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Found 522 results
  1. News Article
    NHS staff are failing to follow guidelines for providing care to sickle cell patients - and some of the advice has been branded as “unfit for purpose”. The NHS Race and Health Observatory commissioned research, undertaken by Public Digital, to explore the lived experience of people undergoing emergency hospital admissions for sickle cell and managing crisis episodes at home. The Sickle cell digital discovery report: Designing better acute painful sickle cell care, found that the existence of service-wide information tailored by the National Institute for Health and Care Excellence has “arguably not been designed for an ambulance, A&E and emergency setting”, and states it has been proven that this guideline is “not being used and adhered to consistently”. Moreover, healthcare professionals have warned that the National Haemoglobinopathy Register (NHR) - a database of patients with red cell disorders - is not being readily accessed, while patients reported being treated in a way that breached prescribed instructions. “We believe that sickle cell crisis guidelines could be improved in terms of their usability in a high-pressure emergency setting, and in terms of promoting access to them,” the report authors concluded, adding that current guidance should be adapted. Read full story Source: The Independent, 31 January 2023
  2. News Article
    Plans to prevent one of the deadliest cancers for women in Jamaica have been significantly set back by the Covid pandemic, new figures reveal. The scheme to vaccinate schoolgirls against cervical cancer in Jamaica – which is the cancer with the second highest death rate in the Americas – began in 2018, but the Pan American Health Organization says inoculation rates fell to just 2.71% in 2021. This represents a drastic drop from the 2019 rate of 32%, and far from the WHO target of 90% by 2030. The cancer, which is curable if caught early, kills 22 in every 100,000 women in Jamaica. By comparison, in the UK the rate is 2.4 in every 100,000, and in Canada it is 2. Prevention of cervical cancer in Jamaica is also hindered by low rates of cervical screenings. “Women are afraid of the screening process and potential pain, but there is also a fear of a cancer diagnosis itself,” said Nicola Skyers of Jamaica’s Ministry of Health. “Some people just prefer not to know. But I also think that healthcare providers don’t offer screenings often enough. If a healthcare provider is really ‘selling’ the pap smear, more often than not the woman will choose to have it.” Health workers are forced to focus on cures rather than preventions amid staffing shortages and an overburdened healthcare system, said Skyers. “As a doctor, you won’t be encouraging every women you see to do a pap smear if you have 40 patients waiting outside.” Read full story Source: The Guardian, 2 February 2023
  3. News Article
    More than 500,000 people in the UK will be diagnosed with cancer every year by 2040, according to analysis by Cancer Research UK. In a new report, researchers project that if current trends continue, cancer cases will rise by one-third from 384,000 a year diagnosed now to 506,000 in 2040, taking the number of new cases every year to more than half a million for the first time. While mortality rates are projected to fall for many cancer types, the absolute numbers of deaths are predicted to increase by almost a quarter to 208,000. In total, it estimates that between 2023 and 2040, there could be 8.4m new cases and 3.5 million people could have died from cancer. Cancer Research UK’s chief clinician, Charles Swanton, said: “By the end of the next decade, if left unaided, the NHS risks being overwhelmed by the sheer volume of new cancer diagnoses. It takes 15 years to train an oncologist, pathologist, radiologist or surgeon. The government must start planning now to give patients the support they will so desperately need.” Read full story Source: The Guardian, 3 February 2023
  4. Content Article
    Over the past few years, Patient Safety Learning has heard from many patients about significant safety concerns relating to hysteroscopy procedures in the NHS.[1] From the countless women who have shared individual experiences on the hub to the conversations we have had with the patient group the Campaign Against Painful Hysteroscopy, it is clear that this is a topic needing further exploration and advocacy from a patient safety perspective. I therefore welcomed a recent opportunity to engage with healthcare professionals involved in hysteroscopy procedures and share these concerns when I was invited to attend the Association of Anaesthetists Winter Scientific Meeting 2023 last month. This is the Association’s flagship conference, attended by healthcare professionals from across the UK, and I was invited to contribute to a panel session. This was focused on differing approaches to sedation for hysteroscopy procedures in both operating theatres and outpatient settings. Healthcare professional perspective from Leeds Hysteroscopy is a procedure used as a diagnostic tool to identify the cause of common problems such as abnormal bleeding, unexplained pain or unusually heavy periods in women. It involves a long, thin tube being passed through the vagina and cervix, into the womb, often with little or no anaesthesia. The panel session started with a presentation about hysteroscopies from Dr John Dalton, Dr Tracy Jackson and Maria Chalmers, Specialist Nurse Hysteroscopist. Maria spoke about the approach to hysteroscopy