In recent weeks, there has been sustained public and media interest in the death from COVID-19 of health and social care workers. Both mainstream and social media outlets have been reporting on these deaths individually or collectively, but there has been no formal analysis of this data.
The deaths of 119 NHS staff have now been analysed by three leading clinicians and the results are been published by HSJ.
HSJ highlights three key findings from the analysis:
1. The disproportionately high rate of BAME individuals among those who have died;
2. The absence of those members of staff considered at high risk of viral exposure and transmission; and
3. The overall rate of fatalities compared to the population.
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Source: HSJ, 22 April 2020
Delays in diagnosing and treating people with cancer could lead to more years of lost life than with COVID-19, according to a leading cancer expert.
A drop-off in screening and referrals means roughly 2,700 fewer people are being diagnosed every week, Cancer Research UK says.
Cancer screening has paused in Wales, Scotland and Northern Ireland, with few invitations sent out in England.
People are still advised to contact their GP with worrying symptoms.
But Richard Sullivan, professor of cancer and global health at King's College London, said there was more fear of Covid-19 than of having cancer at the moment. With GPs more difficult to contact than normal, this was resulting in a "dramatic drop-off" in referrals to specialists, he said.
"Most modellers in the UK estimate excess of deaths is going to be way greater than we are going to see with Covid-19," he said.
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Source: 22 April 2020, BBC News
The next few months will be full of grim updates about the spread of the new coronavirus, but they will also be full of homecomings. Patients hospitalised with severe COVID-19, some having spent weeks breathing with the help of a mechanical ventilator, will set about resuming their lives.
Many will likely deal with lingering effects of the virus — and of the emergency treatments that allowed them to survive it.
“The issue we’re all going to be faced with the most in the coming months is how we’re going to help these people recover,” says Lauren Ferrante, a pulmonary and critical care physician at the Yale School of Medicine.
Hospital practices that keep patients as lucid and mobile as possible, even in the throes of their illness, could improve their long-term odds. But many intensive care unit doctors say the pandemic’s strain on hospitals and the infectious nature of the virus are making it hard to stick to some of those practices.
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Source: Science, 8 April 2020
NHS staff still do not have the protective equipment they need to treat coronavirus patients, medics have said.
The British Medical Association (BMA) said doctors were putting their lives at risk by working without adequate protection.
It comes as the health secretary said 19 NHS workers had died with coronavirus since the outbreak began.
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Source: BBC News, 11 April 2020
Doctors seeing patients with blood oxygen levels so low they are surprised they are conscious – yet they are sitting up and talking.
British and American intensive care doctors at the front line of the coronavirus crisis are starting to question the aggressive use of ventilators for the treatment of patients.
In many cases, they say the machines – which are highly invasive and require the patient to be rendered unconscious – are being used too early and may cause more harm than good. Instead they are finding that less invasive forms of oxygen treatment through face masks or nasal cannulas work better for patients, even those with very low blood oxygen readings.
Dr Ron Daniels, a consultant in critical care at University Hospitals Birmingham NHS Foundation Trust, on Thursday confirmed reports from US medics that he and other NHS doctors were revising their view of when ventilators should be used.
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Source: The Telegraph, 9 April 2020
Shortages are dogging the fight against the coronavirus. At Bradford Royal Infirmary (BRI) it's still only possible to test six staff for the virus per day, consultants have been making their own personal protective equipment, and there's an urgent need to save oxygen.
Searching for ways round the problem, Dr Tom has been working with Leeds University on a 3D-printed valve that could be attached to the hospital's ventilators to reduce the amount of oxygen they use.
But he also began looking at CPAP machines used to treat sleep apnoea at home. These maintain air at a continuous pressure, inside a mask, to keep the user's airways open - they have to be repurposed to provide oxygen for use in the hospital, but they use much less of it than standard hospital ventilators.
They said, 'Yes we've got 2,000, how many do you want?''' he says. "And so our plan is to start with 100 and to see whether, if we use these early enough during a patient's stay, we can prevent people deteriorating and needing to go on to the more complex ventilators, and needing to come to the intensive care unit."
We've been testing them over the weekend, and there's evidence from China and from the US that they seem effective. They just help inflate your lungs and that seems to be beneficial.
