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News ArticleA total of 338 patients with a diagnosis of COVID-19 were discharged from Scottish hospitals into care homes in the three months from March this year, says a report from Public Health Scotland. The discharges were necessary to free up space in hospitals for COVID-19 patients but some care home owners have claimed that it introduced the virus into their premises, causing almost 2000 deaths across Scotland.2 Public Health Scotland says that most of the 3599 discharges that took place in the busiest month of March were among people who had never been tested. Of the 650 who were tested, 78 were positive, but the discharges still went ahead. Scotland has been found to have the highest rate of COVID-19 related deaths in care homes of any part of the UK. Read full story Source: BMJ, 29 October 2020
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News ArticleNHS staff and their families accounted for one in six patients in hospital with Covid, due in part to inadequate personal protective equipment (PPE), new research suggests. A study of hospitals from March to June revealed that healthcare workers in patient-facing roles were around three times more likely to be hospitalised with the virus than the general population. Writing in the BMJ, the study's authors called for an urgent focus on how COVID-19 spreads around hospitals to prevent a similar toll in future waves of the pandemic. They also call for hospitals to consider re-deploying staff with vulnerable family members away from high-risk zones. Read full story Source: The Telegraph, 29 October 2020
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News Article
Structural racism led to worse Covid impact on BAME groups
Clive Flashman posted a news article in News
Minority ethnic people in UK were ‘overexposed, under protected, stigmatised and overlooked’, new review finds. Structural racism led to the disproportionate impact of the coronavirus pandemic on black, Asian and minority ethnic (BAME) communities, a review by Doreen Lawrence has concluded. The report, commissioned by Labour, contradicts the government’s adviser on ethnicity, Dr Raghib Ali, who last week dismissed claims that inequalities within government, health, employment and the education system help to explain why COVID-19 killed disproportionately more people from minority ethnic communities. Lady Lawrence’s review found BAME people are over-represented in public-facing industries where they cannot work from home, are more likely to live in overcrowded housing and have been put at risk by the government’s alleged failure to facilitate Covid-secure workplaces. She demanded that the government set out an urgent winter plan to tackle the disproportionate impact of Covid on BAME people and ensure comprehensive ethnicity data is collected across the NHS and social care. The report, entitled An Avoidable Crisis, also criticises politicians for demonising minorities, such as when Donald Trump used the phrase “the Chinese virus”. The report, which is based on submissions and conversations over Zoom featuring “heart-wrenching stories” as well as quantitative data, issued the following 20 recommendations: Set out an urgent plan for tackling the disproportionate impact of Covid on ethnic minorities Implement a national strategy to tackle health inequalities Suspend ‘no recourse to public funds’ during Covid Conduct a review of the impact of NRPF on public health and health inequalities Ensure Covid-19 cases from the workplace are properly recorded Strengthen Covid-19 risk assessments Improve access to PPE in all high-risk workplaces Give targeted support to people who are struggling to self-isolate Ensure protection and an end to discrimination for renters Raise the local housing allowance and address the root causes of homelessness Urgently conduct equality impact assessments on the government’s Covid support schemes Plan to prevent the stigmatisation of communities during Covid-19 Urgently legislate to tackle online harms Collect and publish better ethnicity data Implement a race equality strategy Ensure all policies and programmes help tackle structural inequality Introduce mandatory ethnicity pay gap reporting End the ‘hostile environment’ Reform the curriculum Take action to close the attainment gap Read full story Source: The Guardian, 28 October 2020 -
News ArticleThe government has been warned it is throwing “a lit match into a haystack” by discharging Covid-positive patients to care homes, with politicians demanding that the safety of residents and staff is guaranteed under the new policy. During the first wave of the pandemic, approximately 25,000 hospital patients were sent to care homes – many of whom were not tested – which helped spread the virus among residents. Around 16,000 care home deaths have been linked to COVID-19 since the start of the crisis. The strategy was one of the government’s “biggest and most devastating mistakes” of the crisis, says Amnesty International, and questions have been raised over the decision to introduce a similar policy as the UK’s second wave intensifies. As part of the 2020 adult social care winter plan, the government has called on local authorities and care providers to establish “stand-alone units” – so-called “hot homes” – that would be able to receive and treat Covid hospital patients while they recover from the disease. There is also an expectation that, due to housing pressures and a shortage of suitable facilities, some patients may be discharged to “zoned accommodation” within a home, before being allowed to return to normal living settings once they test negative for the virus. Councils have been told to start identifying and notifying the Care Quality Commission of appropriate accommodation, and to ensure high infection prevention standards are met. Under the requirements outlined by the government, discharged patients “must have a reported Covid test result". However, The Independent revealed on Monday that these rules have not been followed in some cases, with a recent British Red Cross survey finding that 26 per cent of respondents had not been tested before being discharged to a care home. There is also concern whether care homes possess enough adequate personal protective equipment to prevent outbreaks, with the CQC revealing last month that PPE was still not being worn in some sites. Read full story Source: The Independent, 27 0ctober 2020
