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Content ArticleThis Healthcare Safety Investigation Branch (HSIB) investigation explores the care of patients who present to child and adolescent mental health services (CAMHS) with questions about their gender identity and are referred to specialised gender dysphoria services. Gender dysphoria is a sense of unease, distress or discomfort that a person may have because of a mismatch between their biological sex and their gender identity. For example, a child who is registered as male at birth might feel or say that they are a girl, or feel that neither ‘boy’ nor ‘girl’ are the right word to describe how they feel about themselves. Gender dysphoria is not identified as a mental illness by the NHS, but some people may develop mental health problems because of gender dysphoria.
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News Article
Autistic girl, 14, unlawfully detained in hospital, high court judge finds
Patient Safety Learning posted a news article in News
A 14-year-old autistic girl was unlawfully detained in hospital and restrained in front of scared young patients, a high court judge has found. On one occasion last month the teenager managed to break into a treatment room where a dying infant was receiving palliative care. She was restrained there by three security guards, Mr Justice MacDonald said in a judgment in the family court that ordered Manchester city council (MCC) to find the girl a suitable community care placement instead of what he described as the “brutal and abusive” and “manifestly unsuitable” hospital environment. Nurses witnessed the girl screaming “very loudly” and sounding “very scared” when repeatedly held down on her hospital bed so that she could not move her legs, arms or head, before being tranquillised. Other children on the ward were frightened to witness the frequent battles between the girl and security guards, the judge said. The judge noted that the teenager made “regular and determined” efforts to run away, sometimes using screwdrivers to try to unlock doors and windows, and running away from her family on walks. He described the teenager as having an autistic spectrum disorder and a learning disability. She demonstrated “complex and extreme behaviour” that could not be controlled even within a school environment involving six adults to one child supervision, he added. Despite this, the council and NHS trust decided to have the girl be detained in hospital on a general paediatric ward “solely as a place of safety”, without applying for the necessary court order to do so, the judge found. She did not require any medical treatment, the judge said. Read full story Source: The Guardian, 5 April 2022 -
News Article
Children’s services rated ‘inadequate’ as trust remains ‘outstanding’
Patient Safety Learning posted a news article in News
The children’s inpatient unit at an ‘outstanding’ mental health trust has been downgraded to ‘inadequate’ by the Care Quality Commission (CQC), amid a surge in demand for its services. The CQC previously rated child and adolescent mental health wards at Hertfordshire Partnership University Foundation Trust as “outstanding” in May 2019. But after an inspection in November and December 2021, these services were downgraded to “inadequate” overall and for the key categories of safety and leadership. Although inspecting a core service, the CQC said its visit was “not wide-ranging enough” to update overall trust ratings, so HPFT remains “outstanding” overall. Teenagers aged from 13 to 18 and admitted to Forest House, a 16-bed unit in Radlett providing HPFT’s only inpatient service for children and adolescents, told CQC inspectors they felt “unsafe”, dissatisfied with their care, and had experienced bullying by fellow patients. Leadership in the service had “significantly deteriorated” since previous inspections, CQC chiefs wrote in a report published today, and this was having a “knock-on effect in all areas of care being provided”. Staff morale was low and access to clinical psychologists limited, with a reduced ability to provide therapeutic interventions, inspectors added. Read full story (paywalled) Source: HSJ, 30 March 2022 -
News Article
Police investigating death of young girl at mental health hospital
Patient Safety Learning posted a news article in News
The police are investigating the death of a young person at a mental health hospital, The Independent can reveal. Police are investigating the death of a young girl at The Huntercombe Maidenhead mental health hospital in February. In a statement to The Independent: Thames Valley Police, said: “Thames Valley Police is conducting an investigation after the death of a girl following an incident at Huntercombe Hospital in Maidenhead on Saturday 12 February. The girl’s next of kin have been informed and our officers are supporting them. Our thoughts remain with them at this very difficult time. An investigation is ongoing to understand the circumstances around this tragic incident.” The Care Quality Commission has also said it was notified of the young girls death. The care regulator said it could not comment further. The NHS confirmed to The Independent admissions to one of the hospital’s wards have been suspended. The 60-bed hospital was rated Inadequate and placed in special measures by the CQC in February 2021 following serious concerns over care of patients. Read full story Source: The Independent, 26 February 2022 -
