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Content ArticleThe NHS is not in a place where it can lose staff, but many workers in the health service have faced almost unimaginable difficulties during the pandemic. How worried should we be about NHS staff health and wellbeing? Nigel Edwards and Andy Cowper look at how bad the situation is and what can be done to improve things.
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Content ArticleDespite under-reporting, health workers (HWs) accounted for 2-30% of the reported COVID-19 cases worldwide. In line with data from other countries, Jordan recorded multiple case surges among HWs. This study from Tarif et al. looked at infection prevention and control risk factors in HWs infected with Covid-19. Study findings confirmed the role of hand hygiene as one of the most cost-effective measures to combat the spreading of viral infections.
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Content ArticleThis study in the journal Infection Control & Hospital Epidemiology aimed to determine the extent to which asymptomatic individuals infected with Covid-19 transmitted the disease to other patients and staff on a hospital ward. The authors found that a comprehensive symptoms and signs assessment, in combination with adequate follow-up, allows for a more precise determination of Covid-19 symptoms. The results of the study revealed that asymptomatic infection was quite uncommon amongst adults in this setting.
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Content ArticleThere has been an increase in the use of video group consultations (VGCs) by general practice staff, particularly since the beginning of the Covid-19 pandemic, when in-person care was restricted. This qualitative study in the British Journal of General Practice aimed to examine the factors affecting how VGCs are designed and implemented in general practice. Through semi-structured interviews with practice staff and patients, the authors found that: in the first year of the pandemic, VGCs focused on supporting those with long-term conditions or other shared health and social needs. most patients welcomed clinical and peer input, and the opportunity to access their practice remotely during lockdown. not everyone agreed to engage in group-based care or was able to access IT equipment. significant work was needed for practices to deliver VGCs, such as setting up the digital infrastructure, gaining team buy-in, developing new patient-facing online facilitation roles, managing background operational processes, protecting online confidentiality, and ensuring professional indemnity cover. national training was seen as instrumental in capacity building for VGC implementation.
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Content ArticleCOVID-19 is more likely to lead to Long COVID among persons of working age. In this paper, Darja Reuschke and Donald Houston outline the first estimates of the impact of Long Covid on employment in the UK. Using estimates of cumulative prevalence of Long Covid, activity-limiting Long COVID in the working-age population and of economic inactivity and job loss resulting from Long COVID, they provide evidence of the profound impact of Long COVID on national labour supply. Since the start of the pandemic, cumulatively 2.9 million people of working age (7% of the total) in the UK have had, or still have, Long ovid. This figure will continue to rise due to very high infection rates in the Omicron wave. Since the beginning of the pandemic, economic inactivity due to long-term sickness has risen by 120,900 among the working-age population, fuelling the UK’s current labour shortage. An estimated 80,000 people have left employment due to Long COVID. The authors argue that governments need to tackle the twin challenges to public health and labour supply and provide employment protection and financial support for individuals and firms affected by Long COVID.
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Content ArticleOur health services face an unprecedented challenge in recovering from the pandemic and coping with ongoing waves of covid. With such demand for healthcare services from the general population and covid cases rising once more, some customers are bound to be angry or unhappy. But, as we recover from the pandemic, our handling of complaints must surely change, writes David Oliver in this BMJ article.
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Content ArticleThis blog by doctors Clare Rayner and Amali Lokugamage argues that Long Covid rehabilitation needs a wider focus that goes beyond a purely biomedical paradigm to include complementary therapies and methods. The authors—who have both lived with Long Covid for more than two years—argue that although patients were the first to raise concerns about Long Covid, describe its symptoms and patterns and even research the condition, their narratives and voices are not being included in approaches to treatment. While the biomedical evidence surrounding Long Covid is currently limited, they highlight that there is much valuable lived-experience to be found in patient support and campaign groups, and that patients' knowledge should be drawn on to shape policy and guidance about the condition.