They are also very simple, which means that there's no need for a huge amount of training.
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Source: BBC News, 7 April 2020
Hundreds of people are dying in care homes from confirmed or suspected coronavirus without yet being officially counted, the Guardian has learned.
More than 120 residents of the UK’s largest charitable provider of care homes are thought to have died from the virus in the last three weeks, while another network of care homes is reported to have recorded 88 deaths.
Care England, the industry body, estimated that the death toll is likely to be close to 1,000, despite the only available official figure for care home fatalities being dramatically lower.
The gulf in the figures has prompted warnings that ministers are underestimating the impact of Covid-19 on society’s most frail, and are failing to sufficiently help besieged care homes and workers.
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Source: The Guardian, 7 April 2020
The health service has been promised “whatever it needs” to deal with the coronavirus pandemic, but government spending choices reveal possible long-term changes to funding and policy.
Having initially promised the health service “whatever it needs, whatever it costs” on 11th March, the government made this official when Matt Hancock issued a ministerial direction allowing the Department of Health to “spend in excess of formal Departmental Expenditure Limits”—effectively providing a blank cheque.
But while the government’s actions are designed for the immediate crisis, they may be difficult to reverse once the peak of coronavirus has passed. Indeed, they could yet change how the health service operates on a permanent basis.
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Source: Prospect, 7 April 2020
National NHS leaders are to take action over growing fears that the “unintended consequences” of focusing so heavily on tackling covid-19 could do more harm than the virus, HSJ has learned.
NHS England analysts have been tasked with the challenging task of identifying patients who may not have the virus but may be at risk of significant harm or death because they are missing vital appointments or not attending emergency departments, with both the service and public so focused on covid-19.
A senior NHS source familiar with the programme told HSJ: “There could be some very serious unintended consequences [to all the resource going into fighting coronavirus]. While there will be a lot of covid-19 fatalities, we could end up losing more ‘years of life’ because of fatalities relating to non-covid-19 health complications.
“What we don’t want to do is take our eye off the ball in terms of all the core business and all the other healthcare issues the NHS normally attends to."
“People will be developing symptoms of serious but treatable diseases, babies will be born which need immunising, and people will be developing breast lumps and need mammograms.”
HSJ understands system leaders are hopeful that in the coming days they will be able to assess the scale of the problem, and the key patient groups, and then begin planning the right interventions and communications programme to tackle it.
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Source: HSJ, 5 April 2020
The NHS must ensure that doctors have proper protective equipment, Jeremy Hunt, the former health secretary, has urged.
NHS chiefs say that there are no problems with national stock levels of items including masks, gowns and gloves and that local supply issues should have been resolved over the weekend.
However, hospital staff say that they are still experiencing shortages, with nurses going to DIY shops to stock up or even refusing to work without the right equipment. One London doctor said: “Every time the government is asked they say the equipment is there, and it is just not true.”
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Source: The Times, 23 March 2020
Southampton researchers are trialling an inhaled drug that could prevent worsening of COVID19 in those most at risk.
The trial, led by Tom Wilkinson, Professor of Respiratory Medicince in the Faculty of Medicine and a consultant in respiratory medicine at University Hospital Southampton, will involve 100 patients at Southampton and up to ten other NHS hospitals taking part.
Those patients will receive the best current COVID19 care, whilst inhaling either a placebo or SNG001, a special formulation of the naturally occurring antiviral protein interferon beta 1a (IFN-β), for 14 days.
The trial will be undertaken with Synairgen, a drug development company founded by University of Southampton Professors Stephen Holgate, Donna Davies and Ratko Djukanovic.
Professor Wilkinson said, “COVID19 cis presenting a major challenge to vulnerable patients, the health service and wider society whilst a vaccine will be key, that could some time away. Right now we need effective frontline treatments to give doctors the tools to treat the most vulnerable and to help patients recover quickly as the pressure on health systems mounts."
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Source: University of Southampton, 18 March 2020
NHS staff say they are being put at risk during the coronavirus outbreak because of a lack of protective gear.
One doctor told the BBC that frontline healthcare workers felt like "cannon fodder" as they do not have access to equipment such as face masks. Health workers also expressed concerns that not enough of them were being tested for the virus.
