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Sam

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  1. Sam
    The majority of trust leaders have reported an increase in the ‘burden’ put on them by regulators, citing more demanding ‘ad hoc’ requests during heightened operational pressure.
    In NHS Providers’ latest survey of NHS trust leaders’ experiences of regulation, a little over half of respondents – 52% – said the burden from NHS England and the Care Quality Commission had increased in the past year.
    The percentage was higher among acute/community and community trusts, and all ambulance and specialist trust respondents said the burden had increased. 
    An even higher overall share of trusts – 59% – said “ad hoc requests” from regulators had increased during the same time period. This includes requests for information or meetings at short notice, diverting staff from day-to-day operational duties.
    Read full story (paywalled)
    Source: HSJ, 20 July 2023
  2. Sam
    Exhausted after three sleepless days in labour, Jane O’Hara, then 34, screamed and burst into tears when the midwives and doctors at Harrogate District Hospital told her the natural birth she wanted was not going to happen.
    She ended up needing life-saving surgery and 11 pints of blood after a severe haemorrhage. Mercifully, Ivy was fine and is now a healthy 12-year-old. 
    In recent weeks, the NHS has been rocked by the conclusions of an inquiry into the worst maternity disaster in its history: 201 babies and nine mothers died and another 94 babies suffered brain damage as a result of avoidable poor care at Shrewsbury and Telford Hospital NHS Trust. This has been linked to a culture of promoting natural — that is, vaginal — birth and avoiding caesarean sections. 
    Blame thus far has been aimed largely at the NHS — but parents have started speaking out online about what they believe has been the role of the National Childbirth Trust (NCT), a leading provider of antenatal classes in Britain, in promoting vaginal births.
    “I can absolutely point to key decisions that I made that were influenced by the NCT’s mantra. I was led into a position where I believed I had more control over my birth than I actually did,” says O’Hara, who is now a professor of healthcare quality and safety at the University of Leeds. She believes she was a victim of a “normal birth” ideology that was heavily promoted at the NCT classes she attended.
    Read full story (paywalled)
    Source: The Times, 10 April 2022
  3. Sam
    Thousands of women are having induction of labour delayed because of a shortage of staff, raising concerns about the safety of them and their babies, HSJ has found.
    The issue has been highlighted at seven hospitals in Care Quality Commission reports over the past six months, and HSJ has identified a further three trusts declaring they are concerned about it in their own board papers over the same period. 
     At University Hospitals of Leicester Trust, more than 1,300 “red flags” were raised in a five-month period due to delays in the induction of labour, linked to staffing levels, the CQC said earlier this month. Most were dealys in continuing inductions, and a smaller number were delays between admission and beginning an induction. UHL indicated it had set its own “red flag” bar locally, so all the delays did not represent a national alert. 
    Carolyn Jenkinson, CQC deputy director of secondary and specialist healthcare, told HSJ: “At some maternity services we’ve found women having to wait long periods of time to be induced or for transfer to a labour ward once the induction process has started, and in some cases a lack of effective monitoring during periods of delay.
    “Where we have found concerns about delayed treatment – including induction of labour – we have made clear to those trusts that effective oversight of the issue is vital and that all action possible should be taken to mitigate any risk and keep people using the service safe.”
    Read full story (paywalled)
    Source: HSJ, 27 September 2023
  4. Sam
    Trust leaders have been asked to “self-assess” the quality of their “improvement culture” as part of an initiative launched by NHS England chief executive Amanda Pritchard in the spring to lead the service's new improvement drive.
    The call came from NHS Impact, led by former Modernisation Agency chief David Fillingham, who along with NHS Impact’s deputy chair – University Hospitals Coventry and Warwickshire Foundation Trust CEO Andy Hardy – has written to service leaders, setting out the first stage in the improvement drive.
    They have asked the boards and CEOs of trusts and integerated care boards to “engage directly” with a new self-assessment tool and maturity matrix created by NHS Impact. This is designed to gauge their progress on adopting the five practices that NHS IMPACT claim “form the DNA of an improvement culture”.
