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Found 1,566 results
  1. News Article
    Inspectors have raised “new and ongoing” patient safety concerns at Shrewsbury and Telford Hospitals Trust, it has emerged. The Care Quality Commission has issued a new warning notice to the Midlands trust after an inspection of the hospital earlier this month sparked concerns for the welfare of patients on its medical wards. These concerns are separate from the trust’s maternity service, which, it was revealed on Tuesday, is now facing a police investigation alongside an NHS inquiry into more than 1,200 allegations of poor maternity care dating back to the 1970s. In October, a patient at the hospital bled to death after a device used to access his bloodstream became inexplicably disconnected while he was receiving care on the renal unit. The Health Service Journal reported the latest concerns related to the inappropriate use of bed rails and risks of patients falling from beds after several incidents. The CQC is also concerned about the trust’s use of powers to detain elderly or vulnerable patients on wards. The concerns also include patients being at risk of abuse and learning from past incidents not being shared with staff. Read full story Source: The Independent, 1 July 2020
  2. News Article
    The government must set out plans for an inquiry into its handling of the coronavirus pandemic, the health service ombudsman has said. This was not about blaming staff but about "learning lessons", he said. Ombudsman Rob Behrens said patients were reporting concerns about cancelled cancer treatment and incorrect COVID-19 test results. Ministers have not committed to holding an inquiry, but have accepted there are lessons to be learned. The Parliamentary and Health Service Ombudsman (PHSO) stopped investigating complaints against the NHS on 26 March, to allow it to focus on tackling the COVID-19 outbreak. But people had continued to phone in with these concerns, Mr Behrens said. "Complaining when something has gone wrong should not be about criticising doctors, nurses or other front-line public servants, who have often been under extraordinary pressure dealing with the Covid-19 crisis," he said. "It is about identifying where things have gone wrong systematically and making sure lessons are learned so mistakes are not repeated." Read full story Source: BBC News, 1 July 2020
  3. News Article
    A dramatic collapse in standards at a care home where a dozen people died from COVID-19 has been revealed by inspectors who discovered hungry and thirsty residents living with infected wounds in filthy conditions. Infection control was inadequate, residents with dementia were left only partially dressed and one family complained of finding their loved one smeared in dried faeces at Temple Court care home in Kettering, which is operated by Amicura, a branch of Minster Care which runs more than 70 homes in the UK. Amicura said the home had been “completely overwhelmed” by COVID-19 infections which it said arrived with 15 patients discharged from hospitals in the second half of March. They were overrun,” one relative told the inspectors. “They were short-staffed and then with the influx of people, they couldn’t cope.” Residents’ wounds had become necrotic and infected, requiring hospital treatment and several people had experienced falls, some of which resulted in injuries needing hospital treatment, the inspectors found. The conditions discovered by the Care Quality Commission on 12-13 May were so poor that surviving residents were moved out immediately. The CQC report into the service, published on Friday, found multiple breaches of the health and social care act. Northamptonshire police have launched an investigation to identify whether any offences may have been committed. Read full story Source: The Guardian, 26 June 2020
  4. News Article
    The Care Quality Commission (CQC) has launched a review into its own regulatory response to a troubled autism service. The CQC has asked its head of inspection for child and justice services, Nigel Thompson, to examine its response to concerns that were raised about an autism service in south Staffordshire in 2019. Concerns were reported directly to the CQC in early 2019, by parents of children under the services, while similar issues were highlighted in a report from the local Healthwatch branch last July. In a statement, the CQC said: “Following concerns raised with us by families, in relation to The Hayes autism service run by Midlands Psychology, we are looking at the evidence we received about this service and how we assessed this to inform our regulatory response. “We are looking into these concerns in accordance with our complaints process. As a learning organisation, we welcome all feedback and we have already met with some of the families, but some meetings have been delayed due to the covid-19 pandemic.” Read full story Source: HSJ, 25 June 2020
  5. News Article
