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Found 205 results
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  13. News Article
    An Essex maternity department has been served with further warnings by the Care Quality Commission (CQC) and again rated “inadequate”. Serious concerns were raised about the services at Basildon University Hospital in the summer, after several babies were found to have been starved of oxygen and put at risk of permanent brain damage. Despite the CQC issuing warning notices to Mid and South Essex Foundation Trust in June 2020, a subsequent visit on 18 September found multiple problems had persisted. The CQC’s findings at Basildon included: the service was short-staffed and concerns were not escalated appropriately multidisciplinary team working was “dysfunctional”, which sometimes led to safety incidents doctors, midwives and other professionals did not support each other to provide good care. Read full story (paywalled) Source: HSJ, 19 November 2020
  14. News Article
    A trust which was heavily criticised for poor infection prevention and control last summer has been praised for making improvements. East Kent Hospitals University Foundation Trust was served with an enforcement notice by the Care Quality Commission in August last year, citing “serious concerns” about patient safety. The trust had twice the national rate of patients infected with COVID-19 after admission to hospital. But a new report, issued today, found significant improvements, with several areas of outstanding practice. The conditions imposed on the trust after last year’s inspection of the William Harvey Hospital in Ashford were also lifted, following the visit by the CQC in early March. Cath Campbell, CQC’s head of hospital inspections in the South East, said the improvements were particularly commendable as the trust had been under extreme pressure as a result of the pandemic. She said: “Leaders adopted learnings from other trusts, and from NHS Improvement which led to the development of a detailed infection prevention and control improvement plan. The trust then set up an improvement group to focus on implementing the actions in the plan and put a committee in place to review internal audit data and led improvements based on this information. “Although there were still one or two areas for improvement which we have advised the trust to look at now, overall this is a very positive report.” Read full story (paywalled) Source: HSJ, 23 April 2021
  15. News Article
    Regulators have sent an improvement director into a North West acute trust amid multiple allegations of poor care and ‘cover up’ across different specialties. University Hospitals of Morecambe Bay Foundation Trust, which spent 18 months in special measures midway through the last decade, is again now the subject of significant regulatory intervention from NHS England. The regulator has appointed Simon Bennett as a board-level improvement director, which comes after he undertook a similar assignment at the struggling Stockport FT. It comes amid ongoing external investigations into the trust’s urology and trauma and orthopaedics specialties, where serious allegations have been made about attempts to cover up poor care. The trust has a troubled history of care failings and regulatory intervention, including a major maternity scandal which culminated in the Kirkup Inquiry in the first half of the 2010s, and being placed in special measures in 2014. It was widely recognised that positive progress was subsequently made to implement the inquiry recommendations and improve services, which culminated in the trust exiting special measures in late 2015, and being rated “good” by the CQC in early 2017. However, the recent allegations and investigations have again brought regulatory intervention. Read full story (paywalled) Source: HSJ, 20 April 2021
  16. News Article
    With the annual NHS Staff Survey recently published, expectation was that this year might look a little different, all things considered. For the mental health sector, the dial didn’t move massively on key questions. The sector still came out bottom for staff who agreed they’d be happy with the standard of care if a friend or family member needed it - otherwise called the “family and friends test”. Although the survey was not that revelatory this year, it is still a helpful barometer for trusts’ safety and quality culture. Sheffield Health and Social Care Foundation Trust comes out lowest on all of the main quality and safety-related questions. On the crucial family and friends question, just 47% of the trust’s staff agreed that would be happy with the standard of care. The trust has been one of the worst performers on the survey for a number of years but appears to have deteriorated further. Sheffield Health and Social Care FT also came out worst on the following key safety culture related questions: When errors, near misses or incidents are reported, my organisation takes action to ensure that they do not happen again I would feel secure raising concerns about unsafe clinical practice My organisation acts on concerns raised by patients/service users. The last two questions are a vital indicator of a trust’s approach to safety and quality. If staff do not feel secure to raise concerns, or if a trust does not act on patient concerns can it really address problems before they escalate? Read full story (paywalled) Source: HSJ, 12 March 2021
  17. News Article