News ArticleChildren with mental health problems are dying because of failings in NHS treatment, coroners across England have said in what psychiatrists and campaigners have called “deeply concerning” findings. In the last five years coroners have issued reports to prevent future deaths in at least 14 cases in which under-18s have died while being treated by children’s and adolescent mental health services (CAMHS). The most common issues that arise are delays in treatment and a lack of support in helping patients transition to adult services when they turn 18. Coroners issue reports to prevent future deaths in extreme cases when it is decided that if changes are not made then another person could die. Dr Elaine Lockhart, the chair of the Royal College of Psychiatrists’ faculty of child and adolescent psychiatry, said the findings were “deeply concerning” and every death was a tragedy. She said there were too often lengthy delays and services were under strain as demand rises and the NHS faces workforce shortages. “In child and adolescent mental health services in England, 15% of consultant psychiatrist posts are vacant,” Lockhart said, calling for more support, investment and planning to grow staff levels. Read full story Source: The Guardian, 3 February 2022
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News ArticleThousands of children are falling through the cracks in youth addiction services owing to Covid, staff shortages and funding cuts, psychiatrists have said, as figures suggest the number able to get help has fallen to the lowest on record. Analysis of data from the National Drug Treatment Monitoring System (NDTMS) found that 11,013 under-18s were in treatment for drug and alcohol dependency in England in 2020-21, which was 3,278 fewer (23% less) than in 2019-20. It was the sharpest annual fall since records began, and means 13,481 fewer children were being treated than at a peak in 2008-09. The vast majority of children in treatment (89%, or 9,832) had a problem with cannabis and 41% (4,459) had a problem with alcohol. About 12% (1,333) were struggling with ecstasy use and 9% (976) reported a problem with powder cocaine. The Royal College of Psychiatrists, which analysed the data, said the pandemic, together with “drastic” historical funding cuts, was preventing young people from accessing the drug and alcohol treatment they need, potentially condemning them to a life of addiction. Dr Emily Finch, the vice-chair of the addictions faculty at the Royal College of Psychiatrists, said: “Children and their families up and down the country are having their lives blighted by drug and alcohol use due to drastic cuts, workforce shortages and the impact of the pandemic. “Addiction is a treatable health condition. Intervening early will mean many kids won’t go on to have an addiction in their adulthood, keeping them out of the criminal justice system and helping them to live full lives. It’s now time for the government to act on their promise and deliver the multimillion-pound investment into drug services.” Read full story Source: The Guardian, 3 February 2022
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Content ArticleSymptoms involving almost every organ system have been reported after SARS-CoV-2 infection. Estimates of the prevalence of long covid (also called post-covid-19 condition, post-acute sequelae of covid-19, or chronic covid syndrome) vary considerably, partly because of confusion around the definition. The term long covid encompasses a broad range of symptoms, including objective complications of covid-19 (pulmonary fibrosis, myocardial dysfunction), mental health conditions, and more subjective, non-specific symptoms resembling those seen in post-viral chronic fatigue syndrome (myalgic encephalomyelitis). Most studies to date have substantial limitations, including small cohorts, absence of control groups, non-standardised capture of symptoms, lack of correction for pre-existing medical conditions, participant reported infection, and variation in follow-up, as well as selection, non-response, misclassification, and recall biases. In children and adolescents, acute Covid-19 is less severe than in adults. Concern among many parents has therefore focused more on the potential long term effects of SARS-CoV-2 infection. Unfortunately, fewer data are available on long covid in young people compared with adults.