    The NHS has kept secret dozens of external reviews of failings in local services – covering possible premature deaths, unnecessary and harmful operations, and rows among doctors putting patients at risk – an HSJ investigation has found. At least 70 external reviews by medical royal colleges were carried out from 2016 to 2019, across 47 trusts, according to information provided by NHS trusts, but more than 60 of these have never been published – contrary to national guidance – while several have not even been shared with the Care Quality Commission (CQC) and other regulators. These include reviews which uncovered serious failings. Bill Kirkup’s review into the Morecambe Bay scandal in 2015 recommended trusts should “report openly” all external investigations into clinical services, governance or other aspects of their operations, including notifying the CQC. Since then the CQC has asked trusts for details of external reviews when it reviews evidence, and in July 2018 it began to ask for copies of their final reports, but HSJ’s research suggests this does not always happen. James Titcombe, the patient safety campaigner whose son’s death led to the inquiry by Bill Kirkup into the Morecambe Bay maternity care scandal, said a review was now needed of whether its recommendations had been implemented. “It is not acceptable that five years [on], there are still secretive royal college reports and patients are kept in the dark,” he said. Read full story Source: HSJ, 25 June 2020
  6. News Article
    Relatives of 450 people who have died in the coronavirus pandemic are demanding an immediate public inquiry. The families want an urgent review of "life and death" steps needed to minimise the continuing effects of the virus and a guarantee that documents relating to the crisis will be kept. A full inquiry would take place later, says lawyer, Elkan Abrahamson, who is representing the families. The government has said its current focus is on dealing with the pandemic. But the COVID-19 Bereaved Families for Justice UK group say immediate lessons need to be learned to prevent more deaths, and that waiting for ministers to launch an inquiry will cost lives. The call for an inquiry comes as a report from the National Audit Office - assessing the readiness of the NHS and social care in England for the pandemic - has shown it is not known how many of the 25,000 people discharged from hospitals into care homes at the peak of the outbreak were infected with coronavirus. Health and Social Care Select Committee chairman Jeremy Hunt said it seemed "extraordinary that no one appeared to consider" the risk. The Department of Health says it took the "right decisions at the right time". Read full story Source: BBC News, 12 June 2020
  7. News Article
    A poll of members by the Medical Protection Society (MPS) found that 43% of doctors fear investigation if patients come to harm because of delays to referrals and reduced NHS services during the pandemic. Treatment has been delayed for millions of patients while the NHS has focused on managing the pandemic - with GPs in many areas still unable to refer as normal and even urgent referrals delayed while the UK has been in lockdown. The NHS Confederation has warned that 10 million people could be on NHS waiting lists by Christmas. Reduced NHS services during the pandemic have left even patients who need urgent treatment or scans for cancer waiting longer. GPonline reported in April that patients had been waiting more than a month for urgent cancer checks - and Cancer Research UK warned in May that 2.4 million patients were waiting longer for scans or treatment because of disruption to services during the pandemic. Read full story Source: GPonline, 11 June 2020
  8. News Article
    Ministers are facing a high court legal challenge after they refused to order an urgent investigation into the shortages of personal protective equipment faced by NHS staff during the coronavirus pandemic. Doctors, lawyers and campaigners for older people’s welfare issued proceedings on Monday which they hope will lead to a judicial review of the government’s efforts to ensure that health professionals and social care staff had enough personal protective equipment (PPE) to keep them safe. They want to compel ministers to hold an independent inquiry into PPE and ensure staff in settings looking after Covid-19 patients will be able to obtain the gowns, masks, eye protection and gloves they need if, as many doctors fear, there is a second wave of the disease. About 300 UK health workers have so far died of COVID-19, and many NHS staff groups and families claim inadequate PPE played a key role in exposing them. Read full story Source: The Guardian, 8 June 2020
  9. News Article
    A hospital trust under the spotlight over avoidable baby deaths provided inadequate antenatal care, with inexperienced junior midwives working alone and doctors not always available to assess high risk women, the Care Quality Commission (CQC) has found. The latest CQC report on maternity services at East Kent Hospitals University Foundation Trust follows a report last month by the NHS Healthcare Services Investigation Branch on 24 maternity care investigations at the trust. Read full story (paywalled) Source: BMJ, 28 May 2020
  10. News Article
    The coroner investigating the botched birth of a baby boy who died from hypoxia has strongly criticised the Healthcare Service Investigation Branch (HSIB) over its report on his death. Karen Henderson, who conducted the inquest into the death of baby Theo Young in May 2018 at East Surrey Hospital said that the HSIB had asked Surrey and Sussex Healthcare NHS Trust not to undertake its own investigation, “effectively preventing the recognition of causes of concern and therefore being unable to undertake any immediate and necessary remedial action at the earliest opportunity to prevent future deaths.” Read full story (paywalled) Source: BMJ, 19 May 2020
