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Content ArticleThis is an Adjournment Debate from the House of Commons on Wednesday 30 November 2022 on patient safety concerns relating to the diagnosis of pulmonary embolisms.
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Content ArticleAn expert review of the clinical records of 44 deceased patients who had been under the care of neurologist Dr Michael Watt has found there were “significant failures” in their treatment and care. Dr Watt, a former Belfast Health and Social Care Trust consultant neurologist, was at the centre of Northern Ireland’s largest ever recall of patients, which began in 2018, after concerns were raised about his clinical work. More than 4,000 of his former patients attended recall appointments. At the direction of the Department of Health, in August 2021, the Regulation and Quality Improvement Authority (RQIA) commissioned the Royal College of Physicians to undertake an expert review of the clinical records of certain deceased patients who had been under the care of Dr Watt, with the intention to understand his clinical practice, to ensure learning for others and to help make care better and safer in the future.
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Content ArticleIn this interview for Healthcare IT News, Lisa Hedges, associate principal analyst at Software Advice, discusses the findings of a survey of 1,000 patients on telemedicine usage after the worst of the pandemic. She also talks about the future of telemedicine. The survey found that: more than half of patients are concerned about the quality of care they're receiving through telemedicine. the majority of people prefer virtual appointments for common illnesses. 86% of patients rate their telemedicine experience as positive. 91% are more likely to choose a provider that offers telemedicine. 49% prefer telemedicine visits for mental health treatment, despite it being one of the more remote-ready specialties.
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News Article
Michael Watt: Review finds 'significant failures' in patient treatment
Patient Safety Learning posted a news article in News
A review of the clinical records of 44 patients who died under the care of former neurologist Michael Watt has found "significant failures in their treatment" and "poor communication with families". While this review looked at a sample of cases in which people died, potentially thousands more could be affected. The review arises from a 2018 recall of 2,500 outpatients who were in Dr Watt's care at the Belfast Health Trust. About one in five patients had to have their diagnoses changed. This separate review into 44 deaths was conducted by the Royal College of Physicians at the request of the regulator, the Regulation and Quality Improvement Authority (RQIA). It highlighted concerns over clinical decision-making, prescribing and diagnostics. It reveals a misdiagnosis rate of 45% among this group of patients, twice that for living patients. Speaking to BBC News NI, the RQIA's chair, Christine Collins, said the outcome of the review was "shocking and gut-wrenching as so many had experienced unpleasant deaths which they ought not to have done". Read full story Source: BBC News, 29 November 2022 -
Content ArticleIn July 2022, HSIB launched a national investigation into the safety risk of clinical investigation booking systems failures. Specifically, the investigation explores the use of paper or hybrid booking systems and the production of appointment letters. This interim bulletin highlights a safety risk identified by the investigation and presents a safety observation for the attention of NHS care providers. Some vital NHS services still use paper-based or hybrid systems, which may have been developed over time and could leave unintended gaps where patients can be lost in the system. The reference case for this investigation is the experience of a patient whose magnetic resonance imaging (MRI) scan was not rescheduled following a cancellation, leading to a delay in the diagnosis of cancer. Hybrid systems were in use, which did not assist staff to keep track of patients. Additionally, the hybrid systems in use did not allow appointment letters in non-English languages to be produced.
