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Found 965 results
  1. Content Article
    Identifying improvements in maternity care to help reduce the risk of delays in crucial interventions during labour when a baby is suspected to be unwell is the focus of this latest Healthcare Safety Investigation Branch (HSIB) report. The report was compiled after a review of 289 of our maternity investigations into intrapartum stillbirths, neonatal deaths and potential severe brain injuries. In 14.9% of the cases the delay was a contributory factor. The review identified issues such as inadequate staffing, poor infrastructure and high workload as contributory factors to the delays. Evidence from national reports confirms that such delays are a recognised patient safety risk. 
  2. News Article
    Patients, including those with the coronavirus, are being kept “head to toe” on trolleys in accident and emergency departments in Manchester, with some forced to wait up to 40 hours for a bed. The “dangerous” situation has sparked warnings from the president of the Royal College of Emergency Medicine over the “potentially lethal” crowding of patients in A&Es across the country this winter. Katherine Henderson said she was “absolutely terrified” by what was happening in some departments. She said she had warned NHS England about the dangers of crowding patients in A&E but that not enough action had been taken. She told The Independent: “Crowding in A&E is unsafe, but with coronavirus it is potentially lethal. We have said this endlessly to NHS England." “Everyone agrees crowding is bad, but what they’re not doing is translating that into action.” After hearing of the situation in Manchester, she added: “Exactly what we said should not happen is happening. I am absolutely terrified by this. What more can I do? I have highlighted this risk everywhere I can over the past few months.” Read full story Source: The Independent, 11 November 2020
  3. News Article
    Planning around what the NHS can deliver this winter must be based on how many nursing staff are available and the workload they can safely take on, the Royal College of Nursing (RCN) has warned. Amid widespread nursing shortages, the union has called on the government to “be honest” about nurse vacancies and address what steps need to be taken to keep staff and patients safe. “It is essential that learning is applied to planning for this winter, including what service can be delivered safely with the workforce available” Last week NHS England moved to its highest level of emergency preparedness. But the RCN warned it still had grave concerns around how services would be safely staffed, claiming it was too late to find the nurses needed to meet the anticipated demands of the incoming winter. Despite an increase in the number of nurses registered with the Nursing and Midwifery Council this year, the college said there were still around 40,000 nurse vacancies in the NHS in England alone. These shortages, which were felt across all areas of nursing, had been exacerbated because of staff self-isolating or being off sick because of COVID-19, the RCN noted. The impacts of workforce shortages meant there was “enormous responsibility” on the nurses working and “intolerable pressure” on senior nursing leaders, it said. Unless local staffing plans prioritised safe and high-quality care, the few nurses in post were at risk of “burn out” this winter, the college added. Read full story (paywalled) Source: Nursing Times, 9 November 2020
  4. News Article
    As many as 2,000 people could die because of Covid-related delays in the Welsh NHS, a cancer expert has said. With virus cases rising, Prof Tom Crosby, of the Wales Cancer Network, fears cancer cases missed in the first lockdown may now be harder to treat. Health Secretary Vaughan Gething said it would be "foolish" to have a plan for backlogs before the pandemic is over. But he said work was under way to address the issue with health boards. Alongside the spread of the virus, medical professionals are very worried about deaths that could occur not because of Covid, but due to the backlog of appointments and surgery it is causing. BBC Wales Investigates has been uncovering the full extent of the looming problem facing the NHS. Delays caused by the pandemic are a serious concern to Prof Crosby, who is medical director at the Wales Cancer Network. He said when the pandemic first hit, acute COVID-19 cases became the focus in hospitals at the expense of cancer, cardiac and orthopaedic appointments. "Some of the conversations we've had with patients in the clinic have been really, really challenging," he said. "Then there are thousands of patients who have not come through to the system that usually would have. Some of those are going to have had cancer, and they will not have been diagnosed now." Prof Crosby has been looking at possible outcomes for cancer patients because of delays in diagnosis and treatment. "We have done some modelling work with England, and it has suggested that between 200 and 2,000 excess deaths will occur as a result of undiagnosed or untreated cancer in Wales," he said. "I think the effects on cancer services are going to be here for two to three years." Read full story Source: BBC News, 9 November 2020
