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Sam

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  1. Sam
    Regulation of managers must not lead to a disbarring process without also introducing ”developmental” and supportive measures, NHS England’s national patient safety director has said.
    Speaking at HSJ’s Patient Safety Congress, Aidan Fowler was asked whether NHS board members and managers should be regulated, amid calls for this in the wake of the Lucy Letby scandal. 
    He said: “I think there are pros and cons to regulation… What I would say is that you just have to be cautious that you do not lead to a disbarring process without the developmental side of regulation, and the support side of regulation. For staff, to support them to do a good job.
    “We have seen that there is a gap in patient safety training for boards, which we need to work on, for them to understand and to encourage them to talk about it more.
    “I think there is a developmental part of regulation, which is really important… in any discussion. I know because we are already having discussions around it. That is a key part to pay attention to.”
    Read full story (paywalled)
    Source: HSJ,18 September 2023
  2. Sam
    National leaders are looking to greatly reduce the number of direct hospital referrals made by GPs, by insisting that they first discuss cases with hospital consultants. 
    The approach – known as “advice and guidance” or “A&G” – involves GPs sending a patient’s details to a consultant who specialises in their condition before making a referral. The consultant then advises on the best course of action.
    “A&G’ has been voluntarily adopted by many health systems, but HSJ has now learnt that a move to significantly increase its use of it is being discussed as part of a new national strategy for outpatient services, due to be published by December.
    Theresa Barnes, outpatients lead at the Royal College of Physicians, is part of a group of clinicians helping to develop the strategy in partnership with NHS England, and said there is a case for A&G to be used “in preference” to direct referrals in a vast number of cases where it is clinically appropriate.
    She told HSJ: “I think there should be a push to use advice and guidance in preference to direct referrals, so we can maximise that pre-referral interaction and deliver as much care as close to patients’ homes as they can get it and without the delay of potentially waiting for a secondary care appointment.”
    Read full story (paywalled)
    Source: HSJ, 20 September 2023
  3. Sam
    A cancer patient with months to live has spoken of her fear and anger after chemotherapy was delayed by this week’s strikes.
    Flora White, 51, began chemotherapy last month, which is required fortnightly to shrink a tumour so it can be surgically removed.
    But it has now been set back, after the appointment she was due to have with her oncologist the day before was cancelled as a result of strikes.
    Ms White said that until she got the devastating news about her own delays she had thought cancer patients would be protected from the impact of industrial action.
    “It’s hard to deal with as it is, let alone the extra worry and stress,” she said.
    “Your treatment being cancelled and delayed, they don’t understand how they’re affecting some people.”
    Earlier this week,  Prof Karol Sikora, a leading consultant oncologist, said it was “against the ethics of medicine” for doctors to strike, as he urged medics to think again.
    “If you miss cancer and someone goes for another two years without a diagnosis, it’s as good as leaving someone in the gutter bleeding ... people will die,” he said.
    Read full story (paywalled)
    Source: The Telegraph, 21 September 2023
  4. 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
  5. Sam
    Senior doctors say female medics have felt pressured into sexual activity with colleagues.
    Four women who head up medical royal colleges in Wales have written an open letter describing misogyny, bullying and sexual harassment in the workplace.
    They told BBC Wales that female staff had been asked for sex by male colleagues while on shift.
    The Welsh government said: "Harassment and sexual violence is abhorrent and has no place in our NHS."
    Chairwoman of the Royal College of Psychiatrists in Wales, Dr Maria Atkins, said: "I've heard from multiple women over the years that during night-time shifts, they've been propositioned by male colleagues and felt pressured to engage in sexual acts.
    "When they've refused they are penalised.
    "It can be very damaging to some less experienced or younger women, because they will be discouraged from engaging with a team, which might have been the specialty of medicine that they wanted to progress their career in."
    Read full story
    Source: BBC News, 22 September 2023
  6. Sam
    A private healthcare provider has been ordered to pay more than £1.5m – the largest fine issued for such a case – after pleading guilty in a criminal prosecution brought by the Care Quality Commission (CQC) over the death of a young woman at Cygnet Hospital Ealing in July 2019.