at the Leeds Centre for Women’s Health, emphasising the importance of: appropriate patient consent for the procedure discussing the likelihood of pain in advance of obtaining consent the patient’s right to withdraw consent or stop the procedure at any time. They described how patients, if they wanted to, were invited to review the procedure on a screen, and reported that there had been positive feedback from patients who have undergone procedures with this option. They also spoke about the value of these procedures taking place in outpatient settings where possible, creating a quicker diagnostic assessment. In their presentation, they reflected on the importance of collecting data about patient outcomes and pointed to broadly positive satisfaction scores with their service. Reflections on consent It was positive to hear a strong emphasis on the importance of patient consent, both before and during a procedure. It is an area of concern that has been consistently raised with us by patients who have undergone hysteroscopy. Through our work, we know that a significant number of women are not given sufficient information beforehand about the nature of the procedure or the potential for high levels of pain. Many have told us they were not asked about their medical history or offered different options for pain relief. These patients often reflect that the consent they gave was therefore not informed. When a patient experiences unexpected levels of pain, they can understandably feel very unsafe. This can lead to lasting trauma and a fear of accessing further important procedures or screenings. It’s therefore essential to make sure women undergoing this procedure feel they have been given all the information available. Panel discussion I introduced the concerns being expressed by many women and this generated an open discussion with colleagues from Leeds and an engaged audience of anaesthetists, many of whom were unaware of the issues that patients are raising about outpatient hysteroscopy. In the panel discussion I spoke about the experiences that have been shared with us at Patient Safety Learning. Some women have described how the lack of forewarning about this procedure, coupled with the trauma of the experience itself, left them feeling that both their body and their trust had been violated. Many women have also described receiving little or no pain relief and not being given the information they needed to make an informed choice about their own care and their own bodies. More than 50,000 people have viewed our community discussion on the hub about hysteroscopy experiences, with many having shared awful experiences exhibiting bullying, lack of compassion, lack of information and horrendous pain. Recent research, published in the British Journal of Anaesthesia, shows that a significant number (17.6%) of women rate their pain during hysteroscopy as greater than 7/10, and only 7.8% report no pain at all.[2] We know that outpatient hysteroscopy is a valuable procedure when done right, with full information, appropriate pain relief options and informed consent. However, as we have heard all too often from patients, in many cases this is not what they are experiencing.[3] Similar concerns were raised this week in a debate in the House of Commons. When discussing the implementation of good practice in these procedures, Government Minister Maria Caulfield note that such guidance was only as effective as its implementation: “The royal college is important because it can bring clinical change on the ground, but it is not enough just to assume that its updated guidance will be enough to change what happens in practice.”[4] Patients and campaigners are not unsupportive of hysteroscopy as a procedure. However, I shared our view, and that of many, that patients should not be expected to tolerate extreme pain or inconsistency of service. I emphasised a need for: increased efforts to ensure that good practice is shared widely and consistently applied. more research to better inform risk assessments about which women are most likely to affected by severe pain. ensuring that all those healthcare professionals involved in these procedures understand the importance of listening to and responding patients, giving women a range of pain relief options and providing the option to stop the procedure. It was useful to discuss with Maria and other clinical colleagues the value of hysteroscopy and the efforts that some centres are making to ensure that patients’ needs are met, and their voices heeded. It was helpful also to see in person the responses of anaesthetists in the room. There was, in some cases, clear concern about the negative experiences that have been shared with Patient Safety Learning by patients. Then we had some interesting reflections on the pain scores presented by the staff at Leeds. Many anaesthetists expressed shock that despite the good service being provided there, median pain scores are 5 out of 10. Some anaesthetists commented that patients wouldn’t be let out of recovery rooms by nursing staff with that extent of pain, and some said that they themselves wouldn’t want to undergo such a procedure in an outpatient setting with that median pain rating. The discussion was an important multi-disciplinary conversation of the value of hysteroscopy as a procedure while highlighting the very real concerns that women are experiencing when Royal College of Obstetricians and Gynaecologists guidelines are not being met consistently. The opportunity to engage in discussion with clinicians who are aiming to put patients’ experience