  5. News Article
    Some disabled people in the UK have been struggling to obtain essentials such as medication and breathing equipment during the Covid pandemic, research for the BBC suggests. Some 60% of those who rely on social care told a YouGov survey they were finding it hard to obtain at least one of their necessities. Charity WellChild said people felt more "forgotten than they ever have been". But ministers say the needs of disabled people were being considered. The Department of Health and Social Care says it has sufficient stocks and patients should contact their local care provider. Like one in 20 of those survey respondents who receive social care, Fi Anderson, a mother of two with muscular dystrophy from Bolton in Greater Manchester, said she has faced problems obtaining breathing apparatus. Her local hospital told her to re-use the filter for her portable ventilator, recommending she boil it, because supplies were so short. Disabled people who rely on social care - which funds equipment and other support to allow them to live independent lives - also said they had struggled to obtain personal protective equipment (PPE) such as face masks. Many of them receive funding directly to employ carers in their home, so they also need to provide them with PPE during the coronavirus crisis. The survey, which the BBC commissioned to mark the 25th anniversary of the Disability Discrimination Act, asked more than 1,000 people about life in the UK with a disability and how it has changed in the shadow of a pandemic. More than 65% felt their rights had regressed, and 71% said disabled people's needs had been overlooked. The Coronavirus Act, which granted the government emergency powers, gave local councils the ability to reduce care, education and mental health provision for disabled people if it became necessary during the pandemic. According to the latest figures from the Office for National Statistics, nearly six out of 10 deaths from COVID-19 were of disabled people. Read full story Source: BBC News,
  6. News Article
    Widespread nursing shortages across the NHS could lead to staff burnout and risk patient safety this winter, the Royal College of Nursing has warned. The nursing union said a combination of staff absence due to the pandemic, and around 40,000 registered nursing vacancies in England was putting too much strain on the remaining workforce. The government says more than 13,000 nurses have been recruited this year. It has committed to 50,000 more nurses by 2025. It also hopes England's four-week lockdown will ease pressure on the NHS. The RCN has expressed concern that staff shortages are affecting every area of nursing, from critical care and cancer services to community nursing, which provides care to people in their own homes. The union said it was worried the extra responsibility and pressure placed on senior nurses could lead to staff "burnout", as hospitals struggle to clear the backlog of cancelled operations from the first wave of coronavirus and cope with rising numbers of new Covid patients, as well as the annual pressures that winter typically brings. Read full story Source: BBC News, 7 November 2020
  7. Content Article
    The onset of COVID-19 caused some patients throughout the United States to delay their surgeries as many hospital systems postponed nonemergent procedures. This led to a potentially large backlog of case volume. In a recent McKinsey survey of health system leaders, hospital executives said they may struggle to address this backlog given workforce availability, enhanced sanitation protocols, and reserved inpatient capacity. Without healthcare systems recalibrating demand and capacity, patients could face long backlogs for procedures, and potentially experience higher morbidity and mortality rates. Solutions may include 1) reducing the unnecessary deferral of care, 2) effectively addressing new throughput challenges, 3) using advanced analytics to better forecast demand and manage capacity in real time, and 4) reimagining operating room operations to increase long-term capacity. Berlin et al. explore these solutions further in this article.