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News ArticleAlmost half of hospital patients have been discharged without receiving the results of their coronavirus test – including some patients who were sent to care homes, new research from Healthwatch and British Cross has revealed. Independent national patient body Healthwatch England said it had learned many patients were discharged from hospitals between March and August this year without proper assessments with many vulnerable people sent home without medication, equipment or the care they needed. At the start of the pandemic thousands of patients were discharged to care homes as NHS England instructed hospitals to free up 15,000 beds ahead of the first wave of coronavirus. Approximately 25,000 patients were sent to care homes with some not tested, sparking fears this helped seed care homes with the virus. There have been around 16,000 care home deaths linked to COVID-19. According to a survey of almost 600 discharged patients and interviews with 60 NHS staff, Healthwatch England said it had found serious flaws with the way hospitals had followed NHS England’s instructions. Read full story Source: The Independent, 24 October 2020
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News Article
Alfreton's Field House mental health unit in special measures
Patient Safety Learning posted a news article in News
A mental health unit where a patient was found dead has been placed into special measures over concerns about safety and cleanliness. Field House, in Alfreton, Derbyshire, was rated "inadequate" by the Care Quality Commission (CQC) following a visit in August. A patient died "following use of a ligature" shortly after its inspection, the CQC said. Elysium, which runs the unit for women, said it was "swiftly" making changes. The inspectors' verdict comes after the unit was ordered to make improvements, in January 2019. Dr Kevin Cleary, the CQC's mental health lead, said: "There were issues with observation of patients, a lack of cleanliness at the service and with staffing. "There were insufficient nursing staff and they did not have the skills and experience to keep patients safe from avoidable harm. Bank and agency staff were not always familiar with the observation policy." "It was also worrying that not all staff received a COVID-19 risk assessment, infection control standards were poor, and hand sanitiser was not available in the service's apartments." The CQC said a follow-up inspection on Monday had showed "areas of improvement" but it would continue to monitor the service. Read full story Source: BBC News, 22 October 2020 -
News Article
Infection control experts issue open letter on care home visiting
Patient Safety Learning posted a news article in News
A group of experts in nursing and infection prevention and control (IPC) is today warning against the use of IPC measures as a “rationale” for stopping safe and compassionate visits in care homes during the Covid-19 pandemic. In a new open letter published in Nursing Times, the specialists say that preventing people from visiting loved ones in social care settings in the name of IPC is a “misinterpretation and at times even abuse” of IPC principles. The letter is the brainchild of independent global health consultant and former Infection Prevention Society (IPS) president, Jules Storr. Among the signatories are five former IPC presidents, current president Pat Cattini as well as incoming president Jennie Wilson. Dr Ron Daniels, chief executive of the UK Sepsis Trust, is also on the list, Helen Hughes, chief executive of Patient Safety Learning, as well as leading IPC nurse specialists, nurse academics, a GP and carers. Ms Storr, a nurse by background, and the hub topic lead, said she was motivated to take action after hearing “the most heart-breaking” stories from health professionals and relatives of residents about restricted visits in the UK in the wake of COVID-19. Some had not seen relatives for weeks or months, whilst others were only allowed to see their loved one once a week for 20 minutes at a distance, she said. One individual had told her how when their father had died only one family member was permitted in the home and they were not allowed to sit close enough to hold his hand. Ms Storr said these practices were “absolutely outrageous and wrong from an infection prevention point of view”. Read full story Source: Nursing Times, 16 October 2020 -
News ArticleCare homes should refuse to take coronavirus patients from hospitals if they cannot prevent the spread of the disease, the care watchdog has told The Independent. Staff should admit these patients only if care homes are equipped with the right personal protective equipment (PPE) and infection prevention measures, the Care Quality Commission (CQC) said. During the first wave of the pandemic, care homes saw widespread outbreaks of the virus with 16,000 deaths. Homes struggled to access protective clothing for staff and were forced to take 25,000 untested patients discharged from hospitals. In an in-depth interview, Kate Terroni, the CQC’s chief inspector of social care, said care homes should not be put under pressure during a second wave to take infected patients they could not properly look after. She said any home that refused to admit patients would have her support. “Care home providers should only admit a resident when they are confident they can meet their care needs, so where they are confident they’ve got good infection prevention control, they’ve got the right PPE, they’ve got the right workforce." “We will absolutely support a provider to say they cannot admit someone if those ingredients aren’t in place.” Read full story Source: The Independent, 12 October 2020,