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Content Article
The State of the World's Midwifery 2021
Patient Safety Learning posted an article in Maternity
The State of the World’s Midwifery (SoWMy) 2021 builds on previous reports in the SoWMy series and represents an unprecedented effort to document the whole world’s Sexual, Reproductive, Maternal, Newborn and Adolescent Health (SRMNAH) workforce, with a particular focus on midwives. It calls for urgent investment in midwives to enable them to fulfil their potential to contribute towards UHC and the SDG agenda. -
News ArticleAround 80% of adolescents who died by suicide or who had self-harmed had consulted with their GP or a practice nurse in the preceding year, shows new research. The large study of 10 to 19-year-olds between 2003 and 2018, published in the Journal of Child Psychology and Psychiatry, also puts forward a series of proposals to deal with the problem. The study, funded by the NIHR Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), a partnership between The University of Manchester and The Northern Care Alliance NHS Foundation Trust (NCA). It showed that 85% who later took their own lives consulted with their GP or a practice nurse at least once in the preceding year; the equivalent figure was 75% for those youngsters who harmed themselves non-fatally. Lower than expected rates of diagnosis of psychiatric illness, around a third in both groups, were probably down to a lack of contact with mental health services, rather than an absence of psychiatric illness, argue the research team. Depression was by far the commonest of the examined conditions among both groups, accounting for over 54% of all recorded diagnoses. Also, while suicide was more common in boys, non-fatal self-harm was more common in girls. Two-thirds of adolescents who died by suicide had a history of non-fatal self-harm. And while self-harm risk rose incrementally with increasing levels of deprivation, suicide risk did not. Read full story Source: The University of Manchester, 7 December 2021
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News ArticleNearly 2,000 children and teenagers have been left waiting for specialist mental health care for at least a year in Scotland, according to official figures branded “damning” by psychiatrists. New NHS Scotland data has revealed that, at the end of September, there were 1,978 patients who had been waiting 52 weeks or more for a Child and Adolescent Mental Health Services (CAMHS) appointment. That is more than double the 959 young people who were waiting that long the previous September – despite efforts by Nicola Sturgeon’s government to meet its own 2023 target for 90% of young people to receive help within 18 weeks. Ahead of the Holyrood Budget on Thursday, the figures prompted calls from service providers for a “radical transformation of our mental health services” enacted with the same zeal as the response to the coronavirus pandemic and with a focus on earlier interventions to prevent young people “giving up on their futures”. According to the latest figures, there were a total of 11,816 young people waiting for an appointment by the end of September – just 78% of them who had been seen within 18 weeks. Dr Helen Smith, chair of the CAMHS faculty of the Royal College of Psychiatrists in Scotland, said the long waits for help highlighted the “many problems” with these services “across the length and breadth of the country”. “The fact that our vulnerable children and young people are still waiting to be seen is, frankly, not good enough,” Dr Smith said. “We need them to be able to access the right support at the right time, from the correct services.” Read full story Source: The Independent, 8 December 2021
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News ArticleMore than one in ten secondary school pupils and over a third of school staff who had COVID-19 have suffered ongoing symptoms, figures suggest. The most common symptom reported by staff and pupils was weakness/tiredness, while staff were more likely to experience shortness of breath than pupils, according to a small study of schools in England. The survey from the Office for National Statistics (ONS) estimates that about 35.7% of staff and 12.3% of secondary school pupils with a previously confirmed Covid-19 infection reported experiencing ongoing symptoms more than four weeks from the start of the infection. Among those experiencing ongoing symptoms, 15.5% of staff and 9.4% of secondary school pupils said their ability to carry out day-to-day activities had been significantly reduced. Geoff Barton, general secretary of the Association of School and College Leaders, said: “This survey data reveals the largely hidden long-term effects of Covid on both students and school and college staff. Read full story Source: Wales Online, 28 September 2021
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News Article
Why vaccinating all teens is a difficult decision
Patient Safety Learning posted a news article in News