  11. News Article
    The deaths of more than 50 hospital and care home workers have been reported to Britain’s health and safety regulator, which is considering launching criminal investigations, the Guardian has learned. The Health and Safety Executive (HSE), which investigates the breaking of safety at work laws, has received 54 formal reports of deaths in health and care settings “where the source of infection is recorded as COVID-19”. These are via the official reporting process, called Riddor: Reporting of Injuries, Diseases and Dangerous Occurrences. Separately, senior lawyers say any failures to provide proper personal protective equipment (PPE) may be so severe they amount to corporate manslaughter, with police forces drawing up plans to handle any criminal complaints. Despite weeks of pleading, frontline medical staff complain that PPE is still failing to reach them as hospitals battle the highly contagious virus. Senior barristers say criminal investigations should be launched, and that there are grounds to suspect high-level failures. Read full story Source: The Guardian, 10 May 2020
  12. News Article
    Inquests into coronavirus deaths among NHS workers should avoid examining systemic failures in provision of personal protective equipment (PPE), coroners have been told, in a move described by Labour as “very worrying”. The chief coroner for England and Wales, Mark Lucraft QC, has issued guidance that “an inquest would not be a satisfactory means of deciding whether adequate general policies and arrangements were in place for provision of PPE to healthcare workers”. Lucraft said that “if there were reason to suspect that some human failure contributed to the person being infected with the virus”, an inquest may be required. The coroner “may need to consider whether any failures of precautions in a particular workplace caused the deceased to contract the virus and so contributed to death”. But he added: “An inquest is not the right forum for addressing concerns about high-level government or public policy.” Labour warned the advice could limit the scope of investigations into the impact of PPE shortages on frontline staff who have died from COVID-19. “I am very worried that an impression is being given that coroners will never investigate whether a failure to provide PPE led to the death of a key worker,” said Lord Falconer, the shadow attorney general. “This guidance may have an unduly restricting effect on the width of inquests arising out of Covid-19-related deaths.” Read full story Source: The Guardian, 29 April 2020
  13. News Article
    We don’t yet know the number of NHS staff who have lost their lives in the battle against COVID-19. On Wednesday, Dominic Raab put the figure at 69, but the true figure is considered to be far greater. These deaths are not “natural” casualties of the coronavirus pandemic. In fact, they may be the result of a failure in the government’s duty to care for NHS staff, which is why it is vital it is properly investigated under the law. Since the pandemic reached the UK, we have heard countless reports of doctors and nurses raising the alarm over the lack of personal protective equipment (PPE) when treating COVID-19 patients. How many of these deaths could have been prevented had sufficient PPE been provided to NHS workers? And if there is a lack of PPE, how did this happen? The health secretary, Matt Hancock, says the biggest challenge is “one of distribution rather than one of supply”. Should more have been done to meet this challenge, and if so what? Does the government have a legal duty to do more to protect the lives of healthcare workers? There must be investigations into the individual deaths of NHS workers, out of respect to them, and also so that future deaths can be prevented. The evidence appears to be that the government has failed to protect them from risk to their lives, and if that is the case then an investigation will be required by law. Read full story Source: The Guardian, 25 April 2020
  14. News Article
    More than 16% of people who had tested positive for coronavirus when they died were from black, Asian and minority ethnic (BAME) communities, new data shows. On Monday, NHS England released data showing the ethnic breakdown of people who have died with coronavirus for the first time. The statistics come days after a review was announced to examine what appears to be a disproportionate number of BAME people who have been affected by Covid-19. Last week Downing Street confirmed the NHS and Public Health England will lead the review of evidence, following pressure on ministers to launch an investigation. Discussing the review, Professor Chris Whitty, the chief medical officer for England, said ethnicity is "less clear" than three others factors in determining who is most at risk from coronavirus. Read full story Source: The Independent, 21 April 2020
  15. News Article