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News ArticleA number of patients in a cancer ward have died in hospital after a coronavirus outbreak and more have tested positive for the virus. NHS Lothian have not confirmed how many died but said it was fewer than five and a ‘very small number’ of patients. The health board is investigating the Western General Hospital in Edinburgh which has had to put measures in place to further contain the outbreak. Another six patients have tested positive for the virus so the hospital has closed the oncology ward to new patients being admitted. The hospital has also asked patients, who would usually be allowed to go home over the weekend and return to hospital on Monday, to stay in hospital the whole week. Dr Donald Inverarity, consultant microbiologist at NHS Lothian, said: ‘Our thoughts are with the family of the deceased and I would like to express our sincere condolences." "A multidisciplinary Incident Management Team was immediately established and all necessary infection control measures are in place. The situation will continue to be reviewed and monitored very closely." The health board’s Health Protection Team and the nationwide Test and Protect teams are carrying out contact tracing of visitors and outpatients where necessary. Routine coronavirus screening of staff and patients is also taking place as part of an enhanced regime. Read full story Source: Metro, 10 October 2020
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News ArticleInspectors have demanded improvements from a hospital after a report highlighted a number of failings over COVID-19 precautions. The Care Quality Commission (CQC) inspected the emergency department and medical wards at the William Harvey Hospital in Ashford, Kent, on 11 August. Inspection teams visited a ward where patients showed symptoms and were awaiting test results as well as a ward caring for patients who had COVID-19. A ward for patients without the virus and a fourth ward where there had been an outbreak of COVID-19 were also inspected. The CQC said it took urgent enforcement action, telling the trust to ensure there was an "effective system to manage the health and safety of people using the hospital". The report revealed staff did not always wear PPE or face coverings correctly in medical wards. One member of the nursing team was seen to be wearing a mask incorrectly in the ward where there had been an outbreak of the coronavirus. At least seven members of staff were seen entering and leaving the ward caring for people who were suspected of having COVID-19 without adhering to hand hygiene practices. Staff did not always remove PPE upon entering a new clinical area of the emergency department. Nor did they always put on or take off their PPE when entering and leaving patient bays. While equipment was said to have been cleaned on the day, inspectors found this was not always recorded. The report also detailed that five members of staff were seen in one room that was too small to enable the practised social distancing in that space. East Kent Hospitals Trust chief executive Susan Acott said: "In August, a CQC inspection team visited the William Harvey Hospital and saw examples of practice which falls short of the high standard we all want to provide for our patients." "Keeping our patients and staff safe is our priority. We have responded to the CQC with the actions we are taking and we are committed to the care and safety of every patient in our hospitals." Read full story Source: BBC News, 7 October 2020
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News ArticleSenior doctors specialising in infectious diseases have written an open letter expressing "concern" about the rapid increase in COVID-19 cases in Northern Ireland. The letter is signed by 13 medics from hospitals across Northern Ireland. It calls for the public to stick to government guidance on reducing social interactions and also warns against "stigmatising people and areas with high levels of infection." The letter reads: "We need to support people who test positive. This pandemic requires us to work together to bring it under control urgently. We need to reduce the potential for transmission to protect our health service, and we need to fix our test and trace system to try and gain better control of this virus in our community." On Monday, 616 new cases of COVID-19 were identified in Northern Ireland, bringing the total during the pandemic to 14,690. The number of deaths recorded by the Department of Health remains at 584. Among those who have signed the letter are Dr Claire Donnelly, a consultant physician who specialises in infectious diseases; consultant virologist Dr Conall McCaughey and consultant paediatrician Dr Sharon Christie. Entitled an "appeal to people to adhere to Covid public health guidance", the letter lays bare the stark reality of the infections rates. The letter adds: "Worryingly the number of cases is increasing rapidly in many areas over the last week, indicating that we have widespread community transmission in many parts of Northern Ireland." Read full story Source: BBC News, 6 October 2020
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News Article
Did early focus on hand washing and not masks aid spread of COVID-19?