  8. News Article
    Vulnerable patients at a major NHS hospital at the centre of England’s coronavirus second wave have been left without help to eat or drink because wards are so dangerously understaffed, The Independent can reveal. Dozens of safety incidents have been reported by doctors and nurses at the Liverpool University Hospitals Trust since April, citing the lack of nurses as a key patient safety risk. Across several wards, just two registered nurses per ward were being expected to look after dozens of sick patients – a ratio of nurses to patients far below recommended safe levels. On one ward there were 36 patients to two registered nurses – with the nurse in charge of the ward having only qualified six months earlier. The safety concerns also include a diabetic patient – where there was no evidence nurses had monitored their blood glucose levels and insulin medication, which if left unchecked could prove fatal. Other patients have been forced to eat food and drink which has gone cold by the time staff are ready to help them. The hospital is among the worst affected by the surge in coronavirus cases in the north of England. It’s medical director warned on Friday that it was at 100 per cent capacity and unable to maintain standards of care. Read full story Source: The Independent, 5 November 2020
  9. News Article
    An NHS hospital at the epicentre of the coronavirus second wave is facing the threat of action by the care watchdog as it struggles to keep patients safe, The Independent has learned. Senior NHS bosses in the northwest region have been accused of putting politics ahead of patient safety and not doing enough to help the hospital to cope with the surge in Covid patients in recent weeks. The Care Quality Commission (CQC) warned the Liverpool University Hospitals Trust on Friday that it could face action after an inspection carried out last week in response to fears raised with the regulator. In a message to his colleagues on Friday, Liverpool University Hospitals (LUH) Trust medical director Tristan Cope warned the hospital had been overwhelmed by coronavirus and standards of care could no longer be maintained. He criticised NHS England and said the trust had been “abandoned” as coronavirus cases surged. He confirmed the CQC’s intention to take action against the trust but said the regulator had failed to appreciate the pressure staff in the hospital were under. Dr Cope, a consultant in anaesthesia and critical care, said: “LUH is now essentially overwhelmed by the demand. We cannot maintain patient flow and usual standards of care. We have put forward a proposal to further reduce elective [planned] activity, but maintaining capacity for the most urgent cases that would suffer from a two-four week delay." “It is a very sound plan that our divisional teams have worked up. However, NHS England are prevaricating and delaying with the usual request for more detail, more data, etc. It is clear to me that the politics is outweighing the patient safety issues of the acute crisis." Read full story Source: The Independent, 3 November 2020
  10. News Article
    Several hospitals in the north of England are already at full capacity and may have to start moving patients to other regions, doctors have warned. Consultants fear that if Covid infection rates do not begin to fall significantly the NHS will be overwhelmed in less than a month from now. Members of the British Medical Association have reported that Intensive Care Units (ICU) in a number of regions, including Manchester, Liverpool and Hull, are close to capacity as the number of people hospitalised with COVID-19 continues to grow. Dr Vishal Sharma, chairman of the BMA’s consultants committee, told The Telegraph: “Capacity in the north of England is at the limits and in some places above the limit. Our next concern is ICU capacity, which is always tight at this time of year, even without Covid.” Dr Sharma said some general ward beds could be adapted to provide intensive breathing support for Covid patients, and the re-opening of Manchester’s Nightingale Hospital may also take the pressure off ICU departments. But more radical steps may have to be taken if numbers of hospitalised patients continue to rise. “We may have to move patients around the country to create extra capacity, but if the whole country starts to struggle things will get very difficult." Read full story Source: The Telegraph,
  11. News Article
    Almost half of all staff absence linked to coronavirus in parts of northern England Tens of thousands of NHS staff are off sick or self-isolating because of coronavirus, according to data shared with The Independent as the second wave grows. In some parts of northern England, more than 40% – in some cases almost 50% – of all staff absences are linked to COVID-19, heaping pressure on already stretched hospitals trying to cope with a surge in virus patients. The problem has sparked more calls for wider testing of NHS staff from hospital leaders and nursing unions who warned safety was being put at risk because of short staffing on wards. Across England, more than 76,200 NHS staff were absent from work on Friday – equivalent to more than 6% of the total workforce. This included 25,293 nursing staff and 3,575 doctors. Read full article Source: The Independent, 1 November 2020