    It is the highest ever fine issued to a mental health service following a prosecution by the CQC. 
    The firm pleaded guilty to one offence of failing to provide safe care and treatment, acknowledging failures to: provide a safe ward environment to reduce the risk of people being able to use a ligature; ensure staff observed people intermittently in line with the company procedures; and train staff to be able to resuscitate patients in an emergency.
    The offences related to the case of a young woman who was admitted to a ward in Cygnet Hospital Ealing in November 2018.
    In July 2019, she took her own life while on the ward. CQC said Cygnet Ealing had been aware the young woman tried to harm herself in an almost identical way four months earlier, but had failed to mitigate the known environmental risk she was exposed to.
    Read full story (paywalled)
    Source: HSJ, 21 September 2023
  7. Sam
    Some patients in England are waiting up to two-and-a-half years for important diagnostic tests such as ultrasound, MRI and CT scans, according to figures seen by the Guardian.
    The longest waits were two-and-a-half years for an MRI scan, almost two years for an ultrasound and a year for a CT scan, responses to freedom of information requests by the Liberal Democrats show.
    People with heart problems are among the worst affected. Examples from NHS trusts included a 49-week wait for an echocardiogram and a 475-day wait for an angiography.
    Under the NHS constitution, patients should wait less than six weeks for diagnostic tests. The target is for only 1% to wait more than six weeks, but now 25% of all patients do so, according to research from the House of Commons library, commissioned by the Lib Dems.
    Ed Davey, the leader of the Lib Dems, said: “What this Conservative government has done to the NHS is nothing short of a national scandal. Millions are forced to wait in pain and discomfort, anxiously wondering when they will get a diagnosis, let alone treatment.
    “We cannot fix our economy without fixing our NHS. People can’t get back to work when they’re stuck waiting to see a GP, get a diagnosis or start treatment. The longer they wait, the worse their health gets and the greater the stress for themselves and their loved ones."
    Read full story
    Source: The Guardian, 24 September 2023
  8. Sam
    A rise in hip fractures last year could be a symptom of a wider increase in general physical deconditioning in older and vulnerable people following the pandemic, senior clinicians have warned.
    Around 72,000 hip fractures were recorded in 2022 compared to 66,000 in 2020 and 67,000 in 2021, according to the 2023 National Hip Fracture Database report, published this month.
    The report, published by the Royal College of Physicians, said: “These additional hip fractures happened despite a fall in the size of the ‘at risk’ older population over the preceding three years, as a result of Covid-19-related mortality among older people and those living in care homes.”
    “Our casemix run chart shows a slight increase in the proportion of hip fractures occurring in people aged under 80.
    “This is perhaps an early indication of Public Health England’s [now the UK Health Security Agency] predictions that physical deconditioning and increased risk of falling due to the pandemic may lead to an increase in the number of people who are at risk of fragility fracture.”
    Read full story (paywalled)
    Source: HSJ. 25 September 2023
  9. Sam
    The chief executive at a trust behind one of the UK’s first ‘virtual hospitals’ has said this model is the ‘new gold standard’ for care provision and the trust is looking at a significant expansion.
    West Hertfordshire Teaching Hospitals Trust boss Matthew Coats said the trust aimed to eventually have “hundreds” of virtual beds for patients to be monitored at home.
    The trust has been at the forefront of NHS England’s programme to significantly expand the use of virtual wards across the NHS. It was also among the first to launch a virtual ward to monitor Covid patients at home during the pandemic.
    Its virtual ward model has since evolved beyond covid, to what the trust calls its “virtual hospital”, providing remote care for patients across several different pathways and specialties, including heart failure, respiratory and frailty patients, who are admitted from either a hospital bed, the emergency department or by GPs.
    Mr Coats told HSJ its virtual hospital is not only supporting better flow through the hospital, but is also leading to better patient experience.