    The NHS should expect a “huge number” of legal challenges relating to decisions made during the coronavirus pandemic, healthcare lawyers have warned. The specialists said legal challenges against clinical commissioning groups and NHS providers would be inevitable, around issues such as breaches of human rights and clinical negligence claims. Francesca Burfield, a barrister specialising in children’s health and social care, told HSJ’s Healthcheck podcast: “I think there is going to be huge number of challenges. If and when we move through this there will not only be a public enquiry, [but] I anticipate judicial reviews, civil actions in relation to negligence claims and breach[es] of human rights….” She said criminal proceedings by the Care Quality Commission or Crown Prosecution Service would also be a possibility, around issues such as deprivation of liberty, neglect, safeguarding, and potential gross negligence manslaughter. Read full story Source: HSJ, 20 April 2020
  16. News Article
    An acute trust in the Midlands has contacted 136 women who received major treatment from a gynaecology consultant, after initial investigations revealed “unnecessary harm” to several patients. Read full story (paywalled) Source: HSJ, 17 April 2020
  17. News Article
    The health service has been promised “whatever it needs” to deal with the coronavirus pandemic, but government spending choices reveal possible long-term changes to funding and policy. Having initially promised the health service “whatever it needs, whatever it costs” on 11th March, the government made this official when Matt Hancock issued a ministerial direction allowing the Department of Health to “spend in excess of formal Departmental Expenditure Limits”—effectively providing a blank cheque. But while the government’s actions are designed for the immediate crisis, they may be difficult to reverse once the peak of coronavirus has passed. Indeed, they could yet change how the health service operates on a permanent basis. Read full story Source: Prospect, 7 April 2020
  18. News Article
    “Recurrent safety risks” around clinical care at an embattled NHS trust’s maternity service have been identified in a report published on Tuesday. The Healthcare Safety Investigation Branch (HSIB) has been investigating East Kent hospitals university NHS foundation trust since July 2018 after a series of baby deaths. Among those treated at the trust was Harry Richford, whose death was “wholly avoidable”, seven days after his emergency delivery in November 2017, an inquest found. Speaking on Tuesday, Harry’s grandfather Derek Richford said it is clear that sufficient lessons were not learned from his death. The independent report, published on Tuesday by the Department of Health and Social Care, discusses 24 maternity investigations undertaken since July 2018, including the deaths of three babies and two mothers. It said: “These investigations have enabled HSIB to identify recurrent safety risks around several key themes of clinical care in the trust’s maternity services.” Read full story Source: The Guardian, 8 April 2020
  19. News Article
    Complaints about NHS care cannot always be investigated properly because of medical records going missing, the public services watchdog has said. Ombudsman Nick Bennett said many people were left "suspicious" and thought there was a "darker motivation". One woman whose notes went missing said she no longer trusted what doctors said and had lost faith in NHS transparency. The Welsh NHS Confederation said staff were "committed to the highest standards of care". In a report called Justice Mislaid: Lost Records and Lost Opportunities, Mr Bennett found 70% of 17 cases he looked at in Welsh NHS hospitals and care settings could not be properly investigated because of lost documents. Read full story Source: BBC News, 10 March
  20. News Article
    Executives in charge of the health secretary’s crisis-hit local hospital are facing calls to step down after The Sunday Times raised serious questions about attempts to cover up catastrophic medical mistakes. West Suffolk Hospital in Bury St Edmunds had placed Dr Patricia Mills, one of its most senior consultants, under disciplinary investigation after she had voiced concerns about blunders that had killed one patient and left another seriously brain-damaged. A number of doctors have claimed that a bullying management culture has led to staff being too afraid to speak up about patient safety concerns at the hospital. Executives were accused of being obsessed with maintaining the hospital’s “outstanding” status in annual Care Quality Commission. One of the governors said their were "frustrations and concerns" among his fellow council members that they were being kept in the dark by the hospital's executives. Read full story (paywalled) Source: The Sunday Times, 8 March 2020
  21. News Article
    An NHS trust at the centre of an inquiry into preventable baby deaths will repay money it received for providing good maternity care. In 2018, Shrewsbury and Telford NHS Trust received almost £1m, weeks before its services were rated inadequate. The BBC revealed in December the trust had qualified for the payment under the NHS's Maternity Incentive Scheme. The trust said an "incorrect submission" had been made and it had ordered an independent review. Shrewsbury and Telford NHS Trust (SaTH) is at the centre of England's largest inquiry into poor maternity care, with more than 900 families contacting a review looking into concerns over preventable deaths and long-term harm. Former health secretary Jeremy Hunt wrote to ministers questioning if improvements to the Maternity Incentive Scheme were needed in light of payments made to both Shrewsbury and Telford and East Kent Hospitals, despite both facing serious questions over the safety of maternity services. The trust in Shropshire was paid £963,391 after certifying it had met the 10 safety standards demanded by the scheme, which is run by NHS Resolution. In the letter, seen by the BBC, Mr Hunt suggested one improvement would be to link payments to CQC maternity and safety ratings. "The whole approach is likely to be discredited if trusts can meet all 10 actions and yet still be delivering poor standards of care," the letter said. Read full story Source: BBC News, 6 March 2020