The UK's vaccine advisory body has decided not to recommend vaccines for healthy 12-15-year-olds, but it will offer vaccines to thousands more children with underlying health problems. Ministers will now seek more advice on extending the rollout based on factors such as school disruption. There is general agreement that this was a really tricky call to make. Bur The Joint Committee on Vaccination and Immunisation (JCVI) has focused squarely on the health benefits of vaccination to children themselves - not on the impact to their schooling or other people. Children's risk from Covid isn't zero but the chances of them becoming seriously ill from Covid are incredibly small. Deaths among healthy children are extremely rare - most have life-limiting health conditions. That means there needs to be a clear and obvious advantage to giving them a jab. However, a very rare side-effect of the Pfizer and Moderna vaccines has made that calculation a lot more complicated. Paul Hunter, professor of medicine at University of East Anglia, says there's been intense pressure on the JCVI and he can understand why they are being cautious. "I don't know what the answer is - I'm very close to the fence on this. There's not enough data to be absolutely certain." Read full story Source: BBC News, 4 September 2021 -
Content ArticleAlexander James Davidson was aged 17 years and 6 months when he died at the Queens Medical Centre on 26 February 2018. Alex was previously fit and well before suddenly taking ill with abdominal pain on 17 January 2018. Between that date and his admission to the Queens Medical Centre on 8 February 2018, Alex made contact with his GP on three occasions, had four telephone triage assessments undertaken by the NHS 111 service and two admissions to his local Accident & Emergency Department at the Kingsmill Hospital. Alex’s symptoms of sudden onset acute abdominal pain, tachycardia, and vomiting and diarrhoea were attributed either to stress or to a bout of gastroenteritis. At no stage prior to 8 February 2018 was gallstones or pancreatitis considered as a differential diagnosis. When Alex was eventually admitted to the Queens Medical Centre Emergency Department on 8 February 2018, he was found to be septic as a result of an infected and necrotic pancreatic pseudocyst, which had evolved as a complication of gallstone pancreatitis, a rare condition in someone of Alex’s age. Despite medical intervention, Alex did not survive. The inquest explored the medical treatment and intervention that Alex received in the six weeks prior to his death. The medical evidence concluded that the pancreatic pseudocyst had likely formed by the time Alex began vomiting on 18 January 2018, and from that point onwards, it was unlikely he would survive even with treatment on account of the high mortality rate associated with this condition
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Content ArticleA Parliamentary and Health Service Ombudsman (PHSO) report of an investigation that found that Averil Hart's tragic death from anorexia would have been avoided if the NHS had cared for her appropriately. Ignoring the alarms: How NHS eating disorder services are failing patients highlights five areas of focus to improve eating disorder services.
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Content ArticleThe RCNi (the publishing company of the Royal College of Nursing) have brought together a selection of their most popular articles on the topic of sepsis from across their journals to inform your practice. Sepsis remains a significant cause of death – it is estimated that 44,000 people die from ‘the silent killer’ every year. RCNi has a wide range of resources available to help nurses improve diagnosis and early management of the condition.
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Content ArticleThe creation of a national network of medical examiners (MEs) was recommended in the Shipman inquiry and was alluded to in the Mid-Staffordshire and Morecambe Bay public inquiries. The Parliamentary Under-Secretary of State for Health, Lord O’Shaughnessy, confirmed in October 2017 that a national system of medical examiners will be introduced from April 2019. The ME reforms set out in the 2009 Coroners Act will be implemented nationally in two phases. By April 2019, NHS trusts should set up non-statutory schemes, based upon the national pilots (particularly in Leicester, Sheffield and Gloucester), funded in part from cremation form fees, in preparation for the commencement of a statutory scheme in 2020/21. A National Medical Examiner will be appointed, reporting directly to the National Director of Patient Safety.
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Content ArticleEpilepsy12 was announced as the winner of the 2018 Richard Driscoll Memorial Award for outstanding patient involvement in clinical audit at the annual Healthcare Quality Improvement Partnership (HQIP) AGM in London. The submission from the Royal College of Paediatrics and Child Health (RCPCH) demonstrated Epilepsy12’s overarching goal to improve NHS healthcare services for children and young people with seizures and epilepsy.