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News Article
All GPs to receive direct access to cancer tests
Patient Safety Learning posted a news article in News
All GP practices in England will be able to book cancer tests directly for their patients from later this month, NHS bosses say. The option of GPs booking CT scans, ultrasounds and MRIs has been gradually rolled out in recent years, as community testing centres have opened. NHS England chief executive Amanda Pritchard will announce later all GPs will now be able to do this. GPs have previously relied on referring on to specialist hospital doctors. Before referring, they have to identify clear symptoms the patient may have a specific type of cancer. But only one out of every five cancer cases is diagnosed through these urgent GP referrals. Patients with less clear symptoms face long waits for check-ups or are diagnosed only after presenting at an accident-and-emergency (A&E) unit or being referred to hospital for something else. And Ms Pritchard will tell delegates at the NHS Providers annual conference of health managers, in Liverpool, today, she hopes the new initiative will lead to tens of thousands of cancer cases every year being detected sooner. Read full story Source: BBC News, 16 November 2022 -
News Article
Europe faces ‘cancer epidemic’ after estimated 1m cases missed during Covid
Patient Safety Learning posted a news article in News
Experts have warned that Europe faces a “cancer epidemic” unless urgent action is taken to boost treatment and research, after an estimated 1m diagnoses were missed during the pandemic. The impact of Covid-19 and the focus on it has exposed “weaknesses” in cancer health systems and in the cancer research landscape across the continent, which, if not addressed as a matter of urgency, will set back cancer outcomes by almost a decade, leading healthcare and scientific experts say. A report, European Groundshot – Addressing Europe’s Cancer Research Challenges: a Lancet Oncology Commission, brought together a wide range of patient, scientific, and healthcare experts with detailed knowledge of cancer across Europe. One unintended consequence of the pandemic was the adverse effects that the rapid repurposing of health services and national lockdowns, and their continuing legacy, have had on cancer services, on cancer research, and on patients with cancer, the experts said. “To emphasise the scale of this problem, we estimate that about 1m cancer diagnoses might have been missed across Europe during the Covid-19 pandemic,” they wrote in The Lancet Oncology. “There is emerging evidence that a higher proportion of patients are diagnosed with later cancer stages compared with pre-pandemic rates as a result of substantial delays in cancer diagnosis and treatment. This cancer stage shift will continue to stress European cancer systems for years to come. “These issues will ultimately compromise survival and contribute to inferior quality of life for many European patients with cancer.” Read full story Source: The Guardian, 15 November 2022 -
Content ArticleCancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years.
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News ArticleVoices offer lots of information. Turns out, they can even help diagnose an illness — and researchers in the USA are working on an app for that. The National Institutes of Health is funding a massive research project to collect voice data and develop an AI that could diagnose people based on their speech. Everything from your vocal cord vibrations to breathing patterns when you speak offers potential information about your health, says laryngologist Dr. Yael Bensoussan, the director of the University of South Florida's Health Voice Center and a leader on the study. "We asked experts: Well, if you close your eyes when a patient comes in, just by listening to their voice, can you have an idea of the diagnosis they have?" Bensoussan says. "And that's where we got all our information." Someone who speaks low and slowly might have Parkinson's disease. Slurring is a sign of a stroke. Scientists could even diagnose depression or cancer. The team will start by collecting the voices of people with conditions in five areas: neurological disorders, voice disorders, mood disorders, respiratory disorders and pediatric disorders like autism and speech delays. This isn't the first time researchers have used AI to study human voices, but it's the first time data will be collected on this level — the project is a collaboration between USF, Cornell and 10 other institutions. The ultimate goal is an app that could help bridge access to rural or underserved communities, by helping general practitioners refer patients to specialists. Long term, iPhones or Alexa could detect changes in your voice, such as a cough, and advise you to seek medical attention. Read full story Source: NPR, 10 October 2022
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News Article
Longest diagnostic waits at highest level since Covid lockdown
Patient Safety Learning posted a news article in News
The share of referrals waiting more than three months for a diagnostic test — one of the key problems behind long waits for cancer treatment — is worse than at any point since February 2021, during the second national covid lockdown. NHS England data released this morning for September shows 12.4% of the 1.6 million awaiting a test had been on the list longer than 13 weeks. At the peak of June 2020, 32% waited more than 13 weeks, but the proportion dropped back beneath 1 in 10, in May 2021, as services ramped up activity following the impact of the major winter 2020-21 Covid wave. Echocardiography patients and those needing endoscopies had the highest proportion of patients waiting more than six weeks – these specialties jointly comprise about a third of the total national waiting list and had 48 and 38%, respectively, of their lists over six weeks. Katharine Halliday, president of The Royal College of Radiologists, said: ”Today’s cancer waiting times data is alarming. We know the longer patients wait for a diagnosis or treatment, the less their chance of survival. “Our members are clinical radiologists and clinical oncologists, and much of their work involves diagnosing and treating cancer. Today’s figures show the NHS in England would have to employ 441 radiology consultants, the equivalent of a 16% increase in the current workforce, in order to clear the six-week wait for CT and MRI scans in one month.” Read full story (paywalled) Source: HSJ, 10 November 2022 -