Patient Safety Learning posted a news article in News
From the moment coronavirus reached UK shores, public health advice stressed the importance of washing hands and deep-cleaning surfaces to reduce the risk of becoming infected. The advice was informed by mountains of research into the transmission of other respiratory viruses: it was the best scientists could do with such a new pathogen. But as the pandemic spread and data rolled in, some scientists began to question whether the focus on hand hygiene was as crucial as it seemed. The issue has resurfaced after Monica Gandhi, a professor of medicine at the University of California, San Francisco, told the US science magazine Nautilus that the easiest way to catch the virus was through droplets and aerosols sprayed from an infected person’s mouth or nose. “It’s not through surfaces,” she said. “We now know the root of the spread is not from touching surfaces and touching your eye. It’s from being close to someone spewing virus from their nose and mouth, without in most cases knowing they are doing so.” Gandhi’s is not a lone voice. Her comments follow a prominent paper in the Lancet from Emanuel Goldman, a professor of microbiology at Rutgers University in New Jersey. He was sceptical about the relevance of scientific studies that showed the virus could survive on surfaces for days at a time. “In my opinion,” he wrote, “the chance of transmission through inanimate surfaces is very small, and only in instances where an infected person coughs or sneezes on the surface, and someone else touches that surface soon after the cough or sneeze.” He defined soon as within one to two hours. Dr Julian Tang, an honorary associate professor of respiratory sciences at the University of Leicester, thinks hand washing should stay but agrees the risk from contaminated surfaces has been overplayed. He points to documents from the UK government’s Scientific Advisory Group for Emergencies (Sage) that estimate hand washing can reduce acute respiratory infections by only 16%. Meanwhile, he adds, the World Health Organization has warned about surfaces being a likely route of transmission while conceding there are no reports demonstrating infection this way. Tang believes that a preoccupation with contaminated surfaces distracted countries from taking airborne transmission seriously and played down the necessity of wearing masks. “What we’ve always said is that the virus transmits by all routes. There might be some transmission by hand and fomites and we’re not opposed to hand washing, but the emphasis is wrong,” he told the Guardian. Read full story Source: 5 October 2020 -
News ArticleA technical glitch that meant nearly 16,000 cases of coronavirus went unreported has delayed efforts to trace contacts of people who tested positive. Public Health England (PHE) said 15,841 cases between 25 September and 2 October were left out of the UK daily case figures. They were then added in to reach Saturday's figure of 12,872 new cases and Sunday's 22,961 figure. PHE said all those who tested positive had been informed. But it means others in close contact with them were not. The issue has been resolved, PHE said, with outstanding cases passed on to tracers by 01:00 BST on Saturday. The technical issue also means that the daily case totals reported on the government's coronavirus dashboard over the past week have been lower than the true number. Read full story Source: BBC News, 5 October 2020
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News ArticleCovid infection rates among doctors, nurses, and other hospital and care home staff have risen more than fivefold over the past month in London, scientists have discovered. The figures – provided by the Francis Crick Institute – have triggered considerable concern among scientists, who fear similar increases may be occurring in other regions of the UK. Increasing numbers of infected healthcare workers raise fears that the spread of COVID-19 into wards and care homes – which triggered tens of thousands of deaths last spring – could be repeated unless urgent action is taken. “It is very, very worrying,” said Professor Charles Swanton, who helped set up the institute’s Pipeline testing service. “Keeping hospitals and care homes free of the virus is crucial but these figures suggest we are heading in the wrong direction.” The Francis Crick Institute – one of Britain’s leading biomedical research centres – decided in March to use its array of powerful laboratory devices to set up a Covid testing service for hospital and care home staff in central and north London. Many other UK academic institutions offered to start similar services but were discouraged by the Department of Health and Social Care which said it wanted to centralise testing operations. Read full story Source: The Guardian, 3 October 2020
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News Article
Patients left 'in limbo' by NHS virus response