    Read full story (paywalled)
    Source: HSJ, 25 September 2023
  10. Sam
    The Biden administration announced Wednesday that it is reviving a programme to mail free rapid coronavirus tests to Americans.
    Starting 25 September, people can request four free tests per household through covidtests.gov. Officials say the tests are able to detect the latest variants and are intended to be used through the end of the year.
    The return of the free testing program comes after Americans navigated the latest uptick in covid cases with free testing no longer widely available. The largest insurance companies stopped reimbursing the costs of retail at-home testing once the requirement to do so ended with the public health emergency in May. The Biden administration stopped mailing free tests in June.
    The Department of Health and Human Services also announced Wednesday that it was awarding $600 million to a dozen coronavirus test manufacturers. Agency officials said the funding would improve domestic manufacturing capacity and provide the federal government with 200 million over-the-counter tests to use in the future.
    “These critical investments will strengthen our nation’s production levels of domestic at-home COVID-19 rapid tests and help mitigate the spread of the virus,” HHS Secretary Xavier Becerra said in a statement.
    Experts say free coronavirus testing proved to be an effective public health tool, allowing people to check their status before attending large gatherings or spending time with older or medically vulnerable people at risk of severe disease even after being vaccinated. It also enables people to start antiviral treatments in the early days of infection to prevent severe disease.
    Read full story (paywalled)
    Source: Washington Post, 20 September 2023
  11. Sam
    Hospitals are still promoting a “natural birth is best” philosophy – despite a succession of maternity scandals highlighting the dangers of the approach.
    A Telegraph investigation has found a number of trusts continuing to push women towards “normal” births – meaning that caesarean sections and other interventions are discouraged.
    On Saturday, the Health Secretary has expressed concern about the revelation, vowing to raise the matter with senior officials.
    Guidelines for the NHS make it categorically clear that a woman seeking a caesarean section should be supported in her choice, after “an informed discussion about the options”.
    Maternity services were last year warned by health chiefs to take care in the language they used, amid concern about “bias” towards natural births.
    The warning from maternity officials followed concern that women were being left in pain and fear, with their preferences routinely ignored.
    The findings come 18 months after Dame Donna Ockenden published a scathing report into maternity care at Shrewsbury and Telford NHS Trust, which warned that a focus on natural birth put women in danger. 
    Read full story (paywalled)
    Source: The Telegraph, 23 September 2023
  12. Sam
    The U.S. Department of Health and Human Services (HHS), through the Agency for Healthcare Research and Quality (AHRQ), announced nine grant awards of $1 million each for up to 5 years to support existing multidisciplinary Long COVID clinics across the country to expand access to comprehensive, coordinated, and person-centered care for people with Long COVID, particularly underserved, rural, vulnerable, and minority populations that are disproportionately impacted by the effects of Long COVID.
    The grants are a first of their kind. They are designed to expand access and care, develop, and implement new or improved care delivery models, foster best practices for Long COVID management, and support the primary care community in Long COVID education. This initiative is part of the Biden-Harris Administration's whole-government effort to accelerate scientific progress and provide individuals with Long COVID the support and services they need.
    “The Biden-Harris Administration is supporting patients, doctors and caregivers by providing science-based best practices for treating long COVID, maintaining access to insurance coverage, and protecting the rights of workers as they return to jobs while coping with the uncertainties of their illness,” said Secretary Xavier Becerra. “Treatment of Long COVID is a major focus for HHS, and AHRQ is helping lead the way through grants to investigate best practices and get useful guidance to doctors, hospitals, and patients.”
    Read full story
    Source: AHRQ, 20 September 2023
  13. 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
  14. Sam
    Brain surgery using artificial intelligence could be possible within two years, making it safer and more effective, a leading neurosurgeon says.
    Trainee surgeons are working with the new AI technology, to learn more precise keyhole brain surgery.
    Developed at University College London, it highlights small tumours and critical structures such as blood vessels at the centre of the brain.
    The government says it could be "a real game-changer" for healthcare in the UK.