Prime Minister Boris Johnson said the UK had "stockpiles" of personal protective equipment (PPE). But Dr Samantha Batt-Rawden, from lobbying group the Doctors' Association, said she had heard from doctors who had not got access to PPE - or it had expired or run out.
"All these doctors are worried that that's increasing their likelihood of contracting the virus and then ultimately spreading it to patients," she said.
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Source: BBC News, 18 March 2020
Prime Minister Boris Johnson has announced plans to test more people for coronavirus.
At the moment only people in hospital are being routinely tested, so if you have symptoms and you are not sure if you have the virus, you may well never know.
As of 18 March, 56,221 people in the UK had been tested for coronavirus. The number of tests has been rising from just over 1,000 a day at the end of February, when testing began, to more than 6,000 per day by mid-March.
The government plans to increase this to 10,000 a day initially, with a goal of reaching 25,000 tests a day. But it has been criticised by some experts for not testing widely enough, and people have been complaining online about not having access to tests despite having symptoms.
Public Health England says it will do some surveillance testing on a local level if clusters of cases are identified, using a network of 100 designated GP surgeries. This is to try to get a sense of how many milder cases there are in the community that do not result in hospitalisation.
But the UK is not currently doing any mass surveillance testing or actively tracing people who have come into contact with known cases
The Director General of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, said he had a "simple message" for all countries: "Test, test, test."
He added: "We cannot stop this pandemic if we do not know who is infected."
The UK's chief scientific officer Sir Patrick Vallance told a group of MPs that "we simply don't have mass testing available for the population now", and that "when you only have capacity to do a certain number of tests" you have to prioritise the most vulnerable groups.
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Source: BBC News, 19 March 2020
The mother of a student, who took his own life, said today she felt 'sick to her stomach' after an NHS communications manager labelled a media report on her son's suicide a 'malarkey'.
Pippa Travis-Williams, whose son Henry was found dead days after leaving a mental health unit run by the Norfolk and Suffolk Foundation Trust (NSFT) in 2016, said an email sent by NSFT communications manager Mark Prentice to his boss was 'disgusting'.
It comes weeks after Mr Prentice gloated in another email to his boss that the NSFT had 'got away (again)' with media coverage of the death of a dementia patient.
In an email to his boss, explaining why NSFT chief executive, Jonathan Warren, was going on BBC Look East, Mr Prentice said the NSFT might look 'uncaring' if Mr Warren did not appear and then described the coverage of Mr Curtis-Williams' suicide as a 'malarkey'.
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Source: Ipswich Star, 10 March 2020
Complaints about NHS care cannot always be investigated properly because of medical records going missing, the public services watchdog has said.
Ombudsman Nick Bennett said many people were left "suspicious" and thought there was a "darker motivation".
One woman whose notes went missing said she no longer trusted what doctors said and had lost faith in NHS transparency.
The Welsh NHS Confederation said staff were "committed to the highest standards of care".
In a report called Justice Mislaid: Lost Records and Lost Opportunities, Mr Bennett found 70% of 17 cases he looked at in Welsh NHS hospitals and care settings could not be properly investigated because of lost documents.
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Source: BBC News, 10 March
A police investigation has been launched into an alleged assault against an elderly patient with Alzheimer’s by NHS staff at the troubled East Kent Hospitals University NHS Foundation Trust.
The Independent can reveal nurses and carers at the William Harvey Hospital have been suspended after being filmed by hospital security staff for eight minutes allegedly holding down the man’s arms and legs as well as his face while they inserted a catheter.
The trust has confirmed it has launched an investigation and alerted police after the incident on 15 December on the Cambridge J ward at the William Harvey Hospital in Ashford. A spokesperson “apologised unreservedly” for the incident and said it was being treated with the “utmost seriousness”.
A whistleblower spoke out to The Independent about the incident, fearing it was being covered up by the trust after staff were told “don’t discuss it, don’t refer to it at all”.
The senior clinician said they had decided to go public after the “horrific” incident because of the trust’s toxic culture and concerns for the welfare of other patients on wards.
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Source: The Independent, 7 February 2020
A GP has been given three life sentences for 90 sex assaults on female patients.