Patient Safety Learning posted a news article in News
The stress and anxiety caused to patients by "poor communication" from NHS bodies in England during the covid pandemic has been criticised by MPs. While recognising the huge burden placed on the NHS, their report said cancelled treatments and surgery had left some "in limbo" and others "too scared" to seek medical help. The report also questioned why weekly testing of NHS staff had not yet begun. And it called for their mental and physical wellbeing to be supported. Jeremy Hunt, who chairs the Health and Social Care Committee, which compiled the report, praised the "heroic contribution" made by front-line NHS staff during the pandemic, which had saved many lives. But he said the pandemic had "massively impacted normal NHS services" and this situation could have been improved with clearer communication to patients and better infection control measures in hospitals. The report, based on evidence from doctors, nurses, patient groups and NHS leaders, said the case for routine testing for all NHS staff in all parts of the country was "compelling" and it should be introduced as soon as possible before winter to help reduce the spread of the virus. The government and NHS England told the committee they wanted to bring in routine testing of staff but any plans depended on the capacity available. Read full story Source: BBC News, 1 October 2020 -
News Article
South Wales hospital cancels most operations after Covid outbreak
Patient Safety Learning posted a news article in News
Most operations have been cancelled at a hospital in a COVID-19 hotspot in south Wales after an outbreak of the virus involving more than 80 people. Hospital chiefs said transmission had taken place within the Royal Glamorgan hospital at Llantrisant and some wards where patients and staff had been infected were closed. The hospital, which is within Rhondda Cynon Taf, one of the areas under local lockdown restrictions, said it was trying to speed up the testing of patients and staff. In a statement, it said: “Significant temporary service restrictions will be put in place at Royal Glamorgan hospital from 2pm Wednesday 30 September as increased action is taken to contain a COVID-19 outbreak within the hospital. Teams have been working at pace to implement robust measures to manage the outbreak. However, additional cases linked to transmission within the hospital have been confirmed in recent days with the number of cases currently standing at 82." Andrew RT Davies, shadow health minister for the Welsh Conservatives, called on the Welsh government to explore using field hospitals and other health facilities to alleviate pressure on the Royal Glamorgan. He added: “This is very concerning, particularly as many of the additional cases are linked to transmission within the hospital, and so questions over processes and protocols must be asked.” Read full story Source: The Guardian, 30 September 2020 -
News Article
Coronavirus: NHS faces pandemic 'triple whammy' this winter
Patient Safety Learning posted a news article in News
The NHS is facing a "triple whammy" of rising COVID-19 cases, a major backlog in treatment and reduced capacity due to infection-control measures, according to health bosses. The NHS Confederation report on the English NHS said more investment was desperately needed. The NHS bosses also called on ministers to be "honest and realistic" about waiting lists for treatment. It comes despite the government promising an extra £3bn this winter. That money - announced over the summer - was intended to help hospitals cope with the extra-infection control measures required and to pay for patients to be treated privately for routine treatment, such as knee and hip replacements. But hospitals are still performing only half the number of routine operations they normally would. Two million patients have already waited longer than 18 weeks for treatment, the highest number since records began, in 2007. And services in other areas, such as cancer care, are running at about three-quarters capacity. Of the more than 250 bosses who responded to the confederation's survey: fewer than one in 10 said the current level of funding allowed them to deliver safe and effective care nearly nine in 10 said a lack of funding would be a significant barrier to achieving waiting-time targets for everything from mental-health care to cancer treatment and routine operations. Read full story Source: BBC News, 29 September 2020 -
News Article
'A one-off test is a folly': The truth behind covid false negative covid results
Patient Safety Learning posted a news article in News