  12. News Article
    Cancer patients have had surgery cancelled because of coronavirus for the first time as pressure mounts on hospitals from the second wave, The Independent has learnt. Nottingham University Hospitals Trust has confirmed it had to postpone the operations because of the number of patients needing intensive care beds. While hospitals across the north of England have been forced to start cancelling routine operations in the last 10 days, maintaining cancer and emergency surgery had been a red line for bosses given the risk to patients from any delays. Cancer Research UK said it was “extremely concerning” that some operations had been postponed and called for urgent action and investment to make sure treatments were not curtailed further. In a statement to The Independent, Nottingham University Hospitals medical director Keith Girling said: “We’ve had to make the extremely difficult decision to postpone operations for four of our cancer/pre-cancer patients this week due to pressure on our intensive care units from both Covid-19 and non-covid related emergencies." “We expect to treat one of the postponed patients next week, and we’re in contact with the others to arrange a new date, which will be imminent. This delay, however short, will be incredibly hard for the patients and their families, and I’m truly sorry for any distress this will have caused. Read full story Source: The Independent, 27 October 2020
  13. News Article
    Mass cancellations of routine operations in England are inevitable this autumn and winter despite an NHS edict that hospitals must not again disrupt normal care, doctors’ leaders have said. Organisations representing frontline doctors, including the British Medical Association (BMA), also criticised NHS England for ordering hospitals to provide “near normal” levels of non-Covid care in the second wave of the pandemic, and demanded that fines for failing to meet targets be scrapped. "Things are very, very difficult at the moment, very challenging at the moment. It feels like a juggling act every day,” said one official in the South Yorkshire NHS. “The problem is both the growing numbers of patients coming into hospital with Covid and the numbers of staff we have off sick due to Covid, either because they are ill themselves or because someone in their household has symptoms, so they are isolating.” Read full story Source: The Guardian, 23 October 2020
  14. News Article
    A hospital in Yorkshire has said it is cancelling planned surgeries for at least two weeks as the number of coronavirus patients there hits levels not seen since May. Bradford Teaching Hospitals said it was being forced to stop non-urgent surgery and outpatient appointments for two weeks from Tuesday because of the numbers of severely ill COVID-19 patients. In statement the hospital said it had seen a spike in admissions in the last few days with 100 coronavirus patients now on the wards with 30 patients needing oxygen support – the highest number of any hospital in the northeast and Yorkshire region. It also said more patients were needing ventilators to help them breathe in intensive care. The trust is the latest to announce cancellations, joining the University Hospitals of Birmingham, Nottingham University Hospitals and Plymouth Hospitals as well as those in Liverpool and Manchester where hundreds of Covid patients are being looked after. Read full story Source: The Independent, 21 October 2020
  15. News Article
    Greater Manchester is set to run out of beds to treat people left seriously ill by COVID-19, and some of the region’s 12 hospitals are already full, a leaked NHS document has revealed. It showed that by last Friday the resurgence of the disease had left hospitals in Salford, Stockport and Bolton at maximum capacity, with no spare beds to help with the growing influx. The picture it paints ratchets up the pressure on ministers to reach a deal with local leaders over the region’s planned move to the top level of coronavirus restrictions. It suggested that Greater Manchester’s hospitals are quickly heading towards being overwhelmed by the sheer number of people with Covid needing emergency care to save their lives, in the same way that those in Liverpool have become in recent weeks. By Friday 211 of the 257 critical care beds in Greater Manchester – 82% of the total supply – were already being used for either those with Covid or people who were critically ill because of another illness. Read full story Source: The Guardian, 18 October 2020
  16. Content Article
    Telemedicine has potential to address inequity in healthcare but not until certain barriers are addressed. This article from Joanna Pearlstein in Wired discusses how physicians and care organisations have to be creative and rely on partnerships and local resources, such as school district hot spots or public library broadband access, to make the system reliably work for all their patients.