    Clinicians within a major teaching hospital’s cancer services have raised multiple concerns over patient safety, which they believe have resulted from badly planned service changes in response to the covid crisis. HSJ has spoken to several staff members who have worked in the haematology speciality at University Hospitals Birmingham Foundation Trust since last June, when the services underwent significant changes to free up capacity for coronavirus patients. This involved most haematology services at Heartlands Hospital in east Birmingham moving to the trust’s main Queen Elizabeth Hospital site in Edgbaston. The staff, who all wished to remain anonymous, told HSJ the transfer happened at just one week’s notice and was poorly planned. Once implemented, they said QEH’s newly enlarged service suffered from extreme staffing shortages, leading to several “never events”, such as patients being given the wrong blood type. In one resignation letter, a nurse who had transferred to QEH told managers patients’ “basic care needs are not being met”. The nurse said most shifts were understaffed, with examples of three nurses looking after 30 patients and added in the resignation letter: “I am witnessing strong and knowledgeable colleagues breaking down on each shift. “Furthermore, never events are happening at an alarming rate, necessary resources are commonly unavailable and communication between all levels of seniority is poor…" Read full story (paywalled) Source: HSJ, 2 February 2021
  18. News Article
    Bosses at the controversial NHS gender-change clinic for children have been removed after regulators highlighted a string of failures. The management team of the Gender Identity Development Service (GIDS) in London has been 'disbanded', documents reveal. It comes weeks after the clinic, run by the Tavistock and Portman NHS Trust, was judged 'inadequate' by the Care Quality Commission. Watchdogs said staff were afraid to raise concerns about patient safety for fear of 'retribution' from bosses. A report said: 'Staff did not always manage risk well. Many of the young [patients] were vulnerable and at risk of self-harm." The management team of the Gender Identity Development Service (GIDS) in London has been 'disbanded', documents reveal. It comes weeks after the clinic, run by the Tavistock and Portman NHS Trust, was judged 'inadequate' by the Care Quality Commission. "The size of the waiting list meant staff were unable to proactively manage the risks to patients waiting for a first appointment." Read full story Source: MailOnline, 31 January 2021
  19. News Article
    A quiet revolution in the NHS has happened. After decades of an internal market, NHS England has outlined new changes tying financial allocations and incentives to system-level performance instead. Over the past six months, providers had been allocated block funding based on activity from 2019/20 with top-ups and retrospective funding to support covid pressures, ensuring they financially break even during the crisis. Now, in a letter accompanying funding envelopes for Integrated Care Systems and Sustainability and Transformation Partnerships around the country, NHSE outlined how health service finances will be system managed for the remainder of the year. Systems will have not only control of the kitty (with all system costs to be met from its allocation) but funding will be linked to the performance of their member organisations, with some incentive payments or penalties for over/under performance at a system level. Glen Burley, the chief executive of a group of three acute trusts in the West Midlands, branded the move “very risky” and suggested a more traditional tariff performance would drive performance. Highlighting another of his concerns he said: “We have very little experience of doing so at system level, so this is a very risky tactic in a very risky year.” How systems will manage the shortfalls will hinge on elective delivery, system co-ordination, how to reduce forecast costs and recover income, set, of course, against the threat of a second wave of COVID-19. Read full story Source: HSJ, 17 September 2020
  20. News Article
    Yesterday marked the second World Patient Safety Day, and this year’s theme shined a light on health worker safety – those on the frontline of the pandemic have been selfless in their sacrifices to care for an ailing global population. What has become ever clearer is that a health system is nothing without those who work within it and that we must prioritise the safety and wellbeing of health workers, because without safe health workers we cannot have safe patients. Improving maternity safety has been a priority for some time – although rare, when things go wrong the consequences are unthinkable for families and the professionals caring for them. Maternity negligence makes up 50% of the total value of negligence claims across all NHS sectors, according to the latest NHS Resolution annual report and accounts. It states there were claims of around £2.4 billion in 2019/20, which is in the region of £6.5 million a day. This cost says nothing of the suffering families and professionals associated. However, without investing in the maternity frontline we cannot hope to make integral systemic changes to improve maternity safety and save mothers’ and babies’ lives, writes Sara Ledger, head of research and development at Baby Lifeline in the Independent. "We owe it to every mother and baby to rigorously and transparently scrutinise the safety of maternity services, which will be in no small way linked to the support staff receive." Read full story Source: The Independent, 17 September 2020
  21. News Article