When Sarah found herself suffering sudden bouts of breathlessness in May, she took herself to hospital. But after her COVID-19 swab test came back negative, doctors said she was probably anxious, and sent her home. Despite this, Sarah’s symptoms continued to worsen. A week later, she was rushed to hospital in an ambulance. Paramedics told her that based on her clinic observations, she should be in a coma. Then came more surprising news: She had tested positive for coronavirus Sarah’s story – given to a patient safety charity under a pseudonym – is one that resonates with Dr Claudia Paoloni, president of the Hospital Consultants and Specialists Association. She detailed another case in which a patient tested negative twice: once when she was first admitted to hospital and once later in her hospital stay. She finally tested positive on her third test – by which time she was on a ventilator in intensive care. Paolini believes COVID-19 swab tests produce a troublingly high rate of false negative results, and the problem lies in the reliance on a single test. “To use as a one-off test in any capacity to exclude someone from having COVID-19 is a folly.” If you want to exclude someone from having the virus, Paoloni said, you must do multiple tests and collect multiple negative results. “If the test and tracing system is not working, which is the case here, transmission will continue unabated in the community.” The most recent data published by the Office for National Statistics says the test’s sensitivity - which it says can tell us how likely it is to return a false-negative result, may be somewhere between 85% and 98%. Dr Deenan Pillay, Professor of Virology at University College London and member of Independent Sage, a group of scientists providing transparent advice during the crisis, said a significant number of self-administered tests could be coming back negative for people who do in fact have the virus. “The single biggest reason why a swab from someone who has COVID-19 comes up as negative is the quality of the swab that is taken,” Dr Pillay said. “Swabbing your nose and throat in a way that will pick up the virus means really scraping down the side of the wall of the nose or back of the throat to get cells from the lining of the throat. That’s not a pleasant thing to do.” This is of course true for at-home testing, which relies on the patient or a family member to collect the swab. But it could be true at testing centres, too. Tom, a 29-year-old from London whose name has been changed for this story, said there were no medical staff on site when he visited a Covid testing centre in London. The only people he interacted with were staff from a third-party contractor paid to carry out testing. “The man simply handed me a test, read out the instructions to self-administer the test, and asked me to do it myself,” he said. Pillay agrees that testing methods are likely to have an impact on false negative results. “I have seen the documentation given out at testing centres and it is very confusing,” he said. “Centres often expect you to administer the test yourself or get someone else in your car to administer it for you, all of which creates difficulties.” Pillay believes the solution lies in having medically trained staff at testing centres. “The way the system is developed at the moment, outsourced to private companies like Deloitte and Lighthouse Labs, is just woeful,” he said. “The whole system is failing at the moment. And it’s happening just as the numbers of infections are starting to rise,” Dr Pillay said. Read full story Source: Huffpost, 27 September 2020 -
News Article
Coronavirus: Tens of thousands ‘wrongly given’ all clear by Lighthouse Labs
Patient Safety Learning posted a news article in News
Tens of thousands of people infected with coronavirus were incorrectly given the all clear by England’s Lighthouse Laboratories, a High Court trial will be told next week. Court documents seen by The Independent show the labs are accused of unfairly selecting software that was shown in a test to produce significant numbers of errors and false negatives, samples that should have been positive or classed as needing to be re-taken. The two companies behind the Lighthouse Labs in England – Medicines Discovery Catapult Ltd and UK Biocentre Ltd – are accused of treating British company, Diagnostics.ai unfairly and giving preferential treatment to Belgian company UgenTec, despite the British firm’s software performing better in the test. The case, first revealed by The Independent in June, also includes a judicial review of the procurement decision against health secretary Matt Hancock – one of the first court hearings over the procurement processes followed by the government since the start of the pandemic. The Independent understands lawyers for Diagnostics.ai will accuse the laboratories of choosing a software solution that went on to produce tens of thousands of incorrect results which will have led to infected people going about their normal lives while at risk of spreading the virus. In June, UgenTec chief executive Steven Verhoeven told The Independent the suggestion its software had made errors was “incorrect”. The Department of Health refused to comment on the legal action but said in June that the UgenTec software had been used for several months and was subject to quality assurance processes, though it did not give any further details. Mr Justice Fraser will hear opening arguments in the case on Monday at the High Court. Read full story Source: The Independent, 25 September 2020 -