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News ArticleWhen Susan Sullivan died from Covid-19, her parents’ world fell quiet. But as John and Ida Sullivan battled the pain of losing their eldest, they were comforted by doctors’ assurance that they had done all they could. It was not until more than a year later, when they received her medical records, that the family made a crushing discovery. These suggested that, despite Susan being in good health and responding well to initial treatments, doctors at Barnet hospital had concluded she wouldn’t pull through. When Susan was first admitted on 27 March 2020, a doctor had written in her treatment plan: “ITU (Intensive therapy unit) review if not improving”, indicating he believed she might benefit from a higher level of care. But as her oxygen levels fell and her condition deteriorated, the 56-year-old was not admitted to the intensive unit. Instead she died in her bed on the ward without access to potentially life-saving treatment others received. In the hospital records, seen by the Observer, the reason Susan was excluded is spelled out: “ITU declined in view of Down’s syndrome and cardiac comorbidities.” A treatment plan stating she was not to be resuscitated also cites her disability. For John, 79, a retired builder, that realisation was “like Susan dying all over again”. “The reality is that doctors gave her a bed to die in because she had Down’s syndrome,” he said. “To me it couldn’t be clearer: they didn’t even try.” Susan is one of thousands of disabled people in Britain killed by Covid-19. Last year, a report by the Learning Disabilities Mortality Review Programme found that almost half those who died from Covid-19 did not receive good enough treatment, including problems accessing care. Of those who died from Covid-19, 81% had a do-not-resuscitate decision, compared with 72% of those who died from other causes. Read full story Source: The Guardian, 10 July 2022
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Content ArticleThe COVID-19 pandemic has made it more difficult to maintain high quality in medical education. As online formats are often considered unsuitable, interactive workshops and seminars have particularly often been postponed or cancelled. To meet the challenge, Angelina Müller and her colleagues converted an existing interactive undergraduate elective on safety culture into an online event. In this article, they describe the conceptualisation and evaluation of the elective.
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News Article
JCVI chief calls for mandatory masks in hospitals amid Covid surge
Patient Safety Learning posted a news article in News
It would be “sensible” for hospitals to reintroduce mandatory mask-wearing, the chair of the Joint Committee on Vaccination and Immunisation has said, as several trusts in England and Wales announced the move. When NHS rules on wearing masks in England were dropped on 10 June, local health bodies were given the power to draft their own policies. Their guidance, however, is no longer legally enforceable. Figures from NHS England show there were about 10,658 patients hospitalised with coronavirus on Monday. Infections have doubled in a fortnight across England – with about 1,000 patients being admitted with the virus each day. Prof Andrew Pollard, who is also the director of the Oxford Vaccine Group, which developed the AstraZeneca jab, said there were an “extraordinary” number of cases at the moment. “I certainly know more people now who have had Covid than at any time in the past,” he told the BBC Radio 4’s Today programme. “Because there’s so much in the community, anything we can do in our hospitals to reduce the potential outbreaks make sense and so the mandatory mask wearing in hospitals is very sensible policy,” he added. Read full story Source: The Guardian, 5 July 2022 -
Content ArticleThere was a national roll out of ‘COVID Virtual Wards’ (CVW) during England's second COVID-19 wave (Autumn 2020 – Spring 2021). These services used remote pulse oximetry monitoring for COVID-19 patients following discharge from hospital. A key aim was to enable rapid detection of patient deterioration. It was anticipated that the services would support early discharge, reducing pressure on beds. This study from Georghiou et al. evaluated the impact of the CVW services on hospital activity. The study found no evidence of early discharges or changes in readmissions associated with the roll out of COVID Virtual Wards across England.