at the heart of their service was much appreciated and we’re going to follow up with Maria and John to hear more about their service and the plans they have for continual improvement and for the best experience for women. We applaud the Association of Anaesthetists for highlighting these issues and aim to engage further to increase awareness of hysteroscopy pain and the need for urgent action. We look forward to sharing the recording of the session via the hub as soon as it becomes available. Join the conversation There is much work still needed to raise awareness of the patient safety issues concerning hysteroscopy procedures and to make the changes required to ensure good practice is applied consistently across the country. In the coming weeks, we will be publishing a new policy blog looking at this in greater detail and considering what more needs to be done to improve patient safety. In the meantime, if you have an experience you would like to share with us, please do get in touch. Perhaps you are a healthcare professional with insights to share on this topic? A patient who has had a hysteroscopy? A researcher? We'd love to hear from you if have a different perspective to add. You can join the conversation on the hub or get in touch with us directly by emailing content@pslhub.org. References 1. Campaign Against Painful Hysteroscopy, Open letter to the Department of Health and Social Care, 20 October 2020 2. Richard Harrison, William Kuteesa, Atul Kapila, Mark Little, Wiebke Gandhi, Deepak Ravindran, Carien M. van Reekum and Tim. V Salomons, Pain-free day surgery? Evaluating pain and pain assessment during hysteroscopy, 13 September 2020 3. Patient Safety Learning, Guidance for outpatient hysteroscopy: Consultation Response, 16 March 2022 4. House of Commons Debate, NHS hysteroscopy treatment, 31 January 2023
  5. News Article
    All three acute trusts in an integrated care system are failing to meet national requirements to tackle health inequalities after being overwhelmed by emergency and elective care pressures. A report by Devon Integrated Care Board found progress on addressing variation in poor health outcomes had “slipped due to capacity issues.” Both Royal Devon University Healthcare Foundation Trust and Torbay and South Devon FT were rated “red” for a lack of headway. All trusts were told by NHSE in 2021 to undertake a range of actions as part of work to reduce health inequalities during 2022-23. These included publishing analyses of waiting times disaggregated by ethnicity and deprivation, using the waiting list data to identify disparities between different patient groups, and measuring access, experience and outcomes for patients from a deprived community or an ethnic minority background. Sarah Sweeney, interim chief executive of National Voices, which represents health and care charities and patients, said she was “really concerned to see that some ICSs are not making as much progress on reducing health inequalities as expected and hoped”. “These inequalities are completely unjust and preventable,” she said. Read full story (paywalled) Source: HSJ, 30 January 2023
  6. Event
    until
    Join us to learn how welfare rights advice services are being integrated with healthcare nationwide to tackle poverty and health inequality. This event will be of interest to people working in Integrated Care Systems and public health policy and practice. Taking action on poverty and health inequality is ever more important for the NHS, as the current cost of living crisis increases hardship among communities. The consequences for health and wellbeing will be felt most keenly among low income and vulnerable patient groups. Health justice partnerships are targeted interventions that support patients with social and economic circumstances that are root causes of health inequality. They are partnerships between health services and organisations specialising in welfare rights. Advice on welfare rights issues is integrated with patient care, helping people resolve problems relating to benefits, debt, housing, employment and immigration, among others. This can support those in the hardest circumstances to maximise their health and wellbeing. This one-day in-person workshop is an opportunity to learn about health justice partnerships and how they are being implemented across the country in a range of NHS settings. We will be joined by speakers who are engaged in service delivery, policy and research, who will provide examples and insights from their work. Speakers will include: Professor Dame Hazel Genn, Director of the Centre for Access to Justice, UCL Cedi Frederick, Chair of the NHS Kent and Medway Integrated Care Board Natalie Davis, Head of Legal Support Policy, Ministry of Justice Catherine McClennan, Director of the Women’s Health and Maternity Programme, Cheshire and Merseyside Health & Care Partnership Paul Sweeting, Insight and Performance Partner, Macmillan Cancer Support Refreshments are provided and there will be opportunities for discussion and networking. Outline of the day (provisional timings) 09.15: Registration and refreshments 10.15: Plenary session 1 - Introducing Health Justice Partnerships 11.45: Plenary session 2 - Health Justice Partnership case studies 13.00: Lunch provided 14.00: Plenary session 3 - Implementing Health Justice Partnerships 15.15: Group discussion session 4 - Where next for you? 16.30: Refreshments and networking Please see our website for further information on Health Justice Partnerships. Register for a place This event is supported by The Legal Education Foundation.
