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Content ArticleThere are around 1.3 billion people in the world with a disability, but in many settings, the understanding of reasonable adjustments among healthcare workers is inadequate to provide the same quality of care for people with disabilities as individuals without disabilities. Inclusive healthcare requires improvements in accessibility and training for healthcare professionals. Some progress is being made and medical education in some countries now includes disability, human rights and reasonable adjustments in education and training. This Lancet article outlines global examples of attempts to improve healthcare workers' understanding of disabilities and inclusion.
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Content ArticleIleostomy is a common treatment option for various gastrointestinal conditions. This study in Surgery aimed to examine how receiving care at different facilities might increase the risk of post-discharge complications and readmission following ileostomy. The authors used a national cohort to explore the associations of care fragmentation among ileostomy patients experiencing adverse outcomes and increased hospitalisation.
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News Article
People in UK turning to DIY health treatment amid shortage of GP appointments
Patient Safety Learning posted a news article in News
Almost one in four people have bought medicine online or at a pharmacy to treat their illness after failing to see a GP face to face, according to a UK survey underlining the rise of do-it-yourself treatment. Nearly one in five (19%) have gone to A&E seeking urgent medical treatment for the same reason, the research commissioned by the Liberal Democrats shows. One in six (16%) people agreed when asked by the pollsters Savanta ComRes if the difficulty of getting an in-person family doctor appointment meant they had “carried out medical treatment on yourself or asked somebody else who is not a medical professional to do so”. Ed Davey, the leader of the Liberal Democrats, said delays and difficulty in accessing GP appointments constituted a national scandal, and face-to-face GP appointments had become “almost extinct” in some areas of the country. He said: “We now have the devastating situation where people are left treating themselves or even self-prescribing medication because they can’t see their local GP.” Dr Richard Van Mellaerts, the deputy chair of the British Medical Association’s GP committee in England, said: “While self-care and consulting other services such as pharmacies and NHS 111 will often be the right thing to do for many minor health conditions, it is worrying if patients feel forced into inappropriate courses of action because they are struggling to book an appointment for an issue that requires the attention of a GP or a member of practice staff.” Read full story Source: The Guardian, 2 January 2024 -
Content ArticleThe Belmont Report was written by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Commission, created as a result of the National Research Act of 1974, was charged with identifying the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and developing guidelines to assure that such research is conducted in accordance with those principles. Informed by monthly discussions that spanned nearly four years and an intensive four days of deliberation in 1976, the Commission published the Belmont Report, which identifies basic ethical principles and guidelines that address ethical issues arising from the conduct of research with human subjects.
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Content ArticleThe ethnicity data gap pertains to three major challenges to address ethnic health inequality: Under-representation of ethnic minorities in research Poor data quality on ethnicity Ethnicity data not being meaningfully analysed. These challenges are especially relevant for research involving under-served migrant populations in the UK. This study in BMC Public Health aimed to review how ethnicity is captured, reported, analysed and theorised within policy-relevant research on ethnic health inequities. The authors concluded that the multi-dimensional nature of ethnicity is not currently reflected in UK health research studies, where ethnicity is often aggregated and analysed without justification. Researchers should communicate clearly how ethnicity is operationalised for their study, with appropriate justification for clustering and analysis that is meaningfully theorised.
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Content ArticleAn estimated 2.1 million people are living with Long Covid in the UK alone. The Conversation recently asked 888 people in the UK with Long Covid about their experiences of stigma, and 95% of them said they had experienced stigma related to their condition. On top of the physical symptoms, people living with Long Covid may have to contend with discrimination and prejudice within their communities, workplaces and even health services. Long Covid is a relatively new medical condition, and has been subject to lots of misinformation and minimisation of its legitimacy as a physical illness. To date, there have been no estimates as to how common stigma around long COVID is, which has limited our ability to tackle the problem. Being aware of numerous anecdotes of the discrimination Long Covid patients face, The Conversation decided to look into the extent of this problem and designed a questionnaire together with people who had lived experience of the illness. The questions aimed to estimate how commonly people with Long Covid experience stigma across three domains. “Enacted stigma” means being treated unfairly due to their long COVID, “internalised stigma” is where people feel embarrassed or ashamed of their illness, and “anticipated stigma” is a person’s expectation that they will be treated poorly because of their condition.
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Content ArticleData federation is a process that uses software to connect many existing systems so that they can function as one. It was recently announced that the contract to develop the NHS Federated Data Platform (FDP).has been awarded to US analytics and AI firm Palantir. This blog explains what the FDP is and what it will do, as well as outlining issues surrounding data privacy that have been raised with the Department of Health and Social Care and NHS England by National Voices and other organisations.