    Those five practices are:
    A shared purpose and vision which are widely spread and guide all improvement effort. Investment in people and in building an improvement focused culture. Leaders at every level who understand improvement and practise it in their daily work. The consistent use of an appropriate suite of improvement methods. The embedding of improvement into management processes so that it becomes the way in which we lead and run our organisations and systems. Read full story (paywalled)
    Source: HSJ, 29 September 2023
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  5. Sam
    Patients are being urged to shop around on the NHS app and website to cut their waiting time for treatment in England.
    IT systems have been updated to allow patients to more easily exercise their right to choose where they go for planned care, such as knee operations.
    They will now be able to view up to five providers - filtered by distance, waiting times and quality of care.
    But hospitals warned staffing shortages still needed to be tackled to make the biggest impact on waits.
    The idea of choosing where to go for treatment has been in place since the early 2000s, but few use it.
    Currently only1 in 10 exercises their right to choose, with patients reporting they are not always offered a choice of where to go or that it is hard to select different venues.
    Ministers believe that by searching the list of different hospitals, patients will be able to reduce their waits - potentially by up to three months, research suggests.
    Read full story
    Source: BBC News, 25 May 2023
  6. Sam
    A hospital review of mesh operations by a surgeon who left dozens of patients in agony is now looking into another type of procedure he carried out.
    Tony Dixon, who used mesh surgery to treat bowel problems, has always maintained he did the operations in good faith.
    Now it has emerged that other patients who had their rectum stapled are also being written to.
    Spire Hospital Bristol said its "comprehensive" review remains ongoing.
    Mr Dixon pioneered the use of artificial mesh to lift prolapsed bowels and a review of the care he gave patients receiving Laparoscopic ventral mesh rectopexy has already concluded.
    Now the Spire has contacted patients who underwent a Stapled Transanal Rectal Resection (STARR operation) with Mr Dixon.
    Many of the affected patients have told the BBC they did not give informed consent for the procedure and are in chronic pain.
    Read full story
    Source: 11 September 2023
  7. Sam
    A nurse-led trial has found that a new electronic tool could reduce the number of preventable injuries and deaths caused by wrongly inserting nasogastric tubes.
    The study, led by Tracy Earley, a consultant nutrition nurse at Royal Preston Hospital, tested a new fibre-optic device which can tell clinicians definitively if a nasogastric tube – which is inserted through the nose and delivers food, hydration and medicine into the stomach – has been placed correctly.
    Currently, to check if nasogastric tubes – also referred to as NG tubes – are in the right place, nurses have to extract bodily fluid from the patient through the tube. Clinicians then test this fluid on a pH strip to judge whether the placement is correct.
    Studies show that interpreting the pH level results in mistakes 12-30% of the time, and that in 46% of cases nurses are unable to draw aspirate at all. This means patients have to undergo x-rays, leaving them without nutrition or treatment for longer.
    The study tested a device called NGPod, which uses a fibre-optic sensor to retrieve the pH reading from the tip of the NG tube leading to a definitive 'yes' or 'no' result in terms of whether it has been placed correctly – removing the need for aspirate or interpretation from the health professional.
    It found that the device was as accurate as pH strip testing, and removed all of the risks associated with making subjective pH strip judgements.
    Read full story
    Source: Nursing Times, 18 July 2023
  8. Sam
    An NHS trust has concluded that its former chief executive is not a “fit and proper person” to be on an NHS board, after investigating allegations of sexual harassment and inappropriate behaviour, HSJ has learned.
    HSJ understands The Robert Jones and Agnes Hunt (RJAH) Orthopaedic Hospital Foundation Trust commissioned a specialist external workplace investigation into Mark Brandreth, which considered serious allegations made about his behaviour during his time as trust chief executive between April 2016 and August 2021.