  7. News Article
    Women’s healthcare in the UK is worse than that of China and Saudi Arabia, according to a global tracker. Poor efforts at prevention, diagnosis and treatment of health problems left the UK ranked lower than several countries with a troubling record on women’s rights. The research, which compared a wealth of data, found Britain fared worse than most comparable Western countries, including the United States, Australia, New Zealand, France and Germany. The UK was placed 30th out of 122 countries, in the 2021 Hologic Global Women’s Health Index published on Tuesday. The score – three points lower than when a similar exercise was carried out last year – places it on a par with Kazakhstan, Slovenia, Kosovo and Poland for women’s healthcare provision. Read full story Source: The Telegraph, 24 January 2023
  8. News Article
    A study of 10,650 females in the UK found those with a combined household income of up to £25,000 per annum are less health literate and are less likely to attend health screenings or vaccination invitations. In fact, 1 in 10 have never had health issues such as blood pressure or cervical cancer checked, compared to just 5% of those in a household earning more than £40,000 per annum. 15% of lower earners said they didn’t take up offers of preventative healthcare because they felt it was not needed. They are also the least able to talk to and understand healthcare professionals (72% compared to 81% of high-income households) and least likely to know where to access health information (79% compared to 89% of high-income households). Although 75% feel informed about what is needed to be healthy, this rises to 88% of those in high-income households. It also emerged 30% of low earners who experience daily pain, such as joint pain, backaches or headaches, have stopped work completely as a result, compared to just 10% of high-income households. Read full story Source: The Independent, 24 January 2023
  9. Content Article
    Key findings The gap in Index scores between women in high-income and low-income economies nearly doubled between 2020 and 2021. In 2021, 22 points separated women in high-income economies — whose score remained unchanged at 61 — and women in low-income economies, whose score dropped from 49 to 39. Women’s ability to meet their basic needs — such as affording food — fell, while men’s ability to do so did not change. Women were slightly more likely than men to say there were times in the past year when they did not have enough money to afford needed food (37% of women vs. 33% of men). This gap was wider in 2021 than it was in 2020 — as women lost ground while men largely remained steady. Women in 2021 were more stressed, worried, angry and sad than they were in 2020 — or at any point in the past decade. Stress, worry and anger each increased by three percentage points within the span of a year, while sadness notably rose by six points. More than 4 in 10 women in 2021 said they experienced worry (43%) and stress (41%) during a lot of the day before the survey, nearly one in three experienced sadness (32%), and more than one in four experienced anger (26%) — all at record levels. In nearly 50 countries and territories, less than 10% of women said they had been tested for cancer in the previous year. Worldwide, just 12% of women in 2021 were tested for any type of cancer in the past 12 months, which means more than 2 billion of the world’s women went untested. Belief in the value of going to a healthcare professional declined among women with an elementary education or less. While belief in the value of going to a healthcare professional remained relatively stable among women with four years of education beyond high school or a college degree (92%), it dropped seven points among those with an elementary education or less — from 87% to 80% — leading to a 12-point gap between the two groups. Annual visits to healthcare professionals correspond with two additional years in a woman’s life expectancy. Even after accounting for gross domestic product (GDP) per capita, life expectancy for women who said they had been to a healthcare professional in the past year was 78, compared to 76 for women who said they hadn’t been.
  10. Content Article
    NHS England asks all organisations to undertake this review and: 1 Respond back to NHSE in relation to: Communication barriers. Reduced patient engagement (activation) in their care. Workforce’s conscious & unconscious biases. Biases that are embedded across the system. Transitions of care. Inaccessibility of care (including digital exclusion, and geographical isolation). Limited insights/data. 2 Adapt their existing Equalities Impact Assessment to reflect this new tool. 3 What specific next actions are you taking as a team that can publish as part of the patient safety health inequalities roadmap? E.g, Adapting existing Equalities Impact Assessment (EQIA)/Project/programme plan. Creating new SMART objectives/programmes of work/targets. Revisiting the data/evidence base relating to inequalities or updating your monitoring process. Revising/expanding the scope of ongoing stakeholder involvement.