    A GP practice serving one of Greater Manchester’s most deprived communities has been banned from operating for four months after regulators uncovered a catalogue of basic failures - including failing to follow up on a child reporting breathing difficulties for three days. Jarvis Medical Practice in Glodwick has had its registration with the Care Quality Commission (CQC) suspended after ‘serious concerns’ passed to the body led to a snap inspection last month. Inspectors found the practice, based at Glodwick Primary Care Centre, was failing 20 separate standards, many of them relating to patient safety. It noted ‘poor quality’ and conflicting records that were sometimes impossible to properly understand and urgent home visits delayed or not carried out at all. In one case a patient with a lump apparently received no physical examination and was not referred for tests or scans ‘due to Covid-19’. Inspectors also found examples of patients with breathing difficulties, including a child, who were not dealt with for days after they got in touch. In one case no further contact was made for 11 working days, with no explanation provided in the patient's notes. The practice, which serves more than 5,000 patients in the Oldham neighbourhood of Glodwick, has now been suspended by the CQC until October 11. Read full story Source: Manchester Evening News, 17 July 2020
  22. News Article
    Daniel Mason was born half a century ago without hands, with missing toes, a malformed mouth and impaired vision. From an early age, he and his family had to deal with people asking about his disabilities. The impact on his life has been considerable. Daniel’s mother Daphne long suspected the cause of his problems was a powerful hormone tablet called Primodos that was given to women to determine whether they were pregnant. But when she raised her concerns with doctors, they were dismissed. Now, at last, Daphne has been vindicated with official confirmation this week that her fears were right, in the landmark review by Baroness Cumberlege into three separate health scandals that has exposed a litany of shameful failings by the NHS, regulatory authorities and private hospitals. This damning report shows again the danger of placing a public service on a pedestal, with politicians happy to spout platitudes but scared to tackle systemic problems or confront the medical establishment. But how many more of these inquiries must be held? How many more disturbing reports and reviews must be written? How many more times must we listen to ministerial apologies to betrayed patients? How much more must we hear of ‘lessons being learned’ when clearly they are largely ignored? Read full story Source: Mail Online, 9 July 2020
  23. News Article
    The trusts which are likely to face the fiercest struggle to deliver quality care in the immediate future have been identified through an analysis carried out exclusively for HSJ. Analyst company Listening into Action has taken data from the NHS Staff Survey 2019 to produce “a set of ‘workforce at risk’ numbers that point to the likelihood (or not) of workforce stability and continuity challenges adversely affecting the care a trust’s key assets are able to deliver in the year ahead”. The analysis shows a strong correlation between staffs’ perceptions of how well they are supported, and care quality — and therefore reveals which trusts face the toughest challenge to improve performance. Read full story (paywalled) Source: HSJ, 9 March 2020
  24. News Article
    Today the results of the National NHS Staff Survey 2019 are out. This is of the largest workforce surveys in the world with 300 NHS organisations taking part, including 229 trusts. It asks NHS staff in England about their experiences of working for their respective NHS organisations. The results found that 59.7% of staff think their organisation treats staff who are involved in an error, near miss or incident fairly. While an improvement on recent years (52.2% in 2015) work is needed to move from a blame culture to one that encourages and supports incident reporting. It also found that 73.8% of staff think their organisation acts on concerns raised by patients/service users. It is vital that patients are engaged for patient safety during their care and there is clear research evidence that active patient engagement helps to reduce unsafe care. Patient Safety Learning has recently launched a new blog series on the hub to develop our understanding of the needs of patients, families and staff when things go wrong and looking at how these needs may be best met.
  25. News Article
    The ghosts of medical errors haunt Dr. Peter Pronovost. Two deaths, both caused by mistakes. First, his father’s, who died as the result of a cancer misdiagnosis. Then a little girl, a burn victim who succumbed to infection and diagnostic missteps at the hospital where Pronovost worked early in his career. Those deaths led Pronovost to pursue a medical career dedicated to patient safety, and to create the medical checklist he has become known for worldwide. Now, he’s implementing his second act, at University Hospitals in the USA, as its Chief Transformation Officer, a job he has held since late 2018. His goal: To transform a $4 billion health care system by reducing shortcomings in medical care and increasing the quality of treatment. The challenge fits Pronovost, says one of his former Johns Hopkins University professors, Dr. Albert Wu. “He’s one of the few people for whom the title might be appropriate, because his work has led to significant changes and innovations in how we deliver health care in the United States. “He’s a once-in-a-generation guy.” Read full story Source: Cleveland.com, 9 February 2020
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