    Mr Brandreth is understood to dispute the allegations as well as the investigation’s findings, and is seeking to challenge RJAH’s handling of the complaints and its process for deciding he did not meet the Fit and Proper Person Test. 
    Sources with knowledge of the situation said almost 30 female RJAH staff members came forward to give information to the investigation, but it focused on 12 employees who were willing to give evidence.
    HSJ has been told that as a result of the investigation, which concluded at the end of last year, the trust’s chair has informed NHSE in writing that it believes Mr Brandreth does not meet the “Fit and Proper Person Test”, implying he should be ruled out of board roles – or roles with equivalent responsibility – at English NHS organisations and adult social care providers.
    However, the trust, in Shropshire, is not planning to publish its ruling and – with no professional regulation in place for health and care managers and/or board members – it is unclear how effective the conclusion will be if it is not made public. A female staff member told HSJ of her concerns that “nothing is being done”.
    Read full story (paywalled)
    Source: HSJ, 21 February 2024
  9. Sam
    It is still unclear how unauthorised metal parts came to be implanted in a number of the 19 children with spina bifida who suffered significant complications after spinal surgery.
    But it has emerged that one child died and 18 others suffered a range of complications after surgery at Temple Street Children’s Hospital – with several needing further surgery, including the removal of metal parts which were not authorised for use.
    Parents of the children undergoing complex surgery were left distraught by the disclosures that emerged yesterday, after campaigning for years while the young patients in need of operations deteriorated on waiting lists.
    Gerry Maguire, of Spina Bifida Hydrocephalus Ireland, said “absolute horror is being visited on parents and their advocates”.
    He condemned as disturbing the information which is “being drip-fed to his group and “more alarmingly the families concerned”. One mother expressed concern about further delays in surgery and said children are too complex to be taken for care abroad.
    Read full story
    Source: Irish Independent, 19 September 2023
  10. Sam
    The UK risks a shrinking workforce caused by long-term sickness, a new report warns.
    Pensions and health consultants Lane, Clark and Peacock (LCP) says there has been a sharp increase in "economic inactivity" - working-age adults who are not in work or looking for jobs.
    The figure has risen by 516,000 since Covid hit, and early retirement does not appear to explain it.
    The total of long-term sick, meanwhile, has gone up by 353,000, says LCP. It means there are now nearly 2.5 million adults of working age who are long-term sick, official data from the Labour Force survey reveals.
    The LCP says pressure on the NHS can account for some of the increase in long-term sickness. Delays getting non-urgent operations and mental health treatment are possible explanations. Others who would otherwise have had a chronic condition better managed may be in poorer health.
    One of the report authors, Dr Jonathan Pearson-Stuttard, said: "The pandemic made clear the links between health and economic prosperity, yet policy does not yet invest in health, to keeping living in better health for longer. NHS pressures have led to disruption of patient care which is likely to be impacting on people's ability to work now and in the future."
    Read full story
    Source: BBC News, 20 February 2023
  11. Sam
    NHS mental health services are stuck in a “vicious cycle” of short staffing and overwhelming pressures, a government committee has warned.
    Rising demand for mental health services has “outstripped” the number of staff working within NHS organisations, according to the public accounts committee.
    A report from the committee warned that ministers must act to get services out of a “doom loop” in which staff shortages is hitting morale and leading people to quit the already-stretched services.
    It found staffing across mental health services has increased by 22% between 2016 and 17 and 2021 and 22 while referrals for care have increased by 44% over the same period.
    Healthcare leaders warned there are 1.8 million people on the waiting list for NHS mental health care with hospital bosses “deeply concerned”.
    Read full story
    Source: The Independent, 21 July 2023
  12. Sam
    The inquiry into how nurse Lucy Letby was able to murder seven babies will now have greater powers to compel witnesses to give evidence.
    In a significant move, ministers upgraded the independent inquiry after criticism from families of the victims that it did not go far enough.
    The inquiry, ordered after Letby was found guilty this month, was not initially given full statutory powers.
    Health Secretary Steve Barclay said he had listened to the families.
