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News Article
Half of ambulance arrivals ‘inappropriate’, says acute trust
Patient Safety Learning posted a news article in News
An audit conducted by an acute trust has found more than half the patients taken to one of its hospitals by ambulance were deemed “inappropriate for conveyance”. The assessment at Scarborough Hospital in Yorkshire, obtained by HSJ through a freedom of information request, examined a random sample of 100 patients, of which around 50 arrived by ambulance. Of those arriving by ambulance, half were deemed not to have required an ambulance conveyance. The Missed Opportunities Audit, which the trust said was “routine” and looked at a range of areas where the emergency department could streamline operations, said: “Fifty-two per cent of conveyance[s] by ambulances were deemed as inappropriate". “The reviewer did not have access to the policies of Yorkshire Ambulance Service, which may account for the low number of appropriate conveyances. However, based on clinical judgment for cases presenting by ambulance the arrivals should have presented either to a community service (33%) or via their own transportation methods (38%), as their documented clinical condition and social circumstances allowed for this.” Read full story (paywalled) Source: HSJ, 9 November 2022 -
News Article
Mental health patients held ‘unlawfully’ in A&Es across the country, experts warn
Patient Safety Learning posted a news article in News
Mental health patients are being held “unlawfully” in A&Es across the country as long waits for care and beds force staff into “fudging” the law, The Independent has been told. The University Hospital of North Midland Trust has been sanctioned by the Care Quality Commission (CQC) for holding mental health patients without any legal authority. However, experts have told The Independent the problem is widespread and occurs across every emergency department in the country with some patients waiting “days” and even “weeks” in A&E. Leaders at Barking, Havering and Redbridge NHS Trust have raised repeated concerns in recent months over patients waiting days in their A&E for mental health care. The CQC raised concerns about the assessment of mental health patients at UHNM following an inspection in October and served the trust with a warning notice. In a letter seen by The Independent, the CQC said two patients were “restricted within hospital unlawfully”. It said although staff were working in the patient’s best interests in both cases it was clear that legal procedures “were not being followed”. “Therefore, this can be seen as a significant infringement of any personal or welfare,” it said. Read full story Source: The Independent. 8 November 2022 -
News Article
GPs giving antidepressants to children against guidelines
Patient Safety Learning posted a news article in News
GPs are breaching medical guidelines by prescribing antidepressants for children as young as 11 who cannot get other help for their mental health problems, NHS-funded research reveals. Official guidance says that under-18s should only be given the drugs in conjunction with talking therapies and after being assessed by a psychiatrist. But family doctors in England are “often” writing prescriptions for antidepressants for that age group even though such youngsters have not yet seen a psychiatrist, according to a report by the National Institute for Health and Care Research (NIHR), the NHS research body. The report linked the prescriptions to the long wait many young people, some self-harming or suicidal, face before starting treatment with NHS child and adolescent mental health services (CAMHS). Under-18s are prescribed the drugs for anxiety, depression, pain and bedwetting. The guidance on antidepressants has been issued by the National Institute for Health and Care Excellence (NICE), which advises the NHS on which treatments are effective. Referencing NICE’s recommendation of a two-step approval process, the NIHR study said “this often” did not happen. “No antidepressants are licensed in the UK for anxiety in children and teenagers under 18 years, except for obsessive compulsive disorder. Yet both specialists [psychiatrists] and GPs prescribe them. Thousands of children and teenagers in the UK are taking antidepressants for depression and anxiety. The numbers continue to rise and many have not seen a specialist.” Read full story Source: The Guardian, 4 November 2022 -
News Article
Patients don’t feel safe in A&E, research finds
Patient Safety Learning posted a news article in News
Visiting A&E or relatives is considered much riskier than attending hospital for other reasons, according to the first in-depth piece of research into the subject. The research, authored by the University of Leicester and NIHR Leicester Biomedical Research Centre Bioinformatics Hub, asked 400 participants how they felt about attending hospital across a range of scenarios during the pandemic. It also revealed that consistent staff use of PPE is seen as a top priority by patients, with staff testing receiving significant but much less support. Participants in the Leicester research were asked to rank how ”safe and confident” they felt coming into hospital for a number of reasons on a scale 1-100. The median score given to “visiting a friend or family member” was 49. The score for attending accident and emergency was 50. Attendance at A&E’s fell sharply during the pandemic peak. It is now rising, but has not reached pre-covid levels. The research suggests that fear could still be playing a significant part in the drop off. Attending hospital for elective care received a median score of 61. Participants were most confident in visiting hospital for essential surgery (median score 78), and clinical scans or x-ray (77). Read full story (paywalled) Source: HSJ, 3 September 2020 -