  22. News Article
    Women are at risk of serious harm and death because hospitals are not always diagnosing ectopic pregnancies quickly enough, an investigation reveals. About 12,000 women a year in the UK suffer an ectopic pregnancy – when a fertilised egg grows outside the womb – putting them at risk if a fallopian tube containing the foetus ruptures and causes potentially fatal heavy bleeding. An investigation by the Healthcare Safety Investigation Branch (HSIB) has found flaws in the treatment women receive. It has highlighted late diagnosis and consequent delay in treatment as a major concern, especially as a result of the condition being mistaken for a urinary tract infection. NHS patient safety data shows that 30 ectopic pregnancies were missed and led to “serious harm” between April 2017 and August 2018. As well as the risk to life, an ectopic pregnancy can also damage a woman’s chances of conceiving again and have serious psychological effects. Read full story Source: The Guardian, 5 March 2020
  23. News Article
    The parents of a baby who nearly died after a series of failings during his birth said they were "heartbroken" mistakes continued to be made East Kent Hospitals told Harry Halligan's parents they would learn lessons from his delivery in 2012. But similar failings recently came to light after the death of Harry Richford in 2017 and the trust is now being probed over up to 15 baby deaths. The trust said it made "many changes to the maternity service" after 2012. Parents Dan and Alison Halligan, from New Romney, said watching news coverage of an inquest into Harry Richford's death earlier this year, which laid bare the failings, had brought back stressful memories. Mr Halligan said the trust "clearly haven't learned from [the] mistakes" made in his son's care, adding that it was "heartbreaking" to see "the same mistakes being repeated". Read full story Source: BBC News, 5 March 2020
  24. News Article
    Mediators want more clinicians to come forward – and lawyers to enable them – to speak directly to patients bringing medical negligence claims against the NHS. Alan Jacobs, mediator at the Centre for Effective Dispute Resolution, told a conference of lawyers that they should do more to encourage discussions between injured people and those allegedly responsible. His call came as figures show record numbers of clinical claims against the NHS went to mediation in 2018/19 – with the majority of mediations resulting in damages being agreed on the day. Jacobs, speaking at the Claims Media conference in Manchester, said the challenge now is to ensure medical professionals volunteer to take part in the process. "It allows an apology to be given face to face and allows explanations to be given," he said. "It is also an opportunity for the clinician to have a discussion, sit down with the claimant and answer questions and concerns. It can be tremendously important for a claimant to vent and express their frustrations and for the trust to hear that." Both claimant and defendant lawyers agreed on the merits of bringing doctors in to the room, but stressed this was not always a realistic aim. Barrister Daniel Frieze, head of the personal injury team at St Johns Buildings, said: "Often it is too late and there is too much water under the bridge. Claimants are very stressed and it may be counter-productive for them to face the other side. I know the idea is of being collaborative but I’m not sure that’s necessarily always true." Read full story Source: 21 February 2020, The Law Society Gazette
  25. News Article
    The Independent Inquiry into the issues raised by Paterson is yet another missed opportunity to tackle the systemic patient safety risks which lie at the heart of the private hospital business model, says David Rowland from the Centre for Health and the Public Interest in a recent BMJ Opinion article. Although the Inquiry provided an important opportunity for the hundreds of patients affected to bear witness to the pain and harm inflicted upon them it fundamentally failed as an exercise in root cause analysis. None of the “learning points” in the final report touch on the financial incentives which may have led Paterson to deliberately over treat patients. Nor do they cover the business reasons which might encourage a private hospital’s management not to look too closely. He suggests that the Inquiry report threw the responsibility for managing patient safety risks back to the patients themselves in two of its main recommendations but that it should be for the healthcare provider first and foremost to ensure that the professions that they employ are safe, competent and properly supervised, and for this form of assurance to be underpinned by a well-functioning system of licensing and revalidation by national regulatory bodies. Read full story Source: BMJ Opinion, 20 February 2020
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