  17. News Article
    ‘Systemic’ problems within mental health services in Birmingham have caused the number of people waiting for an inpatient bed to reach ‘extremely concerning’ levels, according to documents leaked to HSJ. There are currently 41 people waiting to be admitted to a bed by Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) , according to internal documents, while 36 people have already had to be sent to private sector facilities up to 150 miles away. The NHS in the area has indicated to HSJ that it is due to need for “intensive levels of care” now growing because of the impact of the COVID-19 pandemic. In an email thread, sent to 60 people in the trust including senior executives, one senior clinician wrote in response to the bed figures: “The number of patients with Mental Health Act assessments completed is extremely concerning. This needs to be escalated to commissioners. The problem is systemic.” It comes after an HSJ investigation earlier this year into the deaths of 12 patients under BSMHFT’s services. It revealed senior medics had repeatedly warned the trust about severe bed shortages and a lack of capacity within home treatment services. The trust said it was addressing the issues raised, but senior clinicians told HSJ this week the trust is still short of at least 80 adult mental health beds. Read full story (paywalled) Source: HSJ, 15 October 2020
  18. News Article
    At the age of 49, Sarah Fisher feels her life is on a knife-edge. She had a heart attack during lockdown and has subsequently been diagnosed with heart failure. In July, she was told she needed to have an implantable cardioverter defibrillator (ICD) fitted, which can shock the heart back into rhythm when it detects a potential cardiac arrest. But 12 weeks on, she is still waiting. "I could have a cardiac arrest at any point," Sarah says. "It is awful not knowing what is going to happen. "I am on the urgent list – but the infection rates are rising and the clinics are closing." "I don't know when I will get it. "There are so many people in my position – we don't have Covid but our lives are at risk too. We are the forgotten victims of this pandemic." British Heart Foundation analysis of Office for National Statistics data for England and Wales found almost 800 extra deaths from heart disease among under-65s from March to July - 15% more than would be expected. The rate of death was highest during the full lockdown - but, worryingly, the trend continued afterwards. The charity blames delays in people seeking care, as well as reduced access to routine tests and treatments. And NHS England figures show a sharp rise in the numbers waiting over six weeks for a whole range of key tests, including echocardiograms for hearts. Read full story Source: BBC News, 15 October 2020
  19. News Article
    Intensive care units in Liverpool’s hospitals are more than 90% full, according to a local health leader, as the city braces for a second wave of COVID-19 infections. Councillor Paul Brant, cabinet member for adult health and social care at Liverpool City Council, warned that hospital services were once again being forced to care for patients critically ill with coronavirus. "Our intensive, critical care beds are filling up very fast,” he told BBC Radio 4's Today programme. "The most recent figures I've seen suggest they are over 90 per cent full and our acute hospital trusts have occupancy levels of Covid-positive patients of over 250. At the current rate of increase, we would expect Liverpool to surpass the peak of the first wave probably within the next seven to 10 days." Addressing the intensive care situation, he added: "They are not all Covid patients, I should say, but they are running very full and they are running with an increasing number of people who are Covid-positive." He added: "It has become clear that the intensity of the demand on hospital services here in Liverpool is crowding out anything other than dealing with Covid." Read full story Source: The Independent, 14 October 2020
  20. News Article
    Increasing staff absence due to COVID-19 will have a ‘significant impact’ on the ability of the NHS to deliver critical care services and routine operations, leading intensive care doctors have said. The latest NHS England data has shown the number of COVID-19 related absences of staff, either through sickness or self-isolation, has risen from 11,952 on 1 September to 19,493 on 1 October. Staff absence has almost doubled in the North West in this time as well – from 2,664 to 5,142 during the same period. It peaked at 17,628 in the region on 11 April and means the October total accounts for nearly a third of that amount already (29%). Alison Pittard, dean of the Faculty of Intensive Care Medicine, confirmed increasing numbers of NHS critical care staff were absent from work. “I suspect this is due to having to be at home with children asked to isolate and therefore the parent needing to isolate, as was the case in the first wave," she told HSJ. “This will have an impact on our ability to deliver critical care services. We know that staff numbers are inadequate at the best of times, with a significant vacancy rate especially for critical care nurses.” Royal College of Anaesthetists council member Helgi Johannsson said the rising absence rate was “likely to have a significant impact”, particularly on routine operations. Dr Johannsson, a consultant anaesthetist at Imperial College Healthcare Trust, said: “In my hospitals, I have been aware of several doctors and nurses having to isolate due to their children being asked to self-isolate. These healthcare staff were otherwise well and would have been at work." Read full story (paywalled) Source: HSJ, 14 October 2020