  11. News Article
    The percentage of Americans reporting they or a family member postponed medical treatment in 2022 due to cost rose 12 points in one year, to 38%, the highest in Gallup’s 22-year trend. The latest double-digit increase in delaying medical treatment came on the heels of two consecutive 26% readings during the COVID-19 pandemic that were the lowest since 2004. The previous high point in the trend was 33% in 2014 and 2019. An average 29% of U.S. adults reported putting off medical treatment because of cost between 2001 and 2021. Americans were more than twice as likely to report the delayed treatment in their family was for a serious rather than a nonserious condition in 2022. In all, 27% said the treatment was for a “very” or “somewhat” serious condition or illness, while 11% said it was “not very” or “not at all” serious. Lower-income adults, younger adults and women in the U.S. have consistently been more likely than their counterparts to say they or a family member have delayed care for a serious medical condition. In 2022, Americans with an annual household income under $40,000 were nearly twice as likely as those with an income of $100,000 or more to say someone in their family delayed medical care for a serious condition (34% vs. 18%, respectively). Those with an income between $40,000 and less than $100,000 were similar to those in the lowest income group when it comes to postponing care, with 29% doing so. Read full story Source: Gallup News, 17 January 2023
  12. News Article
    Ministers must use legislation to address an “unacceptable and inexcusable” failure to address racial disparity in the use of the Mental Health Act (MHA), MPs and peers have said. The joint committee on the draft mental health bill says the bill does not go far enough to tackle failures that were identified in a landmark independent review five years ago, but which still persist and may even be getting worse. The committee says the landmark 2018 review of the MHA by Prof Simon Wessely – which the bill is a response to – was intended to address racial and ethnic inequalities, but that those problems have not improved since then “and, on some key metrics, are getting rapidly worse”. Lady Buscombe, the committee chair, said: “We believe stronger measures are needed to bring about change, in particular to tackle racial disparity in the use of the MHA. The failure to date is unacceptable and inexcusable. “The government should strengthen its proposal on advanced choice and give patients a statutory right to request an advance choice document setting out their preferences for future care and treatment, thereby strengthening both patient choice and their voice.” A Department of Health and Social Care spokesperson said: “We are taking action to address the unequal treatment of people from Black and other ethnic minority backgrounds with mental illness – including by tightening the criteria under which people can be detained and subject to community treatment orders. “The government will now review the committee’s recommendations and respond in due course.” Read full story Source: The Guardian, 19 January 2023
  13. Content Article
    Key findings In England, Scotland and Wales, life expectancy and healthy life expectancy at birth are lowest for people living in more deprived areas. On average, people in the most deprived 10% of local areas are expected to live a shorter life than those in the least deprived areas. They are also more likely to spend more of their life in poor health. Of these three countries, Scotland has the largest difference between people in the most deprived 10% of local areas and those in the least deprived. This is true both for healthy life expectancy (25 years for men and 21.5 years for women) and life expectancy (13.3 years for men and 10 years for women). It is followed by England and then Wales.
