avoidable harm”, but also described this as “problematic”.
    He said: “I challenge any one of you to define ‘avoidable’. We start to define a complex system in simplistic terms. We hear, ‘we’ve had no avoidable harm for six hears in our hospital’. And you think, ‘is that real?’”
    Mr Fowler stressed the ambition should be to reduce harm to minimal levels, but said the notion that any provider could claim they had no harm for period of years was “hard to credit”.
    He said by pursuing the “zero harm” ambition, the NHS was also “setting unattainable goals to our staff”.
    “[We are] creating unrealistic expectations and burning them [staff] out and potentially creating moral distress when they’re not achieving something they’re told they should achieve,” he said.
    Read full story (paywalled)
    Source: HSJ, 21 September 2023
  25. Sam
    Dr Max Pemberton, columnist for the Daily Mail, gives his opinion of the app that offers patients a GP consultation via their mobile phone. In theory, it sounds great: the patient can dial up, speak to and (via phone camera) see a doctor, who could be anywhere. However, how effective can such consultations be?  "I have been able to test this service for myself — and what I have experienced left me worried", says Dr Pemberton.
    Read full story
    Source: The Spectator, 20 July 2019
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