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Content Article
UK Covid-19 Inquiry Terms of Reference (28 June 2022)
Patient-Safety-Learning posted an article in Covid-19 Inquiry
This document outlines the final terms of reference for the Public Inquiry into the government's response to the Covid-19 pandemic, chaired by Baroness Heather Hallett. The Inquiry will examine, consider and report on preparations and the response to the pandemic in England, Wales, Scotland and Northern Ireland. Baroness Hallett has also recorded a video statement to the public about the Inquiry, which includes a British Sign Language translation. -
Content ArticleThis blog by the charity Picker explores concerns about the safety of staffing levels in the NHS, highlighted by the 2021 NHS Staff Survey. It talks about the potential impact of a recent drop in staff morale. The blog draws out these key findings from the survey: The proportion of staff who felt unwell as a result of work-related stress in the last 12 months rose to 46% – almost half. This was an increase of nearly 3% from the 2020 figure (44%) and continued a trend: the figure has risen each year since 2017, when 38% of staff reported work-related stress. Almost one-in-three staff members say they “often think about leaving” their organisation – an increase of 4% points vs the 26% recorded in 2020. And one-in-six (16%) say they will leave their organisation “as soon as I can find another job” – a 2% point increase from 2020. Only 52% of NHS staff say that they look forward to going to work – a decline of more than 6% points from 58% in 2020. New questions in the survey suggest that many staff are experiencing burnout. Overall, more than a third of staff (34%) said that they ‘always’ or ‘often’ “feel burnt out because of [their] work”. The proportion was even higher for staff in patient facing roles (for example, 41% of registered nurses and midwives) and especially for ambulance personnel (51%).
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News ArticlePatients with long-lasting symptoms from Covid will have access to more convenient tests and checks closer to home, under new NHS measures announced. Specialist clinics, dedicated to Long Covid, will now be able to send people for tests at local one stop shops and mobile clinics, rather than people going back to their GP practice for multiple different tests. Backed by an additional £90 million investment, the updated Long Covid plan includes ambitions for all patients to have an initial assessment within six weeks to ensure they are diagnosed and treated quickly. Latest estimates from the ONS show that around 1.6 million people in England are experiencing ongoing COVID symptoms lasting more than four weeks, with around one in five saying it has a significant impact on their daily life. The plan, which has been developed with expert insights from patients, clinicians and partners across the health and care system, shows the NHS has already made significant progress on delivering the 10 commitments it set out for Long Covid services just over one year ago. This includes establishing a nationwide network of 90 specialist long COVID clinics, 14 hubs for children and young people and investment in training and guidance to support GP teams in managing the condition. Dr Kiren Collison, GP and chair of the NHS long COVID taskforce said: “Long COVID can be devastating for those living with it, and while we continue to learn more about this new condition, it’s important people know they’re not alone, and that the NHS is here for them. “In just under two years, the NHS has invested £224m to support people experiencing long term effects from COVID – from setting up specialist clinics, hubs for children, and an online recovery platform, to providing training for GP teams. “Today’s plan builds on this world-leading care, to ensure support is there for everyone who needs it, and that patients requiring specialist support can access care in a timely and more convenient way.” Read full story Source: NHS England, 28 July 2022
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Content ArticleThe consultancy firm McKinsey & Company explored the effects of the Covid-19 pandemic on the nursing workforce in a global survey that included nurses from United States, the United Kingdom, Singapore, Japan, Brazil and France. The survey findings show a consistency around how nurses feel in their roles today, despite the different healthcare systems and delivery networks in each of the six countries. A substantial population of nurses are expressing a desire to leave direct patient care, with between 28% and 38% of nurse respondents in the United States, the United Kingdom, Singapore, Japan and France indicating that they were likely to leave their current role in direct patient care in the next year. This article explores in detail some of the reasons why nurses are choosing to leave direct patient care, and highlights approaches that might encourage retention, including positive leadership initiatives.
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Content ArticleThis retrospective cohort study in JAMA Internal Medicine aimed to determine whether there are systematic racial and ethnic biases in pulse oximetry among patients with Covid-19, and whether these biases result in patients not being accurately recognised as candidates for oxygen threshold–specific therapy. The authors found that patients from racial and ethnic minority groups with Covid-19 are often subject to overestimation of arterial oxygen saturation levels. This contributes to them not being recognised, or a delay in them being recognised, as eligible to receive Covid-19 therapies.