News Article
Coronavirus: Charity seeks judicial review on care home visit guidance
Patient Safety Learning posted a news article in News
A dementia charity is seeking a judicial review of the government guidance on care home visits. John's Campaign says many care homes in England are still refusing regular face-to-face visits, often essential for people with severe dementia. Dr Angela McIntyre, a retired doctor backing the campaign, has not seen her 92-year-old mother since March. A Department of Health spokesman said: "We know limiting visits in care homes has been difficult for many families." He added: "Our first priority is to prevent infections in care homes, and this means that visiting policy should still be restricted with alternatives sought wherever possible. "Visiting policies should be tailored by the individual care home and take into account local risks in their area." But John's Campaign believes the guidance does not take into account how important visits from family members are for dementia patients and believes it could be in breach of the law. Read full story Source: BBC Health, 3 September 2020 -
News ArticleNurses and essential healthcare staff could be left redundant in the middle of the pandemic as local authorities look to make changes to healthcare contracts that would leave patients facing major disruption, NHS bosses have warned. NHS Providers, which represents all NHS trusts, and NHS Confederation, which represents health and care organisations, said that the decision to put contracts for public health services out to tender as workers battle coronavirus in the community is “completely inappropriate” and a “damaging distraction”, creating uncertainty for those who have spent the past six months on the COVID-19 frontline. Shadow health minister Jonathan Ashworth told The Independent: “This process is disruptive and wasteful at the best of times, but to be doing this mid-pandemic is risky, unnecessary and undermines the ability of frontline health workers to focus not only on preparations for a potential second wave, but a whole host of other health issues, such as Covid rehabilitation, community mental health services and children’s health, all of which are now urgent priorities.” Read full story Source: The Independent, 1 September 2020
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News Article
Not wearing a mask a ‘serious conduct issue’, CEO warns staff
Patient Safety Learning posted a news article in News
A London acute trust has told its staff they may not be paid for time at home self-isolating if it transpires they were not wearing a mask near someone with coronavirus. Staff at Chelsea and Westminster Hospital Foundation Trust were told that if they have to stay at home self-isolating because they were not wearing a mask, that time would have to be taken as annual or unpaid leave. Chief executive Lesley Watts told all staff in an email today, seen by HSJ, that a worker had tested positive for COVID-19, and that four staff members had spent more than 15 minutes with them “without appropriate [personal protective equipment]” and must all now isolate themselves at home for 14 days. The trust considers it “a serious conduct issue not to wear a mask where you are putting colleagues or our patients at risk – this will be dealt with under our formal processes going forward”, Ms Watts said in the email. “If you are sent home to isolate for two weeks because you have not worn a mask, I am now informing you that you will be required to take this as annual or unpaid leave. The four staff members “would not be having to go home to isolate if the use of face masks and social distancing had been in place appropriately”. A Chelsea and Wesminster Hospital spokesman told HSJ: “The guidance around PPE has changed a number of times over the course of the pandemic and we felt it was important to be clear on the trust’s position and to reiterate how seriously we take staff and patient safety." Read full story (paywalled) Source: HSJ, 28 August 2020 -
News ArticleNearly three-quarters of coronavirus patients admitted to hospital suffer ongoing symptoms three months later, new research suggests. A total of 81 patients out of 110 discharged from Southmead Hospital in Bristol were still experiencing symptoms from the virus, including breathlessness, excessive fatigue and muscle aches, after 12 weeks. Many were struggling to carry out daily tasks such as washing, dressing or going back to work, the study found. The majority of patients reported improvements in the initial symptoms of fever, cough and loss of sense of smell, and most had no evidence of lung scarring or reductions in lung function. The findings are part of North Bristol NHS Trust's Discover project, which is studying the longer-term effects of coronavirus - so-called Long COVID. An intensive care doctor, Dr Jake Suett, told Sky News in June that he was still suffering COVID-19 symptoms three months after contracting the disease. Dr Jake Suett, 31, had no underlying health conditions but was still suffering chest pain, breathlessness, blurred vision, memory loss, a high temperature, concentration problems. Dr Rebecca Smith, from North Bristol NHS Trust, said: "There's still so much we don't know about the long-term effects of coronavirus, but this study has given us vital new insight into what challenges patients may face in their recovery and will help us prepare for those needs." Read full story Source: Sky News, 20 August 2020