Manish Shah assaulted 23 women and a 15-year-old girl while working in London - carrying out invasive examinations for his own gratification. The Old Bailey heard he used Angelina Jolie and Jade Goody as examples to frighten patients about their health.
Judge Anne Molyneux described him as a "master of deception who abused his position of power". "You made up stories which got into heads and caused panic," she said.
Shah, from Romford, convinced his victims to have unnecessary checks between May 2009 and June 2013.
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Source: BBC News, 7 February 2020
Patients were harmed at a Midlands trust because of delays in receiving outpatients and diagnostics appointments, the Care Quality Commission (CQC) has warned.
Following the inspection at Northern Lincolnshire and Goole Foundation Trust in September and October last year, the CQC has lowered the trust’s rating in its safety domain from “requires improvement” to “inadequate”. It warned there were insufficient numbers of staff with the right skills, qualifications and experience to “keep patients safe from avoidable harm”.
The report noted the trust had identified incidents in 2018 and 2019 where patients had come to harm due to delays in receiving appointments in outpatients, particularly in ophthalmology. Ten patients were found to have come to low harm, one patient moderate harm and two patients severe harm.
The CQC also issued a Section 31 letter of intent to seek further clarification in relation to incidents where patients had come to harm because of delays to receiving appointments in outpatients and diagnostic imaging, although it has confirmed the trust has provided details on how it is going to manage the issues raised. The watchdog said it would continue to monitor the issue.
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Source: HSJ, 7 February 2020
Dozens of women who thought they were having a "complete mesh removal" have discovered material has been left behind, the BBC's Victoria Derbyshire programme has been told.
Some women have been left unable to walk, work or have sex after having the initial vaginal-mesh implants.
Specialist surgeons say in some cases total or partial mesh removal can be beneficial. But some women said their symptoms had become worse. One was left suicidal.
Vaginal-mesh implants remain available on the NHS in England but only when certain conditions are met. In Scotland, the use of mesh was halted in 2018.
One paitent said her surgeon had promised her a "full mesh removal", but she has now been told more than 10cm (4in) could have been left behind. She had the mesh implanted several years ago to treat urinary incontinence and said she had woken after the surgery with "chronic pain in my legs, my groin and my hips". It is believed she suffered nerve damage.
A year later – after being told by one expert a mesh removal would be unlikely to resolve her pain – she found a surgeon who told her the implant could be completely removed. She had two operations, each taking her half a year to recover from, and was told there had been a full removal. But "within a few months" the pain began to return and her health deteriorated and she found out that only 5–8cm had been removed.
"My whole world turned upside down," she said, breaking into tears.
She has since been told by a separate specialist her form of mesh was one of the most difficult to remove and could cause significant nerve damage if not removed properly. She said she had never been told this by her surgeon.
The number of women affected is unknown but the Victoria Derbyshire programme understands there are at least dozens of such cases.
The Royal College of Obstetricians and Gynaecologists said in a statement that it took "each and every complication caused by mesh very seriously". It said: "Women must be informed of all options available and the benefits and risks of each so they can make the best decision about their care."
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Source: BBC News, 6 February 2020
A shortage of contraception is causing chaos and risks unplanned pregnancies and abortions, doctors are warning.
Leading sexual health experts have written to ministers warning that the supply shortage of contraceptives is beginning to lead to serious problems across the UK.
A number of daily pills and a long-acting injectable contraceptive are thought to be affected, including Noriday, Norimin and Synphase. The problem follows a shortage of hormone replacement therapy for menopausal women last year.
It is unclear how many women use these types of contraception - overall around three million women take daily pills, and more than 500,000 use long-acting contraception, such as coils, implants and injections.
The Royal College of GPs said its members were doing their best to help women find alternatives - there are many different types of daily pill available.
Faculty president Dr Asha Kasliwal said; "We are aware that women are sent away with prescriptions for unavailable products and end up lost in a system. This is causing utter chaos."
The faculty has teamed up with the Royal College of Obstetricians and Gynaecologists and the British Menopause Society to write to ministers, asking them to set up a working group to address the problems. The letter warns women are becoming distressed by having to find alternative products that might not necessarily suit them or go without contraception altogether.
It said this was affecting the "physical and mental wellbeing of girls and women" and could lead to a "rise in unplanned pregnancies and abortions".