    Brain surgery is precise and painstaking - straying a millimetre the wrong way could kill a patient instantly.
    Avoiding damaging the pituitary gland, the size of a grape, at the centre of the brain, is critical. It controls all the body's hormones - and any problems with it can cause blindness.
    Read full story
    Source: BBC News, 28 September 2023
  15. Sam
    More than 1 in 10 sexual harassment complaints against doctors are not investigated by the General Medical Council because of an “arbitary” rule, the Observer has revealed.
    According to data obtained under the Freedom of Information Act, 13% of sexual misconduct complaints made between the years 2017-18 and 2021-22 were closed without investigation because the GMC is prevented from considering alleged incidents more than five years after the event.
    As part of the council’s remit to protect patient safety and improve medical education and practice across the UK it investigates any kind of complaint against doctors.
    The figures show the GMC refused to investigate 170 complaints relating to sexual assault, attempted rape, and rape in the period analysed. In 22 of those cases the five-year rule was cited. It received 566 sexual harassment complaints in the same period.
    Anthony Omo, the GMC’s general counsel and director of fitness to practise, told the Observer: “We can and do waive the five-year rule where there are grave allegations involving sexual assault or rape. In many cases involving sexual allegations, the GMC’s position will be that such serious misconduct is incompatible with continued registration.”
    A government consultation in February heard that the five-year-rule was “arbitrary” and “a barrier to public protection” as it allowed doctors who may be guilty of inappropriate behaviour to continue practising. However, despite commitments from the Department of Health and Social Care to scrap the limitation as a “top priority”, no date has been set.
    Read full story
    Source: The Guardian, 30 September 2023
  16. 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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  17. Sam
    Police are investigating possible corporate manslaughter at the hospital where serial killer Lucy Letby worked.
    The former nurse, 33, was jailed in August for murdering seven babies and attempting to kill six others at the Countess of Chester Hospital.
    Cheshire Police said the latest investigation was in its early stages.
    Lawyers representing some of the victims' families said they were "reassured" steps were being taken to consider the actions of management.
    Organisations and companies can be found guilty of corporate manslaughter as a result of serious management failures resulting in a gross breach of a duty of care under The Corporate Manslaughter and Corporate Homicide Act 2007.
    Det Supt Simon Blackwell, of Cheshire Police, said the inquiry would focus on the indictment period of the charges for Letby from June 2015 to June 2016.
    He said the investigation would consider areas "including senior leadership and decision making to determine whether any criminality has taken place".
    "At this stage we are not investigating any individuals in relation to gross negligence manslaughter," he added.

    Read full story
    Source: BBC News, 4 October 2023
  18. Sam
    Seven trusts have been added to NHS England’s list of providers with the worst elective and cancer problems, putting the number of organisations in the ‘tier 1’ group back into double figures – and five leaving it, HSJ has learned.
    Since last summer, NHS England has put trusts considered most “at risk” of missing recovery trajectories into “tiers” for either elective or cancer performance, or both.
    The list has changed significantly for quarter three of this year, despite only a few months passing since the last rankings were revealed in August.
    HSJ understands this is due to system-level agreements and some national factors, including the impact of ongoing industrial action on elective activity.
    The number of trusts in the most challenged “tier 1” group for both elective and cancer performance has increased from eight to 11, with seven new providers entering this tier and five leaving.
    Read full storySource: HSJ, 9 October 2023 
  19. Sam
    ADHD patients around the UK are finding they can't get hold of medication since a national shortage was announced.
    Three different medicines are affected, and the government says some supply issues could last until December.
    The Department for Health and Social Care (DHSC) says "increased global demand and manufacturing issues" are behind the shortages.
    Medication helps to manage symptoms, which can include difficulty concentrating and focusing, hyperactivity and impulsiveness.
    Dr Saadia Arshad, a consultant psychiatrist, who specialises in diagnosing and treating people with ADHD.
    She says the shortage of medication is "not a new issue, but it's a recurring one".
    Dr Saadia says suddenly stopping meds can lead to patients "feeling jittery, finding it difficult to pay attention, staying focused and feeling restless".