  21. News Article
    Hospitals in Liverpool are scaling back non-urgent operations to help them cope with COVID-19 patients despite NHS bosses insisting that normal care continues during the second wave. NHS trusts elsewhere in north-west England, as well as in the north-east and Midlands, are also preparing to cancel routine surgery such as joint replacements and hernia repairs amid a rapid rise in seriously ill coronavirus patients. A potential second suspension of non-Covid care is looming despite warnings that this may lead to many thousands dying because their cancer, heart problem or other illness is not diagnosed or treated. Steve Warburton, the chief executive of Liverpool University Hospitals NHS trust, acknowledged that doing less surgery would be “distressing” for patients affected but said the city’s three main acute hospitals had reached a “critical point”. It is the first trust in England to make clear it cannot provide normal levels of non-Covid care during the second coronavirus surge, even though NHS England has told all hospitals to do so. The decision is likely to lead to other trusts doing the same. Warburton said: “We will continue to prioritise surgery based in clinical need with a view to maintaining urgent and cancer surgery where possible.” He promised that the trust would continue to provide outpatient appointments “wherever possible” and keep giving patients diagnostic tests such as CT and MRI scans. Read full story Source: The Guardian, 12 October 2020
  22. Content Article
    Due to the concerns around ambulance waiting times, the Healthcare Inspectorate Wales undertook a local review of the Welsh Ambulance Service Trust (WAST). The review explored how the risks to patients’ health, safety and wellbeing are managed whilst they are waiting for an ambulance. It assessed how patients are being managed by WAST’s three Clinical Contact Centres across Wales, from when a request for an ambulance is received to the point the ambulance arrives at the scene.
  23. News Article
    The coronavirus pandemic has made a "difficult situation even worse" for women trying to access contraception, a group of MPs and peers has warned. Their inquiry claims years of cuts means patients "have to navigate a complex system just to receive basic healthcare". It warns damage caused by the pandemic could see a rise in unplanned pregnancies and abortions. Sexual health doctors say the service is "overstretched and underfunded". The All Party Parliamentary Group (APPG) on Sexual and Reproductive Health says cuts to public health funding in England have had a wide-ranging impact, including: service closures reduced opening hours waiting lists staff cuts. The impact of these cuts is often felt by the most marginalised groups. The MPs' group is calling for a single commissioning body to improve accountability. Women are said to be "bounced from service to service" - like Louise, 32, who struggled for years to find a contraception which didn't cause adverse effects. In some cases during lockdown, even essential care provision like emergency fittings and removals of devices have been affected. Lisa's coil fitting in March was cancelled because of the pandemic. She is now pregnant. The inquiry says the underfunding of long-acting reversible contraceptives (LARCs) - intrauterine contraception and implants - means GPs are not incentivised to provide these services, which has contributed to a "postcode lottery" when it comes to services. Read full story Source: BBC News, 11 September 2020
  24. Content Article
    Patient Safety Learning, Health Plus Care and BD are holding a series of webinars on patient safety on the frontline, exploring burning patient safety issues and engaging with frontline health care workers, clinical leaders and patient safety experts. The first of these webinars is at 11.00am (BST) on Wednesday 16 September: Responding to the treatment backlog safely. This blog sets out some of the key points to inform the webinar.
  25. Content Article
    The association between higher registered nurses (RN) staffing (educational level and number) and better patient and nurse outcomes is well-documented. This discussion paper from Van den Heede et al. aims to provide an overview of safe staffing policies in various high-income countries to identify reform trends in response to recurring nurse workforce challenges.
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