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Source: BBC News, 7 February 2020
The toxicity of a commonly prescribed beta blocker needs better recognition across the NHS to prevent deaths from overdose, a new report warns today.
The Healthcare and Safety Investigation Branch (HSIB) report focuses on propranolol, a cardiac drug that is now predominately used to treat migraine and anxiety symptoms. It is highly toxic when taken in large quantities and patients deteriorate quickly, making it difficult to treat. The investigation highlighted that these risks aren’t known widely enough by medical staff across the health service, whether issuing prescriptions to at risk patients, responding to overdose calls or carrying out emergency treatment.
Dr Stephen Drage, ICU consultant and HSIB’s Director of Investigations, said: “Propranolol is a powerful and safe drug, benefitting patients across the country. However, what our investigation has highlighted is just how potent it can be in overdose. This safety risk spans every area of healthcare – from the GPs that initially prescribe the drug, to ambulance staff who respond to those urgent calls and the clinicians that administer emergency treatment."
The report also emphasises that there is a link between anxiety, depression and migraine, and that more research is needed to understand the interactions between antidepressants and propranolol in overdose.
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Source: HSIB, 6 February 2020
The former police chief who investigated mental health services in a crisis-hit health board was “shocked” by the poor working relationships and “blame shifting” he uncovered.
David Strang, who led the independent inquiry into the issues in NHS Tayside, said staff felt isolated and unsupported and people complained about each other’s practices without coming together to sort the issues out.
He described asking staff questions based on information he had received and being met with the response: “Who told you?” He added: “A lot of staff felt there was a real blame culture and that risk and blame fell to the front line.”
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Source: 6 February 2020, The Times
The new executive must act urgently if it is to "divert the current mental health epidemic among young people", Northern Ireland's children's commissioner has said.
Koulla Yiasouma said progress in implementing recommendations in a report on children and young people's mental health services, produced 12 months ago, had been "too slow".
The stark read captured the scale of youth mental health problems in Northern Ireland. The report found that young people are waiting too long to ask for help and even longer to access the right support.
Health Minister Robin Swann said his aim was that young people do not wait longer than nine weeks to see a CAMHS (child and adolescent mental health services) professional."I take the mental health and wellbeing of our children and young people very seriously and I am committed to working with my colleagues in a new executive working group on mental well-being, resilience and suicide prevention," he said.
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Source: 6 February 2020
A whistleblower raised the alarm over patient safety at West Suffolk Hospital because of concerns about the behaviour of a doctor who had been seen injecting himself with drugs, the Guardian has revealed.
The incident had already prompted internal complaints from senior staff at West Suffolk hospital, but the whistleblower decided to take matters a step further when the same doctor was later involved in a potentially botched operation. The whistleblower then wrote to relatives of a dead patient and urged them to ask questions about the conduct of the doctor and his background.
When they did this, the hospital launched a widely criticised “witch-hunt” in an attempt to find out the identity of the leaker.
The doctor’s drug use, which the trust has never acknowledged until now, helps explain why it demanded fingerprint and handwriting samples from staff – tactics which the NHS regulator roundly condemned in a hard-hitting report last week.
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Source: Guardian, 5 February 2020
All NHS hospitals in England have been ordered to create secure areas for coronavirus testing to “avoid a surge in emergency departments”, according to a leaked NHS letter.
Hospitals have been told to create “coronavirus priority assessment pods”, where people will be checked for the virus, which will need to be decontaminated each time they are used.
The letter, seen by The Independent and dated 31 January, instructs all chief executives and medical directors to have the pods up and running no later than Friday 7 February.
It comes as the global death toll from the virus has reached 565 with around 28,000 infected.
One hospital chief executive told The Independent he believed the requirement was “an overreaction”, adding: “I think we should be sending teams out to swab in patients homes as the advice is to stay at home and self-manage as with any other flu".
In the letter, Professor Keith Willett, who is leading the NHS’s response to coronavirus, told NHS bosses: “Plans have been developed to avoid a surge in emergency departments due to coronavirus. “Although the risk level in this country remains moderate, and so far there have been only two confirmed cases, the NHS is putting in place appropriate measures to ensure business as usual services remain unaffected by any further cases or tests of coronavirus.”
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Source: 5 February 2020