News Article
Fear and trauma - the long waits for cancer care
Patient Safety Learning posted a news article in News
There has been a sharp rise in long waits for cancer therapy in the past four years, BBC analysis shows. The number waiting more than the 62-day target time for therapy in the past year has topped 67,000 across England, Northern Ireland and Scotland - twice as many as the same period in 2017-18. Waits are also getting worse in Wales, but data does not go that far back. The national cancer director for the NHS in England said staff were striving to catch up on the backlog of care, but experts warned the problems could be putting patients at risk. Steven McIntosh, of Macmillan Cancer Support, told the BBC that the delays were "traumatic" and people were living "day-by-day with fear and anxiety". He said the situation was "unacceptable" and could even be having an impact on the chances of survival. Describing the NHS as "chronically short-staffed", he said: "The NHS doesn't have the staff it needs to diagnose cancer, to deliver surgery and treatment, to provide care, support and rehabilitation." Read full story Source: BBC News, 9 November 2022 -
News Article
Routine bipolar screening should be ingrained in NHS, say experts
Patient Safety Learning posted a news article in News
Routine screening for bipolar disorder should be ingrained into the NHS, alongside specialist training to help identify the condition and reduce the average nine-and-a-half-year wait to get a diagnosis, experts say. A report by the Bipolar Commission, which brings together academics and other experts in the field, also recommended appointing a national director of mood disorders to ensure everyone has access to a 12-week psychoeducation course, and a specialist doctor to oversee their prescriptions and ongoing care. More than 1 million people in the UK are estimated to have bipolar disorder, which leads to extreme changes in mood and energy levels far beyond most people’s experiences of feeling happy or a bit down. Yet many spend years chasing a diagnosis, or having been misdiagnosed with depression, meaning they cannot access key treatments such as lithium and lamotrigine that help to stabilise mood. According to the report, which was based on an 18-month programme of interviews, surveys and desktop research, many people face a “dangerous” delay in getting diagnosed, with an average wait of nine and a half years. During this time, just over one in three people claimed to have attempted suicide, while those who were misdiagnosed were also more likely to be repeatedly admitted to hospital, the report found. Even once a diagnosis of bipolar disorder is made, the current way most patients are treated – where they are only referred to a psychiatrist if they become seriously unwell – is failing, says Prof Guy Goodwin, emeritus professor of psychiatry at the University of Oxford and co-chair of the commission. “Psychiatric services see people when they are acutely ill … but, once recovered, people are discharged back to the care of their general practitioner. And that model we simply think doesn’t work,” Goodwin said. Read full story Source: The Guardian, 8 November 2022 -
Content ArticleBipolar UK's 'Bipolar Minds Matter' report calls for an immediate restructure of the healthcare system that is failing millions affected by bipolar, and puts forward the case for developing a dedicated care pathway so that people with bipolar can have access to specialist treatment and continuity of support over a lifetime.
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EventuntilSir Mike Richards’ review of diagnostics, Diagnostics: recovery and renewal, which was commissioned in response to recommendations in the NHS Long-Term Plan, outlined a new diagnostic model for services. The review identified key enablers to drive and deliver much needed to change to optimise diagnostic capacity and improve efficiency, along with the need for a major expansion of the workforce and improved connectivity and digitisation across all aspects of diagnostics. Demand for almost all aspects of diagnostics has been rising year on year. The public’s familiarisation with swab testing and testing closer to home through the Covid-19 has provided a strong launch pad to change the approach to diagnostics in response to this rising demand This King's Fund event will explore what can be learnt from the NHS reponse to Covid-19, how partners are working to reshape diagnostic pathways through community diagnostic centres, point-of-care testing and increasing workforce capability and capacity. Register
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News Article
Eighteen deaths following Tees health trusts' safety lapses
Patient Safety Learning posted a news article in News
Eighteen people died at two Teesside hospital trusts following patient safety lapses over a 12-month period. Sixteen such deaths were recorded at the South Tees Hospitals NHS Foundation Trust, with two at the North Tees and Hartlepool NHS Foundation Trust. Examples of patient safety lapses include a failure to provide or monitor care, a breakdown in communication, an out-of-control infection in a hospital, insufficient staffing or a missed diagnosis. NHS England figures show that, between April 2021 and March this year, there were 16,557 incidents at the South Tees Trust, which operates James Cook University Hospital in Middlesbrough, and Northallerton's Friarage Hospital. Thirty-four resulted in "severe" harm. Middlesbrough MP Andy McDonald told the Local Democracy Reporting Service the figures were a concern and that he planned to take them up with the South Tees Trust's chief executive. He said NHS staff worked under "the most demanding of conditions" but added: "Every person going into hospital rightly expects to receive the best treatment. Patient safety is paramount and no family wants to see a loved one suffer." Dr Mike Stewart, the trust's chief medical officer, said: "We encourage an open and transparent culture and promote the reporting of all patient safety incidents, even when there is uncertainty over a direct link between any problems in care and incidents of severe harm or death. "In the last year there were no deaths graded as definitely preventable due to a problem in the care delivered by the trust. "While our reporting has increased consistently over the last three years, the number of serious incidents has not risen, which is strong evidence of a positive safety culture." Read full story Source: BBC News, 30 October 2022 -