    He said he had decided a statutory inquiry led by a judge was the best way forward and "respects the wishes" of the families.
    Mr Barclay said the key advantage was the power of compulsion.
    "My priority is to ensure the families get the answers they deserve and people are held to account where they need to be," he added.
    He said an announcement about who would chair the inquiry would be made in the coming days - ministers have already said it will be a judge.
    Richard Scorer, a lawyer who is representing two of the families, welcomed the government's announcement.
    "It is essential that the chair has the powers to compel witnesses to give evidence under oath, and to force disclosure of documents. Without these powers, the inquiry would have been ineffectual and our clients would have been deprived of the answers they need and deserve," he said.
    Read full story
    Source: BBC News, 30 August 2023
  13. Sam
    Elon Musk's attempt to implant microchips into human brains has been rejected by US medical regulators over concerns about the safety of the technology.
    Mr Musk's Neuralink business, which is hoping to insert tiny chips into people's skulls to treat conditions such as paralysis and blindness, was denied initial permission for clinical trials last year.
    US medical regulators were said to have "dozens" of concerns over the risks posed by the device, Reuters reported. Concerns include fears that tiny electrodes could get lodged in other parts of the brain, which could impair cognitive function or rupture blood vessels.
    Neuralink's chips are designed to be threaded into the brain using tiny filaments and harness artificial intelligence technology to pick up brain activity using a so-called "brain computer interface".
    Read full story (paywalled)
    Source: The Times, 3 March 2023
  14. Sam
    Daniel was about to get the fright of his life.
    He was sitting in a consulting room at the Royal Free hospital in London, speaking to doctors with his limited English.
    The 21-year-old street trader from Lagos, Nigeria, had come to the UK days earlier for what he had been told was a "life-changing opportunity". He thought he was going to get a better job.
    But now doctors were talking to him about the risks of the operation and the need for lifelong medical care.
    It was at that moment, Daniel told investigators, that he realised there was no job opportunity and he had been brought to the UK to give a kidney to a stranger.
    "He was going to literally be cut up like a piece of meat, take what they wanted out of him and then stitch him back up," according to Cristina Huddleston, from the anti modern slavery group Justice and Care.
    Luckily for Daniel, the doctors had become suspicious that he didn't know what was going on and feared he was being coerced. So they halted the process.
     The BBC's File on 4 has learned that his ground-breaking case alerted UK authorities to other instances of organ trafficking. 
    Read full story
    Source: BBC News, 4 July 2023
  15. Sam
    Children's doctors are calling for a complete ban on disposable vapes because they are likely to damage young lungs and are bad for the environment.
    But an anti-smoking campaign group says a ban would make it harder for some adults to give up smoking and increase the trade in illegal vapes.
    UK governments are planning steps to reduce vaping among under-18s.
    Prime Minister Rishi Sunak recently said it was "ridiculous" that vapes were designed and promoted to appeal to children when they were supposed to be used by adults giving up smoking.
    A BBC investigation found unsafe levels of lead, nickel and chromium in vapes confiscated from a secondary school, which could end up being inhaled into children's lungs. Scientists analysing the vapes said they were the worst lab test results of their kind they had ever seen.
    The Royal College of Paediatrics and Child Health (RCPCH) now says the UK government should "without a doubt" ban disposable e-cigarettes.
    Read full story
    Source: BBC News, 6 June 2023
  16. Sam
    Plans to procure more district nursing courses to start this September have been paused because of the merger of Health Education England into NHS England, HSJ understands.
    An email sent last month from a commissioning officer at NHSE’s workforce, training and education directorate – the new HEE – said procurement of new district nursing courses from universities would be paused “until further notice”, due to the “ongoing merger”.
    Since 2009, the number of district nurses working in the English NHS has fallen drastically, from around 7,000 to around 3,900.
    Steph Lawrence, executive director of nursing and allied health professionals at Leeds Community Healthcare Trust, said the decision to pause the expansion of courses was a “huge concern” as numbers of district nurses need to grow “at a much faster rate”.