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News ArticleA London acute trust is planning to provide staff working in frailty units with body cameras and those in antenatal clinics with additional security, as violence and aggression against them goes ‘through the roof’. Matthew Trainer, chief executive of Barking, Havering and Redbridge University Hospitals Trust in north east London, described the measures the trust is planning to take in response to growing staff concerns about their safety. Speaking at a King’s Fund event about making NHS careers more attractive, Mr Trainer said: “We need to understand the impact of violence and aggression against the workforce and that’s going through the roof just now. “Our ultrasound technicians have now asked for help as their antenatal scans are becoming so fraught. We are about to introduce body cameras in our frailty wards to help with the increase in violence and aggression against staff there.” Mr Trainer – who joined BHRUT in 2021 from Oxleas Foundation Trust – said a long-running problem with violence and aggression in emergency departments was spreading to other departments. Mr Trainer stressed the main problem, particularly in frailty units, was not patients’ own behaviour, but that of family and friends visiting them. Read full story (paywalled) Source: HSJ, 13 December 2023
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Content ArticleWith around half a million people receiving homecare medicines services at a cost that is likely to be between £3billion and £4billion each year, there are questions over what the NHS is getting for its money and how governance and accountability within the system could be improved. This article outlines an investigation by The Pharmaceutical Journal that has revealed hundreds of patient safety incidents caused by problematic homecare medicines services.
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News Article
Nearly nine in ten GPs have faced verbal abuse in the last year
Patient Safety Learning posted a news article in News
GPs have warned that the extent of verbal abuse directed at them and their practice staff ‘is increasing’, with the majority reporting that things are worse now than during the height of the Covid pandemic. A UK-wide survey of more than 2,000 doctors – of which 617 were GPs – found that 85% of GPs have reported receiving verbal abuse from patients within the last 12 months. The research conducted by Medical and Dental Defence Union of Scotland (MDDUS) also found that 15% of GPs reporting verbal abuse said they ‘had to resort to involving the police’ to deal with abusive patient situations over the past year. In the survey, GPs identified key triggers such as ‘lack of access to a face-to-face consultation’ and ‘complaints about their quality of care’ as the factors that could escalate to verbal abuse. One GP who responded to the survey said: "During a consultation with a young adult, they got very irate and demanded I just give them what they came for. "I explained they had to calm down and we would only proceed then at which they called me an ugly, fat, c**t and threatened to smash my face in. That consultation stayed with me for quite a while after that." Another said: ‘A patient smashed the surgery front door (it needed replacing) because he didn’t get what he wanted when he wanted it. "This was very scary for staff and other patients and the police didn’t even come until the next day. I felt alone, defensive and wondered why we bother to try to provide a service when some patients have already decided it isn’t good enough for them." Read full story Source: Pulse, 7 December 2023 -
Content ArticleIn this episode of the Medicine and the Machine podcast, Scottish GP Gavin Francis talks about the need to reconsider the importance of convalescence. He discusses the role of GPs in supporting patients through recovery after a hospital admission or period of illness and talks about a lack of awareness of the principles of convalescence amongst patients.
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News Article
NHS England faces lawsuit over patient privacy fears linked to new data platform
Patient Safety Learning posted a news article in News
The NHS has been accused of “breaking the law” by creating a massive data platform that will share information about patients. Four organisations are bringing a lawsuit against NHS England claiming that there is no legal basis for its setting up of the Federated Data Platform (FDP). They plan to seek a judicial review of its decision. NHS England sparked controversy last week when it handed the £330m contract to establish and operate the FDP for seven years from next spring to Palantir, the US spytech company. The platform involves software that will allow health service trusts and also integrated care systems, or regional groupings of trusts, to share information much more easily in order to improve care. Rosa Curling, director of Foxglove, a campaign group that monitors big tech and which is co-ordinating the lawsuit, said: “The government has gambled £330m on overhauling how NHS data is handled but bizarrely seems to have left off the bit where they make sure their system is lawful. NHS England says the platform will help hospitals tackle the 7.8m-strong backlog of care they are facing and enable them to discharge sooner patients who are medically fit to leave. But this may be the first in a series of legal actions prompted by fears that the FDP could lead to breaches of sensitive patient health information, and to data ultimately being sold. “You can’t just massively expand access to confidential patient data without making sure you also follow the law.” Read full story Source: The Guardian, 30 November 2023 -
News ArticleHealth Education England (HEE) and NHS England have warned BMA that its stance on medical associate professionals (MAPs) is impacting NHS relationships and patient confidence. HEE published an open letter to the BMA in response to the union’s call to halt recruitment of MAPs – which includes physician associates (PAs) working in general practice – until regulation is in place. The BMA Council passed a motion calling for a halt to recruitment of MAPs two weeks ago, on the grounds of patient safety. This followed a previous motion to that effect from its GP committee for England earlier this month. Proposing to bring forward a planned meeting with the BMA to discuss the matter, HEE’s letter said: "This continuing public discourse around MAPs is impacting relations between your members and their MAP colleagues, the health and wellbeing of MAPs already working in the NHS, and potentially the confidence of patients." HEE chief workforce, training and education officer Dr Navina Evans and NHS England medical director Sir Stephen Powis argued in the letter that evidence shows "MAPs are safe", and that they "increase the breadth of skill, capacity and flexibility of teams" and reduce workload pressure on other clinicians. ‘Any issues of patient safety identified resulting from MAPs ‘must be addressed in the same way we would any other profession’, the letter added. Read full story Source: Pulse, 27 November 2023