News ArticleCancer patients in this country should have the best survival chances in the world. With its universal healthcare system and world-leading researchers, the UK should be able to offer every patient the knowledge and reassurance that their disease will be picked up quickly and treated rapidly, with the best that science can throw at it. Yet Britain languishes towards the bottom of developed nations’ league tables of cancer performance. On nearly every metric this is one of the worst places in the western world to get cancer — and some experts fear that survival rates are about to go backwards for the first time in a generation. Britain is now operating a “late diagnosis service” for the disease, a former UK cancer tsar has said, while waiting times are creeping up and up and nearly half of patients are diagnosed when their tumours have already spread, slashing their survival chances. Read full story (paywalled) Source: The Times, 22 October 2022
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News Article
Ovarian cancer: 1 in 4 patients ‘see GP three times before referral for tests’
Patient Safety Learning posted a news article in News
More than a quarter of women with ovarian cancer saw their GP three or more times before getting a referral for tests, according to a new study. Researchers also found that almost a third had waited for longer than three months after first going to see their GP before being given the right diagnosis. If doctors are able to diagnose ovarian cancer at the earliest stage, nine out of 10 women will go on to live for five years or longer, but only around one in 10 survive if it is not caught until it has progressed to stage 4, the most advanced stage. The report, by Target Ovarian Cancer, also revealed that 14 per cent of women polled said they were not given their diagnosis in private, meaning others could listen in on the exchange. “I was told of my stage 4 diagnosis behind the curtain on a busy respiratory ward. The rest of the ward heard the conversation,” one woman said. Meanwhile, GPs and ovarian cancer patients told researchers that the support available for the disease is insufficient – with almost half of the women polled not having been asked by a doctor, nurse or other individual providing treatment about how the cancer diagnosis was affecting their mental health. This is despite the fact that 60% of the women diagnosed with ovarian cancer said their mental health had been harmed by the disease. Read full story Source: The Independent. 18 October 2022 -
News ArticleA woman says she was forced to pay around £25,000 for private healthcare to treat endometriosis after her symptoms were “overlooked” for eight years. Aneka Hindocha, 34, started voicing her concerns about painful periods when she was aged 25 but says she was initially told by doctors this was normal. Ms Hindocha, who described the pain of endometriosis as “someone ripping your insides out”, says the condition should have been diagnosed sooner but argued women’s pain often gets overlooked and ignored. Endometriosis is a very common chronic inflammatory condition, impacting an estimated 1.5 million women in the UK. An inquiry by the All-Party Political Group found that like Ms Hindocha, it takes an average of eight years to get a diagnosis. The condition sees tissue comparable to womb-lining grow in other places in the body - with symptoms often debilitating and spanning from infertility to painful periods, tiredness, pain while having sex, as well as depression and anxiety. “I was told painful periods were normal, which they are not, but I believed that at the time,” Ms Hindocha told The Independent. “I thought the issue was me. I thought I was being a hypochondriac.” Her health massively deteriorated in the summer of 2020 and she became bedbound for three days. “I needed someone to find out what was wrong with me,“ Ms Hindocha added. “I was crying I was in so much pain.” She says that two years later she still had not received her laparoscopy despite the fact her pain was getting more severe and so she ended up paying for a private scan. She finally got diagnosed with stage 4 endometriosis a week later. “By the time of having my surgery at the end of February 2022, it had been nearly two years on the NHS waiting list and I was still being told to wait.” Read full story Source: The Independent, 18 October 2022
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News Article
Slow cancer diagnosis twice as likely for ethnic minority patients, survey shows
Patient Safety Learning posted a news article in News
New patient data shows significant regional differences in the effectiveness of primary care in getting cancer sufferers diagnosed – with an even more alarming picture when the data is broken down by ethnicity. A survey of cancer patients asked how many times they had “spoken to a healthcare professional at [their] GP practice about health problems caused by cancer” before they were diagnosed, with a range between one and more than five times. The overall figure for five times or more in England was 7% – but all four cancer alliances in London scored significantly above this. Cancer Research UK said this could reflect the greater concentration of ethnic minority patients in the capital, and the data bore this out. Nationally, 6.6% of white cancer patients had seen five or more primary care staff before getting a diagnosis. This compared to 11.7% for Asian cancer patients and 12.9% for Black cancer patients. Read full story (paywalled) Source: HSJ, 18 October 2022 -
Content ArticleThe aim of community diagnostic centres (CDCs) is to deliver additional diagnostic capacity in England by providing quicker and more convenient access for patients and reducing pressure on hospitals. The vision is for CDCs to be ‘one-stop shops for checks, scans and tests’, designed to achieve early diagnoses for patients and timely treatment and intervention, and are part of the offer of more place-based, person-centred approaches to care, removing some of the known barriers to access. But are CDCs living up to their promise?