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Content ArticleAs a clinician, Abraar Karan rarely sees a patient die from Covid-19 anymore. Those who end up in the hospital these days have benefited from the immense advances in clinical science that have brought us vaccines, monoclonal antibodies, and antivirals, and taught us how best to use these and other existing medications, such as steroids, to save patients’ lives. Collectively, this is an enormous accomplishment. It’s not, however, the end of the pandemic. The end of covid-19 will not be a clinical feat, but a public health one. We need public health innovation from our governments, writes Abraar in this BMJ opinion article.
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News Article
Hospitals bring back masks on wards just weeks after rules relaxed
Patient Safety Learning posted a news article in News
Hospitals are bringing back requirements for masks on wards just weeks after rules were relaxed as Covid rates spike, The Independent can reveal. Experts have warned of a surge in cases, believed to be the fifth wave, with one in 40 people in the UK testing positive for the virus. Meanwhile, latest NHS data shows more than 8,000 Covid-positive patients on wards following a warning of a “deleterious” impact on hospital waiting times. In response, three major hospital trusts have told staff they must wear masks, with warnings more must follow if the NHS is to handle another wave of Covid. Dr Tim Cooksley, president of the Society for Acute Medicine told The Independent: “Over the past 2 years Covid has highlighted and exacerbated what was an already growing crisis. “High staff absence levels, burn-out and low morale have dominated staff landscapes during this time and continue to do so. Future waves and potentially large numbers of upcoming flu cases will only serve to deepen these problems making the hopes of patients, clinicians and politicians alike of elective recovery seem somewhat fanciful." Read full story Source: The Independent, 29 June 2022 -
Content Article
Marie Curie - Better end of life report (April 2021)
Patient-Safety-Learning posted an article in End of life care
The Better End of Life programme is a collaboration between Marie Curie, King's College London Cicely Saunders Institute, Hull York Medical School, the University of Hull and the University of Cambridge. It's first research report outlines key findings of the programme relating to the experience of death and dying during 2020, at the height of the Covid-19 pandemic. This interactive webpage presents graphics which highlight the key findings of the research. -
News Article
NHS crisis caused by Tory underfunding not Covid, say doctors
Patient Safety Learning posted a news article in News
Senior doctors have drawn up a major dossier refuting Sajid Javid’s claim that the pressures on the NHS were created by the Covid pandemic, amid continued warnings over patient safety, scarce beds and staff morale. The health secretary has repeatedly suggested that the problems around record waiting lists and ambulance waiting times have been prompted by the pandemic. Last week in parliament, he accused shadow health secretary Wes Streeting of having his “head under a rock for two years” for not seeing that the pressures stemmed from Covid. However, in a major review of evidence shared with the Observer, doctors pointed to issues around funding, bed capacity, staffing and recruitment that pre-dated the arrival of Covid. The dossier, drawn up by the British Medical Association as it gathers for its annual conference this week, finds that the UK’s health services were ill-prepared for the pandemic as a result of “historical underfunding and under-resourcing in the decade preceding the virus”. Denise Langhor, an emergency medicine consultant in the north-west of England, said that the pandemic had “laid bare” the health service’s problems, but did not create them. “Those problems and those holes already existed,” she said. “It is entirely disingenuous of this government to claim the waiting lists and the difficulties people are experiencing with NHS care at the moment are due to Covid. They have been building for a decade. “Every day, I have patients that I wish I could have treated sooner. It’s an awful thing as a doctor to be trying to look after patients on a corridor, and knowing they are not getting the standard of care that you want to give them. “Frequently it feels like we’re operating by choosing the least worst option rather than the best option.” Read full story Source: The Guardian, 26 June 2022 -
News Article
Covid vaccines cut global death toll by 20m in first year, study finds
Patient Safety Learning posted a news article in News