    “This is a major safety issue for safe and effective care in the community if we don’t have the appropriate numbers of nurses trained. We may also lose nurses as well who want to progress and expand their knowledge,” Ms Lawrence said.
    Read full story (paywalled)
    Source: HSJ, 5 June 2023
  17. Sam
    At least 100,000 people across the UK have had their lives put at risk over the last decade because of delays to them getting tested or treated for cancer, a new report claims.
    In some cases, patients’ treatment options narrowed or their cancer spread or became incurable as a direct result of their long waits for NHS care, according to Macmillan Cancer Support.
    The “inhumane” impact of delays on patients is “shameful”, it said, blaming ministers across the four home nations for underfunding and not tackling staff shortages in cancer services.
    “I’ve had patients arrive for their radical chemotherapy appointment, who wait three hours only to be told that because of staff shortages we can’t deliver their treatment today. It’s inhumane”, said Naman Julka-Anderson, an advanced practice therapeutic radiographer who is also an allied health professional clinical adviser for Macmillan.
    Many waited longer than 62 days to start treatment – surgery, chemotherapy or radiotherapy – after a GP referred them as an urgent case, the charity’s analysis of official NHS data found.
    At least 100,000 of those 180,000 people have seen their symptoms worsen, or their cancer progress or their chances reduce of successfully being treated because they have had to wait.
    Read full story
    Source: The Guardian, 20 June 2023
  18. Sam
    A Swedish appeals court on Wednesday increased a prison sentence for an Italian surgeon over experimental stem cell windpipe transplants on three patients who died.
    Dr Paolo Macchiarini made headlines in 2011 for carrying out the world’s first stem cell windpipe transplants at Sweden’s leading hospital and had been sentenced to no prison time by a lower court.
    But the Svea Court of Appeal concluded that there were no emergency situations among two of the three patients who later died, while the procedure on the third could not be justified. The appeals court sentenced the Italian scientist to 2 1/2 years in jail for causing the death of three people between 2011 and 2014.
    “The patients have been caused bodily harm and suffering,” the appeals court said of the two men and one woman. The patients, it concluded, “could have lived for a not insignificant amount of time without the interventions.”
    Macchiarini denied any criminal wrongdoing. Once considered a leading figure in regenerative medicine, Macchiarini has been credited with creating the world’s first windpipe partially made from a patient’s own stem cells.
    Read full story
    Source: ABC News, 21 June 2023
  19. Sam
    More than 250,000 dementia patients could miss out on new treatments for the disease because they do not have a formal diagnosis, according to government figures.
    NHS data published for the first time shows the prevalence of different types of dementia with which people in England have been diagnosed.
    Dementia is an umbrella term for many different conditions, affecting more than 55 million people worldwide.
    This week, health regulators were urged to approve two new game-changing dementia drugs, after a landmark study confirmed that donanemab slowed cognitive decline in Alzheimer’s patients by 35%, while last year, a second drug, lecanemab, was found to reduce the rate by 27%.
    The NHS primary care dementia figures estimate that there are about 708,000 people over 65 with dementia in England, but only about 450,000 have a recorded diagnosis. That means that more than 250,000 are missing out on these potential new treatments. 
    Read full story
    Source: The Guardian, 20 July 2023
  20. Sam
    The prospect of waiting at least six weeks for a biopsy was too much for Neil Perkin. In February, the 56-year-old was told that he had suspected prostate cancer which needed to be confirmed by examining a sample of his tissue.
    “After the initial appointment with the consultant, there were no letters, texts or anything,” Perkin said. Instead, he decided to pay for it himself: £5,000 – a substantial sum for the part-time ferry operator. The results from a private hospital in Guildford confirmed the cancer.
    “I’d lost faith in the NHS by this point and I went private,” he said. “The cancer was spreading and my surgeon made it clear that if I’d waited for the NHS for my prognosis, [the] chances of cancer recurrence would be far worse.”