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Content ArticleThe BMJ’s new “practical prescribing” series aims to improve decision making Prescribing is one of the most fundamental parts of medicine and one of the most common interventions in health care. In the UK, the British National Formulary lists more than 1600 drugs. The number of prescriptions dispensed in the community in England grew by 66% from 686 million prescriptions in 2004 to 1.14 billion prescriptions in 2021-22.34 Polypharmacy has also increased, with around 15% of people in England taking five or more medicines a day and 7% taking eight or more medicines a day. The BMJ in conjunction with the Drug and Therapeutics Bulletin has commissioned a series of articles on practical prescribing. These articles will highlight important issues for prescribers to consider and prompts for shared decision making between prescribers, patients, and their carers. The series—targeted at all medical and non-medical prescribers, particularly doctors in training—will cover medicines commonly prescribed in primary and secondary care. The format is designed to help readers recall their understanding of a medication through a series of questions, exploring up-to-date evidence, and reviewing accessible information not readily found in prescribing texts.
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News Article
Patients ‘neglected and confused’ after leaving hospital, says NHS watchdog
Patient Safety Learning posted a news article in News
Patients are being left feeling “confused and neglected” by not being told who to contact about their future care when they are discharged from hospital, an NHS watchdog has said. Research by Healthwatch England has found that 51% of people are not being given details when they leave of which services they can turn to for help and advice while they are recovering. The NHS was risking patients having to be readmitted as medical emergencies and hospital beds becoming even more scarce by failing to adhere to its own guidelines on discharge, it said. “While our findings show some positive examples, it’s alarming that guidance on safe discharge from the hospital is routinely not being followed,” said Louise Ansari, the patient champion’s chief executive. Healthwatch asked 583 people and their carers how their discharge had gone. Read full story Source: The Guardian, 19 November 2023 -
Content ArticleNew research from Healthwatch reveals worrying problems with hospital discharge arrangements. Many people told us they are not given the right support or information when being discharged from hospital. Read on about their experiences and Health Watch's calls to action.
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News Article
NHSE tells GPs they’re ‘breaching contract’ by denying record access
Patient Safety Learning posted a news article in News
NHS England has taken the unusual move of warning multiple GP practices they are breaching their contract by refusing to give people automatic access to future entries in their record. Under the current national GP contract, practices were ordered to give people on their list automatic access to prospective (future) medical records, via the NHS App, by 31 October. However, the British Medical Association GP committee has urged GPs to instead adopt an “opt in” model, saying it is concerned that giving automatic access could endanger some people. The BMA gave practices a template letter to use to tell their integrated care boards they cannot move ahead with automatic access “due to several risks that cannot be sufficiently mitigated”. NHS England’s own template letter for ICBs to use in response, seen by HSJ, states: “Based on your letter we interpret that the required changes were not implemented by 31 October 2023, thereby putting you in breach of your contractual obligations. We would therefore like to discuss with you your plan, including the timeline to become compliant.” It is an unusual warning from NHSE which could potentially apply to hundreds or thousands of practices. Read full story (paywalled) Source: HSJ, 16 November 2023 -
News Article
NHS failing to prioritise those in most need, says departing ICB chief
Patient Safety Learning posted a news article in News
The NHS should better track patients with the greatest clinical need so they can move to the front of the queue for treatment, a former government waiting list tsar has said. Anthony “Mac” McKeever told HSJ the health service could improve how it works through its elective backlog by using a system introduced during the covid pandemic to prioritise the most pressing cases. He said a “large chunk” of cases were still not given a code to say how long they are considered to be able to wait for surgery, which is at the heart of this process. Mr McKeever retired as Mid and South Essex Integrated Care Board chief executive this month following nearly five decades in the health service, including as a trust leader. Although Mr McKeever said he only knew the regional situation for the East of England, he would be “very surprised” if the national picture was any different. Waiting list expert Rob Findlay agreed this was a reasonable assumption. Read full story (paywalled) Source: HSJ, 17 November 2023 -
Content ArticleCommunity pharmacies in Sweden have changed during the COVID-19 pandemic, and new routines have been introduced to address the needs of customers and staff and to reduce the risk of spreading infection. Burnout has been described among staff possibly due to a changed working climate. However, little research has focused on the pandemic's effect on patient safety in community pharmacies. The aim of this study was to examine pharmacists' perceptions of the impact of the COVID-19 pandemic on workload, working environment, and patient safety in community pharmacies.