Covid vaccines cut the global death toll by 20 million in the first year after they were available, according to the first major analysis. The study, which modelled the spread of the disease in 185 countries and territories between December 2020 and December 2021, found that without Covid vaccines 31.4 million people would have died, and that 19.8 million of these deaths were avoided. The study is the first attempt to quantify the number of deaths prevented directly and indirectly as a result of Covid-19 vaccinations. “We knew it was going to be a large number, but I did not think it would be as high as 20 million deaths during just the first year,” said Oliver Watson, of Imperial College London, who is a co-first author on the study carried out by scientists at the university. Many more deaths could have been prevented if access to vaccines had been more equal worldwide. Nearly 600,000 additional deaths – one in five of the Covid deaths in low-income countries – could have been prevented if the World Health Organization’s global goal of vaccinating 40% of each country’s population by the end of 2021 had been met, the research found. “Our findings show that millions of lives have likely been saved by making vaccines available to people everywhere, regardless of their wealth,” said Watson. “However, more could have been done.” Read full story Source: The Guardian, 24 June 2022 -
Content ArticleThe first COVID-19 vaccine outside a clinical trial setting was administered on 8 December 2020. To ensure global vaccine equity, vaccine targets were set by the COVID-19 Vaccines Global Access (COVAX) Facility and WHO. However, due to vaccine shortfalls, these targets were not achieved by the end of 2021. Watson et al. aimed to quantify the global impact of the first year of COVID-19 vaccination programmes. The study found that COVID-19 vaccination has substantially altered the course of the pandemic, saving tens of millions of lives globally. However, inadequate access to vaccines in low-income countries has limited the impact in these settings, reinforcing the need for global vaccine equity and coverage.
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News Article
Covid-positive hospital patients rise a quarter in one week
Patient Safety Learning posted a news article in News
The number of patients in English hospitals who have tested positive for Covid has increased 28% in a week, the steepest rise since mid-March The third Covid wave of 2022 has now seen Covid occupation levels rise from 3,835 on 4 June to 6,401 yesterday. The sharpest rise in the number of Covid positive patients came in the North West region, where the total rose by 43% in a week. There are now over 1,000 Covid positive hospital patients in the North West, North East and Yorkshire, Midlands and London regions for the first time since 11 May. Some 38% of Covid hospital patients are being treated primarily for the condition. Read full story (paywalled) Source: HSJ, 24 June 2022 -
News Article
NHS warns of scam Covid-test texts
Patient Safety Learning posted a news article in News
The NHS is warning about widespread scam text messages telling recipients they have been in close contact with a Covid case. "We've seen reports of fake NHS text messages about ordering Omicron Covid-19 test kits," it tweeted. Close contacts of people who have tested positive are no longer advised to test. The aim of the messages appears to be harvesting financial and personal information. In its alert, the NHS says it will "never ask for bank details, so please be aware of suspicious messages". Most people are no longer advised to test for Covid and are ineligible for free tests - but some some pharmacies and shops sell them. Read full story Source: BBC News, 22 June 2022 -
News Article
Trust was sent ‘unfit’ ventilators at height of pandemic
Patient Safety Learning posted a news article in News
A trust was supplied with ventilators that were not ‘fit for NHS purposes’ by two suppliers at the height of the first Covid wave, HSJ has revealed. Guy’s and St Thomas’ Foundation Trust has now received a refund for both contracts, which were signed in March 2020 just as the pandemic began to hit the NHS. The service rushed to secure the equipment in response to fears that existing ventilator capacity would be inadequate to deal with the rising number of seriously ill Covid patients. At the time, the use of ventilators was the only effective therapy for the sickest Covid patients. Minutes published by the trust at its most recent board meeting revealed the issue. GSTT then told HSJ in a statement: “Two contracts for ventilators were in dispute. In one case, the trust has already received a refund. In the other, which involved equipment we do not assess as fit for NHS purposes, the trust was reimbursed by central funding.” The trust would not confirm the number of ventilators involved, the cost or the issue that meant they were not “fit for NHS purposes”. Read full story (paywalled) Source: HSJ, 23 June 2022