  14. Content Article
    It’s so important that mesh-injured women are able to access redress for their injuries, many of which are life-changing. Often, financial support is not a bonus but is necessary, as women have had to leave their jobs or reduce their hours to cope, move to accessible housing or sell their home to live with family. Many have also experienced marriage breakdown as a result of mesh complications. One in four women in Sling The Mesh need a stick to help them walk, so need to pay for mobility aids or scooters, and there are also the ongoing costs of travel to doctors and hospital appointments. Waiting times are up to four years for mesh removal, so many women cash in savings or pensions to pay for private removal which costs thousands. The psychological impact of mesh injuries also takes a toll and with long NHS mental health waiting lists, many turn to the private sector for counselling for post traumatic stress disorder (PTSD) and trauma. Likewise, many women have difficulty accessing NHS Physiotherapy so turn to the private sector for specialised physio to help mobilise internal pelvic scar tissue which can cause ongoing pain after mesh removal. The concept of redress is about proactively correcting a wrong that has been done to a group or individual. It differs from clinical negligence, which is about identifying and proving that the actions of an individual healthcare professional or service caused specific harm. Redress involves an authority taking responsibility for harm that has been caused under its watch, whereas clinical negligence is an adversarial process with strict legal boundaries. In 2020, the Independent Medicines and Medical Devices Safety (IMMDS) Review’s report, ‘First Do No Harm’ (Cumberlege Review), called for “a new independent Redress Agency for those harmed by medicines and medical devices” to be created, based on models operating effectively in other countries.[1] This Agency was to offer women harmed by mesh a specific, non-adversarial route to compensation. However, in its official response to the report, the Department for Health and Social Care (DHSC) rejected this recommendation, stating that “while the government is sympathetic to the experiences of those patients who gave evidence to the report, our primary focus is on improving future medicines and medical devices safety.”[2] The Government's failure to accept the IMMDS recommendations around setting up a Redress Agency means that the clinical negligence system is the only route left to women to pursue financial compensation, and it is a long, onerous process that is often unsuccessful. Sarah’s story - failures in the clinical negligence route Sarah* has spent the last two years fighting for redress through a clinical negligence case because of injuries following pelvic mesh surgery. Over the past few years, she has gone through two episodes of mesh erosion, two surgeries and an episode of sepsis. Since the mesh device was implanted, she has also experienced fibromyalgia and arthritis of the sacroiliac joints. She recently received a letter from the Head of Clinical Negligence at the law firm she was working with, informing her that they would not take her case forward. It was unlikely to be successful as she had her surgery before complications for mesh surgery were fully understood, and prior to 2013 when National Institute for Health and Care and Excellence (NICE) guidelines for urinary stress incontinence were changed. The letter stated: "The difficulty with your claim is that your TVT/mesh insertion surgery took place quite some time ago in 2007 when this was considered to be the gold standard to treat stress urinary incontinence, because the mesh surgery was quick, relatively simple and did not require a prolonged stay in hospital. It was only later on that the problems with mesh and the risks associated with mesh became fully known.” "A court would assess your claim based on the state of medical knowledge and expertise that existed at the time you had the mesh surgery in April 2007, with the problems and risks associated with mesh only becoming known at a later stage. "Consequently, a court will take the view that the consultant advising you at the time of your surgery in 2007 could only advise you based on the state of medical knowledge that existed at that time and cannot be held legally to blame for the treatment and advice that he gave you, if the risks associated with mesh only became apparent afterwards. "Therefore, unfortunately, further to the above we believe that if your claim proceeded further with the commencement of court proceedings, we would not have a reasonable prospect of success." It is my view that, given the evidence of harm caused by pelvic mesh, a woman who underwent surgery in 2007 should be equally entitled to redress as a woman who had surgery much later. I highlighted the issue with Helen Hughes, Chief Executive of Patient Safety Learning, who responded, “When responding to the IMMDS Review, the Government rejected a recommendation to introduce a separate redress scheme for mesh on the basis that patients could take healthcare providers to court for clinical negligence, or manufacturers for product liability. However, as this case sadly illustrates, the legal complexities involved in this means that for many mesh-injured patients this is simply not an option, leaving them with no alternative route to help meet the cost of any additional care and support they may need.” A national Redress Agency is the only way to offer equitable redress A Redress Agency specifically aimed at women with pelvic mesh injuries would offer a more equitable, compassionate route to secure compensation. As well as women having a higher chance of success going through a Redress Agency, women would not be forced to face the stress of legal action that often lasts for years while dealing with the pain and limitations they live with as a result of their injuries. At the moment, it does not appear that the political will or financial provision exists to make this a reality. *name changed for anonymity Related reading Tokenism in patient engagement is unethical—but it is also dangerous. A blog by Kath Sansom Doctors’ shocking comments reveal institutional misogyny towards women harmed by pelvic mesh - a Patient Safety Learning blog “There’s no problem with the mesh”: A personal account of the struggle to get vaginal mesh removal surgery References 1 First Do No Harm. The report of the Independent Medicines and Medical Devices Safety Review, 8 July 2020 2 Government response to the report of the Independent Medicines and Medical Devices Safety Review, 21 July 2021
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