News Article
Overcrowded A&Es ‘much more dangerous now because of covid’
Patient Safety Learning posted a news article in News
Emergency departments across England are reporting ‘dangerous’ overcrowding similar to levels seen pre-covid, and struggling to maintain social distancing, A&E leaders have warned. The Royal College of Emergency Medicine said it was concerned about covid spreading among the most vulnerable patients, as overall transmission rates continue to rise sharply across the UK. It was always anticipated that A&E activity would return to pre-covid levels this winter, following a significant drop-off in A&E activity during the spring and early summer, and that service transformation would be needed to help maintain social distancing. But the emergence of widespread overcrowding so far ahead of winter is of serious concern to system leaders. A&E staff were already being forced to make difficult trade-offs over which patients to isolate, the college’s vice president told HSJ. He also urged NHS leaders not to place unrealistic expectations on the impact a new model involving walk-in patients booking slots by phone could make on addressing overcrowding in emergency departments. RCEM vice president Adrian Boyle said the NHS was “largely back to the pre-covid levels of crowding” but it was “much more dangerous now because of covid”. He said: “We are hearing that most emergency departments can’t maintain social distancing safely and staff are having to make fairly difficult trade-offs about which people need to be isolated. No one can be safely social distanced in a corridor.” Read full story (paywalled) Source: HSJ, 21 September 2020 -
News ArticleWatchdog chief says increasing patient feedback will be the fuel to drive improvements in patient safety Some hospitals and care homes are failing to take action to protect patients from coronavirus as cases rise across the country, the head of the care watchdog has warned. In an interview with The Independent, Ian Trenholm, the chief executive of the Care Quality Commission (CQC), said a series of inspections had revealed a minority of homes and hospitals were not doing enough to prevent infection. He said in one case a care home appeared to have made a “conscious decision” not to follow the rules on wearing masks and gloves and was now in the process of being closed down by the watchdog due to safety fears. Mr Trenholm also revealed the CQC would be looking closely at patients struggling to access services because of the impact of COVID-19 and he warned it would act if some groups were disproportionately affected. The CQC is being forced to move away from its regular inspections of hospitals, care homes and GPs due to the pandemic but Mr Trenholm said it would be redoubling efforts to encourage patients to give feedback on the care they received, adding the watchdog would be more explicit in future about the action it takes. Read full story Source: The Independent, 21 September 2020
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News ArticleA series of hospitals will be designated as coronavirus-free zones during the second wave of the outbreak in a significant policy shift designed to ensure the NHS continues treatment for cancer and other conditions, the Guardian has learned. NHS England is determined not to repeat the widespread suspension of normal service that occurred in the first wave, which doctors and charities have criticised for damaging patients’ health, leading to more deaths and creating a backlog of millions of treatments. In a tacit admission that the March shutdown denied patients vital care, NHS bosses have drawn up plans for certain hospitals – mainly small district generals – to treat no COVID-19 patients and focus instead on common planned operations such as cancer surgery, hip and knee replacements, and cataract removals. Under NHS plans, such “clean” hospitals will as far as possible be kept free of coronavirus patients in a reversal of the approach taken in spring. That should reduce the risk of patients admitted for normal care becoming infected with COVID-19 while on wards. Read full story Source: The Guardian, 21 September 2020