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Content ArticleA substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect. Leape et al. identify a broad range of disrespectful conduct, suggesting six categories for classifying disrespectful behaviour in the health care setting: disruptive behaviour; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behaviour; passive disrespect; dismissive treatment of patients; and systemic disrespect. At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change. Even more common are lesser degrees of disrespectful conduct toward patients that are taken for granted and not recognised by health workers as disrespectful. Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients. Disrespect underlies the tensions and dissatisfactions that diminish joy and fulfilment in work for all health care workers and contributes to turnover of highly qualified staff. Disrespectful behaviour is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture. A major contributor to disrespectful behaviour is the stressful health care environment, particularly the presence of “production pressure,” such as the requirement to see a high volume of patients.
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News ArticlePrivate healthcare companies are harming NHS patients in their own homes by failing to deliver vital medicines, and then escaping censure amid an alarming lack of oversight by ministers and regulators, members of the House of Lords have warned. More than 500,000 patients and their families rely on private companies paid by the NHS to deliver essential medical supplies, drugs and healthcare to their homes. The homecare medicines services sector is estimated to be worth billions of pounds. A report by the Lords public services committee says patients are being harmed due to “real and serious problems” with the services provided by for-profit companies. The absence of a single person or organisation with overall control or oversight of the sector means poor performance is going unchecked, it says. “There are serious problems with the way services are provided,” the Lords report says. “Some patients are experiencing delays, receiving the wrong medicine or not being taught how to administer their medicine. [This] can have serious impacts on patients’ health, sometimes requiring hospital care. This leaves NHS staff either firefighting the problems caused by problems in homecare medicines services, or working on the assumption that those services will fail.” Read full story Source: The Guardian, 16 November 2023
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Content Article“Crisis,” “collapse,” “catastrophe” — these are common descriptors from recent headlines about the NHS in the UK. In 2022, the NHS was supposed to begin its recovery from being perceived as a Covid-and-emergencies-only service during parts of 2020 and 2021. Throughout the year, however, doctors warned of a coming crisis in the winter of 2022 to 2023. The crisis duly arrived. In this New England Journal of Medicine article, David Hunter gives his perspective on the current state of the NHS.
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Content Article
NHS England: Medicines optimisation
Patient Safety Learning posted an article in Medicine management
Medicines optimisation looks at the value which medicines deliver, making sure they are clinically-effective and cost-effective. It is about ensuring people get the right choice of medicines, at the right time, and are engaged in the process by their clinical team. -
News Article
Four-plus pathway patients account for 700k of waiting list
Patient Safety Learning posted a news article in News
New data suggests around 700,000 cases on the elective waiting list relate to patients who are on at least four different pathways, and NHS England says personalised care plans must be developed to treat them more efficiently. NHSE has published new data that reveals the overall referral to treatment waiting list, of 7.8 million cases, is made up of 6.5 million individual patients. The difference is due to some patients waiting for more than one treatment. Stella Vig, NHSE’s clinical director for secondary care, told HSJ around 2-3% of the individual patients on the waiting list are on four to five pathways or more. Read full story (paywalled) Source: HSJ, 9 November 2023 -
News ArticleOne in 10 people attempting to contact their GP practice do not manage to get in contact, while a further 6% are only told to try again another day, according to new official survey findings commissioned by the government. The Office for National Statistics has been quietly carrying out the new regular GP access survey since the spring after ministers said they wanted to monitor the impact of their primary care recovery plan. After a sign of slight improvement in the summer, the latest survey results – for October – show no significant change since May. It also found, as did previous rounds, that of those who had tried to contact a GP practice in the past month, 10 per cent said they could not do so (see chart below, ‘Contact with GP practice’). Of those who did make contact, a further 6 per cent reported they were told to try again another day (see chart below, ‘Next step after contact’). The government and NHS England have made it a high priority in recovery plans that patients should no longer be asked to call back another day to book an appointment and should know “on the day” how their request will be managed, which may mean being advised to use a different service. Read full story (paywalled) Source: HSJ, 9 November 2023
