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Content ArticleLaura Chapman is a law student in Chicago, USA, where she’s studying to become a lawyer. She has lymphoedema, a condition that causes painful swelling in her foot that worsens throughout the day. She needs custom garments to control that swelling, but her Medicaid plan doesn’t cover them. Here’s her story in her own words. Sick Note is a regular newsletter about America's healthcare system.
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Content ArticleThe purpose of this investigation by the Healthcare Safety Investigation Branch (HSIB) is to help improve patient safety in relation to the care of patients who have NHS-funded surgery in an independent hospital. This was initiated in the context of the COVID-19 pandemic, where because of increased pressure on the NHS, independent hospitals have been providing more care for NHS patients, including urgent elective surgical care and delivery of cancer pathways. The HSIB investigation reviewed the experience of a patient with a diagnosis of bowel cancer, who was booked to undergo laparoscopic (keyhole) surgery to remove part of his bowel in in an independent hospital. Following surgery, the patient made slow progress and on day eight following surgery he started to deteriorate rapidly. He was transferred to the local NHS hospital for investigation and further surgery. He died later the same day as a result of sepsis following a complication of his recent surgery.
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News Article
NHS and private hospitals told to improve after patient death
Patient Safety Learning posted a news article in News
The NHS and private hospitals need to improve how they work together after the death of an NHS patient treated privately during the pandemic, a watchdog has warned. An investigation by the Healthcare Safety Investigation Branch (HSIB) found some private hospitals took on more complex patients than they were used to, while problems with communication and confusion over responsibilities created safety risks. It has called on the Care Quality Commission to do more to inspect how the two sectors work together and how patients are transferred between hospitals safely. It launched an inquiry after the death of a patient, known as Rodney, aged 58, who was due to have keyhole surgery to remove part of his bowel due to cancer. His NHS operation was cancelled and rebooked at a nearby private hospital after cancer services were transferred to the independent hospital due to COVID-19. Rodney was asked to sign a consent form for open bowel surgery, rather than the less invasive keyhole procedure, due to guidance at the time around a "potentially increased risk of COVID-19 transmission with laparoscopic surgery", the HSIB said. The cancerous part of his bowel was removed but eight days later his condition he deteriorated rapidly and was transferred to the local hospital so he could receive intensive care - which was not available at the private hospital. When he arrived at the NHS hospital, a scan and more surgery showed a leak in his bowel which led to sepsis and organ failure. He died later that day. As a result of the case, the HSIB launched a wider investigation into NHS surgical services being carried out in independent hospitals. Read full story Source: The Independent, 28 October 2021 -
News Article
Dentist NHS targets can not be reached without putting patients and staff at risk
Patient Safety Learning posted a news article in News
A patients' group says it is concerned over a lack of access to NHS dentists in South Gloucestershire after two surgeries turned private. Frampton and Flaxpits surgeries say NHS targets can not be reached without putting patients and staff at risk. and they must go private to survive. Vicky Marriott, of Healthwatch, an independent statutory body representing patients, said not having an option to have NHS care was a "real concern". In a letter to patients, Dr Dimitri Haddjeri, dentist at Framptom and Flaxpits surgeries, said "target-driven, high-volume dentistry" was "not fit for purpose" and did not put the patient first. He said NHS targets could not be reached without putting patients and staff at risk. Ms Marriott said there were "enormous problems" for people trying to find NHS care across South Gloucestershire, Bristol and North Somerset. "Between July and September this year, in Bristol alone, we've had 73 people contact us saying that they've been emailing or phoning every single dental practice to see if they can get treatment and haven't been able to," she said. Read full story Source: BBC News, 13 October 2021 -
News Article
NHS waits: More people feeling forced into private healthcare
Patient Safety Learning posted a news article in News
"To be put in a position where you're basically begging off people, it's infuriating." Last October, 12-year-old Hayden Kildea was diagnosed with severe scoliosis, a condition where the spine twists and curves to the side. Left untreated, it can become a dangerous and life-limiting condition. The Kildeas, who live in Strabane, Northern Ireland, say they were told Hayden would need urgent surgery - but that because of the backlog caused by the pandemic, he would have to wait more than two years. His mum Shauna found a clinic in Turkey that was able to carry out the operation immediately, but it would cost £50,000 - money the family didn't have. So in the summer, they turned to crowdfunding and campaigning to raise the money. Millions of people across the UK are currently on NHS waiting lists - in Northern Ireland there are over 465,000 people, while in England, 5.6m are queuing for treatment. Data shared with BBC Panorama shows that on average, waiting lists have grown by 50% in the most deprived parts of England since the start of the pandemic, compared with nearly 35% in the most affluent areas. The research, conducted by the King's Fund, also shows that people on waiting lists in poorer areas are nearly twice as likely as those in wealthier areas to wait more than one year for treatment. The Health and Social Care Board in Northern Ireland said patient demand continued "to exceed capacity across a range of specialties". It added: "As a result, even before the pandemic, the number of people waiting longer than the target waiting times was increasing." Read full story Source: BBC News, 27 September 2021 -
Content ArticleThis New Scientist article explores various safety incidents that have occurred in oil companies due to failings in their organisational structures. Lessons can be learnt and applied to safety in healthcare.