    In May he paid another £22,500 for the prostate to be removed at a private hospital in London, with financial help from his family. “I feel let down. It turned out from the pathology that this was urgent and a delay would have made a huge difference to my outcome, my prognosis and quality of life. They got there in the nick of time.”
    Portsmouth Hospitals University Trust said it was sorry to have been unable to meet Perkin’s expectations and strived to provide quality and timely care. “But we recognise that across the NHS there is an increased demand on services and this can impact patient waiting times.”
    Read full story
    Source: The Guardian, 30 July 2023
  21. Sam
    Ambulance chiefs have warned a controversial piece of legislation could lead to legal action against their trusts by patients denied an ambulance.
    The Strikes (Minimum Service Levels) Bill, which is currently going through Parliament, would enable the health and social care secretary to set minimum levels of staffing for ambulance call centres and crews. Employers would be able to issue “work notices” compelling staff to provide cover during any strike.
    But, in its response to the government consultation on how the system would work, the Association of Ambulance Chief Executives has said it does not support the legislation in its current form as it does not believe it will deliver an improvement for patients, or offer a practical means of delivering minimum service levels.
    It said the proposed legislation appears to pass responsibility for the service levels to employers, which could leave them “exposed to patient liability risks to a greater extent than before”.
    Read full story (paywalled)
    Source: HSJ, 22 May 2023
  22. Sam
    A blood test for more than 50 types of cancer has shown real promise in a major NHS trial, researchers say.
    The test correctly revealed two out of every three cancers among 5,000 people who had visited their GP with suspected symptoms, in England or Wales.
    In 85% of those positive cases, it also pinpointed the original site of cancer.
    The Galleri test looks for distinct changes in bits of genetic code that leak from different cancers. Spotting treatable cancer early can save lives.
    The test remains very much a "work in progress", the researchers, from Oxford University, say, but could increase the number of cancers identified.
    Read full story
    Source: BBS News, 2 June 2023
  23. 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
  24. Sam
    HSJ analysis of the NHS England data also found that 19,000 adults with a serious mental illness are waiting for longer than 18 months for a second contact with community mental health services. This is seen as a more meaningful metric for adults than the first contact.
    In total, almost 240,000 children and young people were waiting for treatment from community mental health services in August 2023, as well as more than 192,000 adults.
    The data revealed the median, or typical, waiting time for children and young people from referral to first contact was 178 days. The median wait time for adults from referral to “second contact” was 120 days.
    The NHS long-term plan set out proposals for a four-week waiting time standard for children and adults to access community mental health services. This approach was piloted and a consultation published, but the new standards are yet to be implemented.
    Sean Duggan, chief executive of the mental health network at the NHS Confederation, said leaders would be concerned – although “not surprised” – that patients were waiting so long for community services.
    He added: “We need access and waiting times standards for all mental health services, to help us improve national data and to direct and allocate resources effectively.”
  25. Sam
    Derby and Burton’s maternity services are now among the “most challenged in England”, requiring national involvement to boost improvements. The University Hospitals of Derby and Burton NHS Foundation Trust joins 31 other NHS trusts across England which are now under closer scrutiny aimed at improving the quality of maternity services.
    A report from the trust details that it asked to be added to the national NHS England Maternity Safety Support Programme (MSSP) "voluntarily". Midwifery and obstetric improvement advisors have now been allocated to the trust to spend two days a week on the trust’s sites and also to provide “virtual” assistance.
    A letter to Stephen Posey, the trust’s chief executive, sent by Sascha Wells-Munro, the deputy chief midwifery officer for NHS England, details that the organisation’s addition to the national support programme comes after a number of concerning reports – not just its request. It references the Healthcare Safety Investigation Branch report, published in February, which highlighted the cases of seven women and their babies between January 2021 and May 2022, with three mothers and a baby dying and four mothers suffering extreme consequences.
    Read full story
    Source: Derbyshire Live, 13 September 2023
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