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News Article
COVID-19: Impact of long term symptoms will be profound, warns BMA
Patient Safety Learning posted a news article in News
A third of doctors have treated patients with long term COVID-19 symptoms, including chronic fatigue and anosmia, a survey conducted by the BMA has found. Richard Vautrey, chair of the BMA’s GP committee for England, said it was clear that the long term impact of COVID-19 on patients and the NHS would be profound. “With more patients presenting with conditions as the result of infection, it’s essential that sufficient capacity is in place to support and treat them,” Vautrey said. “With the growing backlog of non-COVID-19 treatment, the likelihood of a season flu outbreak, and the possibility of a second wave of infections we need to see a more comprehensive long term plan to enable doctors to care for their patients this winter and beyond.” The survey also asked doctors about their own experiences of COVID-19: 63% said they did not believe they had contracted the virus, 12% had had a diagnosis of COVID-19 confirmed by testing, and 14% believed they had been infected with the virus. David Strain, co-chair of the BMA’s medical academic staff committee, said that the NHS could not afford more failures of quality and supply in personal protective equipment. “Risk assessments should be available to all working in the NHS and appropriate steps should be put in place to mitigate the risk of catching the virus, even in those that have a low risk of a bad outcome from the initial infection,” he said. Read full story Source: BMJ, 13 August 2020 -
News ArticleFollowing four deaths and more than 300 incidents with steroid replacement therapy involving patients with adrenal insufficiency in the past two years, patients at risk of adrenal crisis will be issued with a steroid emergency card. All adults with primary adrenal insufficiency (AI) will be issued an NHS steroid emergency card to support early recognition and treatment of adrenal crisis, a National Patient Safety Alert has said. The cards will be issued by prescribers — including community pharmacists — from 18 August 2020. AI is an endocrine disorder, such as Addison’s disease, which can lead to adrenal crisis and death if not identified and treated. Omission of steroids in patients with AI, particularly during physiological stress such as an additional illness or surgery, can also lead to an adrenal crisis. The alert has requested that “all organisations that initiate steroid prescriptions should review their processes/policies and their digital systems/software and prompts to ensure that prescribers issue a steroid emergency card to all eligible patients” by 13 May 2021. Read full story Source: The Pharmaceutical Journal, 17 August 2020
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News Article
Hospital has 'closed its doors' to patients, LMC warns NHS England
Patient Safety Learning posted a news article in News
GP leaders have written to NHS England to demand that an NHS hospital trust urgently restores routine referrals as it has 'closed its doors' to some patients, ‘destabilising’ practices in the process. Oxfordshire LMC said local GPs are ‘concerned and angry’ about the ‘ongoing closure’ to routine referrals across multiple ‘high-demand’ specialties by Oxford University Hospital Foundation Trust, while warning GPs are also being asked to carry out tests that should be done in hospital. A ‘significant’ number of specialties are affected, including ENT, general gynaecology, dermatology, ophthalmology, endoscopy and urology, as well as plastics and maxillofacial, it added. The hospital trust said it had remained open for urgent and emergency care and was accepting clinically urgent and suspected cancer referrals, while reinstating services to support 'the vast majority' of routine referrals. But Oxfordshire LMC has this week written to NHS England and the council of governors at OUHFT to demand that there are ‘no further delays’ in restoring the services amid concerns of ‘patient harm’. It said: ‘The LMC believes the continuing closure of some specialty services to routine referrals is now so serious for patients that it has taken a decision to formally raise the concerns of Oxfordshire’s GPs with NHS England.’ Read full story Source: Pulse, 13 August 2020 -
News Article
NHS told to let patients initiate follow-up appointments
Patient Safety Learning posted a news article in News