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Content Article
Pancreatic Cancer UK: Real life stories section
Patient Safety Learning posted an article in Patient stories
These stories provide examples of how people with pancreatic cancer are diagnosed, the treatment they have, their experiences and how they take care of themselves. Everyone diagnosed with pancreatic cancer will be different in terms of how they received their diagnosis and how they respond to and cope with treatment. -
Content ArticleThis short video talks about the importance of recognising the signs and symptoms of head and neck cancer at the earliest opportunity, and describes actions which can be taken to support earlier diagnosis. Although aimed at pharmacists, it provides useful information for all patients and healthcare professionals on symptoms that might indicate head and neck cancer.
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News Article
Influx of very low risk referrals sparks review of cancer services
Patient Safety Learning posted a news article in News
NHS England is in talks about changing a pathway for women with breast problems after performance against the two-week target for them to be seen plummeted. HSJ understands discussions are ongoing between NHS England and the Association of Breast Surgery about changing the symptomatic breast pathway for some patients. This has been prompted by concerns that one stop breast clinics – which take those referred both via the symptomatic route and the standard two-week pathway for suspected cancer – are being flooded with very low risk patients, potentially meaning those at higher risk of cancer wait longer for tests and diagnosis. The symptomatic pathway, which is for patients where cancer is not initially suspected by their GP, was introduced in 2010 because only about half of diagnosed breast cancers were being referred on the normal two-week pathway. The national target is for 93% of patients to be seen within two weeks. However, since 2018-19, national performance against this has reduced from 85.8% to 64.1% last year. There are concerns the pathway has led to too many patients being referred for diagnostic procedures which are inappropriate for their symptoms, preventing those who are more in need of such tests from accessing them in a timely manner. Association of Breast Surgery president Chris Holcombe said: “GPs tend to be quite cautious and send most people along even if the risk is quite small. We will get patients who are 25 and, to be honest, before they come to clinic, I could tell you with 99 per cent certainty they won’t have cancer. But they are worried as anything.” Alternatives to the symptomatic breast pathway which could reduce pressure on one stop clinics and also offer patients a better service are now being evaluated, he said. “There are appropriate ways to see these patients other than in a very high resource clinic,” he added. “But they still need to be seen and seen quickly otherwise they will just bounce back into the one stop clinic.” Read full story (paywalled) Source: HSJ, 10 October 2022 -
Content ArticleCommunity Diagnostic Centres (CDCs) can relieve pressure on NHS acute services and bring diagnostic services closer to patients. This resource by the Chartered Institute of Ergonomics & Human Factors (CIEHF) explores ten principles for including systems thinking in the design of the diagnostic workforce and CDC services.
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Content Article
Risk of suicide after dementia diagnosis (3 October 2022)
Patient Safety Learning posted an article in Dementia
Patients with dementia may be at an increased suicide risk. Identifying groups at greatest risk of suicide would support targeted risk reduction efforts by clinical dementia services. In this study, Alothman et al. examine the association between a dementia diagnosis and suicide risk in the general population and to identify high-risk subgroups. They found that dementia was associated with increased risk of suicide in specific patient subgroups: those diagnosed before age 65 years (particularly in the 3-month postdiagnostic period), those in the first 3 months after diagnosis, and those with known psychiatric comorbidities. Given the current efforts to improve rates of dementia diagnosis, these findings emphasise the importance of concurrent implementation of suicide risk assessment for the identified high-risk groups.