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News ArticleAn investigation into the outbreak of a bacterial infection that killed 15 people has found there were several “missed opportunities” in their care. Mid Essex Clinical Commissioning Group has released the outcome of a 10-month investigation into a Strep A outbreak in 2019, which killed 15 people and affected a further 24. The final report was critical of Provide, a community interest company based in Colchester, as well as the former Mid Essex Hospital Services Trust (now part of Mid and South Essex Foundation Trust). It said: “This investigation has identified that in some cases there were missed opportunities where treatment should have been more proactive, holistic and timely. These do not definitively indicate that their outcomes would have been different.” Investigators found that 13 of the 15 people that died had received poor wound care from Provide CIC. They reported that inappropriate wound dressings were used and record keeping was so poor that deterioration of wounds was not recognised. Even wounds that had not improved over 22 days were not escalated to senior team members for help or referred to the tissue viability service for specialist advice, with investigators told this was often due to concerns over team capacity. The report, commissioned by the CCG and conducted by consultancy firm Facere Melius, said: “[Some] individuals became increasingly unwell over a period of time in the community, yet their deterioration either went unnoticed or was not acted upon promptly. Sometimes their condition had become so serious that they were very ill before acute medical intervention was sought”. Other findings included delays in the community in the taking of wound swabs to determine if the wound was infected and by which bacteria. It said in one case nine days elapsed before the requested swab took place. Even after Public Health England asked for all wounds to be swabbed following the initial outbreak, this was only conducted on a single patient. In other cases there were delays in patients being given antibiotics and this “could have had an adverse impact on the treatment for infection”. It also found that sepsis guidelines were not accurately followed, wounds were not uncovered for inspection in A&E, and some patients were given penicillin-based antibiotics despite penicillin allergies being listed in their health records. Read full story (paywalled) Source: HSJ, 17 September 2020
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News ArticleHealth inspectors have uncovered multiple problems with infection control and the use of personal protective equipment (PPE) in care homes in England ahead of a second spike in COVID-19, which is starting to be detected in care facilities across the country. The Care Quality Commission (CQC) found homes where PPE was not being worn and that had out-of-date infection prevention policies and were failing to take steps to protect black and minority ethnic residents and staff who have been identified as potentially more vulnerable to the virus. The checks took place last month in 59 English care homes and were triggered by concerns about safety and quality or complaints by residents, staff and relatives. The checks precede a government announcement within days of a winter infection control fund that is expected to broadly match the £600m already committed this year. The fund will pay additional staff costs stemming from using fewer highly mobile temporary workers, who have been shown to spread the virus. However, the CQC inspections found PPE being worn inconsistently by staff members, limited supplies of masks in some places, and a failure to store PPE safely away from infection risk. “We found examples of infection prevention and control policies that were out of date,” the inspectors said. “Some had been updated early on in the Covid-19 outbreak but had not been amended since and so contained out-of-date information. This posed a risk to the staff and people who live in the care home. Others had not been updated since 2019. One care home had completed a [contingency] plan, but it only covered the hot weather and did not include preparations for autumn and winter.” Read full story Source: The Guardian, 16 September 2020
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News ArticleAn acute hospital in Greater Manchester is now experiencing a spike in coronavirus patients, following weeks of high infection rates in the community. Figures released by Bolton Foundation Trust today said it currently has 26 suspected covid patients, including three in critical care. These are the highest numbers reported by the trust since the end of May.For most of July, August and early September, the trust had fewer than five covid patients on its wards at any one time. The borough of Bolton has reported high infection weeks for several weeks, with the latest figures suggesting 200 infections per 100,000 people, the highest rate in the country. Dr Francis Andrews, the trust’s medical director, said: “We are seeing more people being admitted with confirmed or suspected covid-19 as a result of the very high rate of infections in Bolton. “This is not a shift we want to see. The situation at the hospital is under control and we were well prepared for this. However, the rate continuing to rise is of concern, and we continue to urge the people of Bolton to consider others when making decisions that could jeopardise their safety." Read full story (paywalled) Source: HSJ, 15 September 2020