Trusts are being encouraged to adopt a system in which patients initiate follow up appointments by the lastest guidance from NHS England designed to help the NHS recover from the covid crisis. It is hoped the approach can reduce unnecessary demand and therefore help trusts cut waiting lists that have soared as a result of the restrictions placed on hospital activity during the pandemic. Under 'patient initiated follow up' (PIFU) patients decide when they require follow up appointments. They are given guidance as to what symptoms and other factors they should take into account when deciding if a follow up appointment is necessary. PIFU is already used by some trusts, but it has not yet become widely adopted. The plan to increase PIFUs was set out in a guidance published today designed to underpin the “phase three letter” sent out to NHS leaders last week. The guidance, Implementing phase 3 of the NHS response to COVID-19 pandemic , says “individual services should develop their own guidance, criteria and protocols on when to use PIFUs”. The document also sets out some overarching principles. It says services will be rated against the following headline metrics: “total number and proportion of patients on the PIFU pathway; patient outcomes, e.g. recovery rates, relapse rates; waiting times; and DNA rates”. Read full story (paywalled) Source: HSJ, 7 August 2020 -
News Article
How to support loved ones in hospital during the coronavirus pandemic
Clive Flashman posted a news article in News
To help stop the spread of the coronavirus that causes COVID-19, the majority of hospitals have stopped or severely restricted visits. This article explains how you can still help a loved one even when you can't see them face to face. During the coronavirus crisis, most hospitals and care homes in the UK have stopped visits. If you have a loved one in a healthcare setting, not being able to go to see them will be incredibly difficult. But these temporary measures have not been taken lightly. Restricting visits to hospitals and care homes is important to reduce the spread of the virus that causes COVID-19 as much as possible. This way hospital and care home residents, and healthcare staff, can be better protected during the pandemic. Read the full article here -
News ArticleUrgent cancer referrals were "inappropriately" rejected by hospitals during the coronavirus lockdown without tests being carried out, GPs have said. Cancer Research UK said the findings from a survey of more than 1,000 GPs were "alarming", warning that patients whose lives may be at risk were being left "in limbo". Family doctors were surveyed in June and asked what had happened to patients they had referred to hospitals for tests in the month to that point because cancer was suspected. A quarter of GPs said urgent referrals had been inappropriately turned down by hospitals more often than had been the case before the pandemic. Four in 10 said that, when tests were refused, patients had been left without proper checks to see whether their case could safely be left without investigation. Read full story (paywalled) Source: The Telegraph, 8 July 2020
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News Article
Hospital ratings often depend more on nice rooms than on health care
Patient Safety Learning posted a news article in News
A study of 50,000 patients throughout the United States showed that those who were the most satisfied with their care (the top quartile) were 26% more likely to be dead six months later than patients who gave lower ratings to their care. The study, “The Cost of Satisfaction,” appeared in JAMA Internal Medicine. The researchers looked at Centers for Medicare and Medicaid Services (CMS) hospital data and patient surveys at more than 3,000 US hospitals over three years. The hospitals where fewer patients died had only a 2% point edge in patient satisfaction over the others. Cristobal Young, associate professor of sociology at Cornell University and lead author of the study, calls it “the halo effect of hospitality.” Young found that what mattered most to patients in ratings were the compassion of nurses and amenities like good food and quiet rooms. It’s why hospital managers are being recruited from the service industry and we’re seeing greeters in the lobby and premium TV channels in rooms, he says. Patients tend to value what they see and understand, but that can be limited, Young continues. They give hospitals good cleanliness ratings when they observe waste baskets are emptied and sheets are changed. “They can’t see a virus or tell you how clean the room is in ways that matter,” he says. Read full story Source: 4 July 2020, Washington Post -
News Article
Third of frail hospital leavers in England find post-discharge care lacking
Patient Safety Learning posted a news article in News
Problems with hospital discharges in England, highlighted in the largest annual patient survey, reinforce the need for greater integration between health and social care, the sector regulator has said. The Care Quality Commission inpatient survey found that a majority of patients were positive about their hospital care but a significant minority experienced problems on discharge. A third of respondents who were frail said the care and support they expected when they left hospital was not available when they needed it. Three in 10 frail people said they had not had discussions with staff about the need for further health and social care services they might require post-discharge. Four in 10 of all patients surveyed left hospital without printed or written information about what they should or should not do after discharge, and the same proportion said their discharge was delayed. Read full story Source: The Guardian, 2 July 2020 -