    Even though she understands the shortage can be worrying, Dr Saadia says it's important that people don't take measures into their own hands.
    "These medicines can be quite potent and the response to medication for two individuals is not the same," she says.
    "So please do not take any action without discussing it with your clinician."
    Read full story
    Source: BBC News, 6 October 2023
  20. Sam
    An NHS trust and ward manager have appeared in court charged with the manslaughter of a 22-year-old mental health patient who died in hospital in July 2015.
    Alice Figueiredo was found dead at Goodmayes Hospital in east London, and an investigation into her death was opened in April 2016. 
    The Crown Prosecution Service (CPS) authorised the Met Police to charge North East London NHS Foundation Trust (NELFT) with corporate manslaughter last month following a five-year investigation.
    It is just the second NHS Trust to face manslaughter charges. The Trust is additionally charged with an offence under section three of the Health and Safety at Work Act in connection with mental health patient Ms Figueiredo's death.
    Ward manager Benjamin Aninakwa also faces a charge of gross negligence manslaughter and an offence under section seven of the Health and Safety at Work act.
    NELFT is just the second ever NHS Trust believed to have been charged with corporate manslaughter, after Maidstone and Tunbridge Wells Trust was charged over the death of a woman who underwent an emergency Caesarean in 2015.
    Read full story
    Source: Mail Online, 6 October 2023
  21. Sam
    A trust saw nearly 1,000 safety reports filed after introducing a new electronic patient record (EPR) – including one where a patient died and 30 others where they suffered harm.
    The Royal Surrey Foundation Trust and Ashford and St Peter’s Hospital Foundation Trust installed a new joint EPR system in the middle of last year.
    But Royal Surrey’s board was told there had been 927 Datix reports — which are used to raise safety concerns — related to the introduction of the “Surrey Safe Care” system, running up until mid September this year.
    The catastrophic harm involved a patient death which the trust says was not “directly linked to technical problems” with the EPR, as “human factors” were involved, including inexperience or unfamiliarity with the electronic prescribing system.
    Louise Stead, chief executive of Royal Surrey, said: “Implementing an electronic patient record is a huge shift for any workforce and we experienced some issues with the functionality of the system and getting users sufficiently trained and confident in using it correctly. We have worked hard to address these issues as quickly and responsibly as possible.
    “Our fundamental aim is for ‘zero harm’ and any harm caused to a patient is taken extremely seriously and investigated. In the case of these Datix incidents the vast majority (over 99%) resulted in low or no harm to patients.
    “However, one case resulted in the tragic death of a patient and we have been working closely with their family to be transparent and learn every possible lesson. This case was not directly linked to technical problems with the electronic patient record system and human factors did contribute. We are sincerely sorry for the failure in their care and devastating impact upon this person’s family.”
    Read full story (paywalled)
    Source: HSJ, 11 October 2023
     
  22. Sam
    Financial directors need to take responsibility for safety, which should be at the core of how the NHS runs services, the leadership of the Health Services Safety Investigations Body (HSSIB) said at its launch Wednesday.
    The Healthcare Safety Investigation Branch is now an independent body – and has been renamed HSSIB – although maternity investigations are hosted by the Care Quality Commission.
    Questioning how many finance directors across the NHS take responsibility for safety, HSSIB’s interim chief investigator Rosie Benneyworth said: “We need a position where finance directors in every organisation are as responsible for safety as the person leading the safety agenda and vice versa, the safety person works with the finance agenda to support them.
    “Often you see the finance director and safety lead don’t work effectively together and we need to change that.”
    Dr Benneyworth said progress will not be made unless operational delivery, financial delivery and safety are tackled “in the same breath”.
    HSSIB’s new chair Ted Baker also called for safety to become a core part of running services “in the way running the accounts is”, as it is currently still seen “as an add-on”.
    He stressed that safety “drives efficiencies, enables innovation and saves costs”.
    Read full story (paywalled)
    Source: HSJ, 19 October 2023
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