News Article
New tool could be used to identify those most at risk from coronavirus
Patient Safety Learning posted a news article in News
A new risk tool could be used to identify those most at threat from COVID-19, so GPs can give patients tailored advice, health officials have said. Scientists at Oxford University are working on a clinical risk prediction model, which aims to give individuals more precise information about the likely impact of the disease on them, instead of a blanket approach. Health officials said the plans aimed to allow “very individualised discussions” between patients and their doctors, in the event of future outbreaks, particularly as winter approaches. Read full story (paywalled) Source: The Telegraph, 23 June 2020 -
News ArticleWhen Dan Scoble came down with the coronavirus in March, all the classic symptoms landed in one fell swoop. “I had everything under the sun: a fever, temperature, fatigue and chest pain,” he said. “My head felt like a balloon.” The 22-year-old, a personal trainer from Oxford who normally breezed through 10-mile runs, suddenly found himself bed-bound. He presumed it would soon blow over, but 12 weeks after falling ill as the country went into lockdown, he is still not back to normal. Dan has left his house just five times in three months — twice to see his GP and three times to hospital. He still suffers from crippling fatigue, recurrent migraines and a persistent sore throat, as well as abdominal and musculoskeletal pain. Read full story (paywalled) Source: The Times, 14 June 2020
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News Article
Patients received ‘derogatory’ treatment at women’s unit
Patient Safety Learning posted a news article in News
Inspectors have placed a women’s mental health service into special measures after patients were said to have been subjected to “inappropriate” and “derogatory” treatment by staff. St Andrew’s Healthcare, which runs the women’s inpatient facility in Northampton, has received a series of damning reports among its services over the past two years. The inspectors noted during visits between February and March that staff reportedly used language to describe patients on a medium secure ward such as “self-harmers”, “attention seeking”, and “kicking off”. Patients said staff used “inappropriate restraint techniques that caused pain” with reports they “bent the patient’s wrist and arm behind their back.” They also said staff spoke to them in a “derogatory manner, for example telling them to sort themselves out when engaging in self harm behaviour.” Inspectors rated the service “inadequate” overall, noting concerns elsewhere including “forensic failure incidents due to staff shortages”, that staff were not reporting all safeguarding concerns and that “managers did not ensure safe and clean environments in the long stay rehabilitation service and learning disability service.” Read full story Source: HSJ, 10 June 2020 -
News Article
Babylon apology after GP app lets patients see other people's consultations
Patient Safety Learning posted a news article in News
Babylon Health is investigating whether NHS patients were among those affected by a 'software error' that allowed people registered with its private GP service to view recordings of other people's consultations earlier this month. Babylon Health has confirmed that a small number of patients were able to view recordings of other patients' consultations earlier this week. The issue came to light after a patient in Leeds who had access to the Babylon app through a private health insurance plan with Bupa reported that he had been able to view around 50 consultations that were not his own. The patient told the BBC he was 'shocked' to discover the data breach. "You don't expect to see anything like that when you're using a trusted app," he said. "It's shocking to see such a monumental error has been made." Babylon told GPonline that the app used by private and NHS patients is the same, but it had yet to confirm whether the roughly 80,000 patients registered with the company's digital first NHS service GP at Hand were among those affected. The problem is understood to have cropped up when a new feature was introduced for patients who switched from audio to video mid-way through a consultation. Read full story Source: GPOnline, 10 June 2020 -
News ArticleMichael Seres, an entrepreneur, patient advocate, husband and father of three, died on Saturday in Orange County, California, of a sepsis infection. He was 51. Seres was widely considered to be one of the first and most prominent “e-patients,” a term which has become popular to denote patients who are informed and engaged in their health, often sharing their experiences online. He is also one of a small number of patient inventors who helped design and build a medical device – a digitally enhanced ostomy bag – that got FDA clearance in 2014. His invention eased the suffering of millions of people with bowel injuries, chronic gut illnesses and cancer. Source: CNBC, 2 June 2020 Read more about Michael and his innovative patient work in our hub blog
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News Article
Fault warning for Emerade 500 adrenaline pens
Patient Safety Learning posted a news article in News
People carrying Emerade 500 microgram adrenaline auto-injector pens should return them and get hold of a prescription for a different brand. A fault has been detected in the pens, meaning the dose of adrenaline may not be delivered when needed for people with severe allergies. The official advice comes from the Medicines and Healthcare products Regulatory Agency (MHRA). Alternative brands - EpiPen and Jext - are available up to 300 micrograms. "Action has been taken to protect patients, following detection of a fault in one component of the Emerade adrenaline auto-injector pens," an MHRA spokesperson said. "Patients should return all Emerade 500 microgram pens to their local pharmacy once they have a new prescription and have been supplied with pens of an alternative brand." If an Emerade pen does need to be used before a patient can get hold an alternative pen, the advice is that it should be pressed very firmly against the thigh. If this does not work, the patient should immediately use their second pen. Read full story Source: BBC News, 19 May 2020 -
News Article
Urgent referrals rejected for one in three GPs during COVID-19 outbreak
Patient Safety Learning posted a news article in News
More than three quarters of GPs fear delays to care because of COVID-19 will harm patients, with one in three reporting that urgent referrals have been rejected during the pandemic, a GPonline poll shows. The poll of 415 GPs found that 77% were concerned that delays to operations and treatments for non-COVID-19 issues would result in patients coming to harm. Meanwhile, 30% of GPs said they have had an urgent referral rejected during the pandemic. Rejected referrals included two-week-wait referrals for suspected cancer as well as urgent referrals for investigations such as ECGs, echocardiograms and CT scans. GPs also highlighted concerns over delays to treatment for cancer, with respondents warning that breast cancer surgeries had been postponed or chemotherapy delayed. Read full story Source: GP Online, 5 May 2020 -
News ArticlePregnancy support helplines are experiencing a massive spike in distressed pregnant women asking for urgent help as charities warn coronavirus upheaval is placing pregnant women at risk. Frontline service providers warn mothers-to-be are anxious about whether they will be denied pain relief options and be separated from their newborn babies due to them being put in neonatal units. Birthrights, a maternity care charity, found enquiries to its advice line in March were up by 464 per cent in comparison to March last year. Women getting in touch also raised concerns about home birth services being withdrawn, midwifery-led birth centres shutting their doors and elective caesareans being discontinued due to the COVID-19 crisis. Baby charity Tommy’s experienced a 71% surge in demand for advice from midwives on its pregnancy helpline last month. The organisation warned coronavirus turmoil is placing pregnant women at risk after their midwives answered 514 urgent calls for help in April which is a sizeable rise from the 300 enquiries they would generally get. Jane Brewin, the charity’s chief executive, said: “Antenatal care is vital for the wellbeing of mother and baby – but the coronavirus outbreak means that many don’t know who they can ask for help, or don’t want to bother our busy and beloved NHS." “Although services are adapting, they are still running, so pregnant women should not hesitate to raise concerns with their midwife and go to appointments when invited. The large increase in people contacting us demonstrates that coronavirus is creating extra confusion and anxiety for parents-to-be, making midwives’ expert advice and support even more important at this time.” Read full story Source: The Independent, 5 May 2020
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News Article
High-risk pregnancies could be missed due to pandemic, experts warn
Patient Safety Learning posted a news article in News
Experts have raised fears that high-risk pregnancies may be missed due to the coronavirus pandemic, leading to a potential rise in stillbirths and neonatal deaths. During a session of Westminster’s Health and Social Care Committee, Gill Walton, the Chief Executive of the Royal College of Midwives, said there was a “fear” among pregnant women presenting themselves to maternity services during the COVID-19 outbreak. Former health secretary Jeremy Hunt, who chairs the committee, said one of the most important elements of maternity safety was to identify higher-risk pregnancies early “so that interventions can be made to prevent stillbirths, complications, or even the death of a baby”. Mr Hunt added the President of the Royal College of Obstetricians, Dr Edward Morris, had told him he is “worried that some higher-risk pregnancies may be being missed” because of fewer face-to-face appointments and missed scans. Asked whether she shared that concern, Ms Walton told MPs: “I do share that concern. Some of that is related to the fear of the pregnant population and presenting to maternity services during the pandemic." "That fear then prevents them sometimes just picking up the phone to call their midwife to say that may be concerned about not feeling well, or that they’ve got reduced foetal movements.” Read full story Source: The Independent, 1 May 2020