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Content ArticleThis blog looks at the introduction of a new safety culture at oil company Amoco in the 1990s, following the company's previous poor safety record. The author highlights the positive impact that this had on fatality numbers, and comments how a similar culture is needed for the oil company BP. Although discussing the oil industry, the issues highlighted are relevant to healthcare safety and culture too.
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Content ArticleImproving the design of technology relies in part, on the reporting of performance failures in existing devices. Healthcare has low levels of formal reporting of performance and failure of medical equipment. This paper from Tase et al. examines methods of reporting in the car industry and healthcare and aims to understand differences and identify opportunities for improvement within healthcare.
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News ArticleNew data indicates the dental crisis shows no signs of slowing, with four in five people (80%) struggling to access timely care during the last COVID-19 lockdown. Access to NHS dental care continues to be a problem for people across England, with Healthwatch recording a 22% rise in calls and complaints about dentistry between January and March 2021. A review of 1,375 people’s experiences shared with Healthwatch found a lack of consistency across the country when it comes to accessing a dental appointment. Whilst some people were asked to wait an unreasonable time of up to three years for an NHS appointment, those able to afford private care could get an appointment within a week. Healthwatch are calling for greater ambition and urgency from NHS dental reform plans to create more equitable and affordable dental care. Imelda Redmond CBE, National Director of Healthwatch England, said: “The twin crisis of access and affordability hitting NHS dentistry means many people are not able to access timely care – and the poorest are hardest hit. Those human stories show that oral health is a social justice and equity issue." Read full story Source: Healthwatch, 24 May 2021
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News Article
People in England ‘face three-year waits for dentist appointments’
Patient Safety Learning posted a news article in News
People are being told to wait until 2024 for dentist appointments while others are being removed from their practice lists for not making appointments sooner, according to a damning report into the state of dentistry. Dental surgeries have reported that they have thousands of people on their waiting lists, while patients are unable to access care after ringing round numerous dental surgeries, a watchdog has warned. Delays have resulted in the worsening of painful symptoms and in one instance even led to a patient needing hospital treatment after overdosing on painkillers, it said. But Healthwatch England said that some people are being offered swift private care as an alternative at the same dental practice, with some patients reporting that they felt pressured to pay for their treatment. Some practices appeared to be prioritising private care, it added. Read full story Source: The Guardian, 24 May 2021 -
News Article
Patients harmed after roll-out of new IT system
Patient Safety Learning posted a news article in News
Patients have come to avoidable harm after a large private provider failed to deliver thousands of medicine prescriptions, according to a report from the Care Quality Commission. Healthcare at Home, which is based in Staffordshire but provides NHS-funded care and medicine supplies to patients’ homes across the country, has been rated “inadequate” and placed in special measures. A report published today said inspectors found more than 10,000 patients missed a dose of their medicine between October and December 2020 due to problems caused by the introduction of a new information system. Reviews have found some suffered avoidable harm as a result. Read full story (paywalled) Source: HSJ, 13 May 2021 -
News ArticleA private healthcare provider has been ordered to pay £20,000 after failing to disclose errors in the treatment of patients under the care of a surgeon. Spire Healthcare was prosecuted today in what the Care Quality Commission (CQC) said was “the first prosecution of its kind against an independent provider of healthcare”. The CQC said concerns around the treatment of four patients were initially raised by Leeds Clinical Commissioning Group, several physiotherapists at the hospital and another surgeon. The patients had surgical procedures carried out by Michael Walsh, a shoulder surgeon who held practising privileges at Spire Leeds until his suspension in April 2018. The procedures resulted in the patients suffering prolonged pain and requiring further remedial surgery. The CQC said it brought the prosecution after Spire failed to share details of what happened to the patients who were being treated by Mr Walsh, in line with their duty of candour responsibilities to be transparent and provide timely apologies when serious incidents occur. Read full story (paywalled) Source: HSJ, 29 April 2021
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Content ArticleThis Healthcare Safety Investigation Branch (HSIB) report highlights a gap between the NHS and other safety-critical industries in identifying and managing barriers to reduce the risk of serious incidents occurring.
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News ArticleNearly 30 patients suffered severe or moderate harm due to quality issues with ultrasounds carried out by an independent provider, a review has found. Scans of 1,800 patients carried out by two sonographers employed by Bestcare Diagnostics were examined as part of a clinical harm review initiated by Coastal West Sussex Clinical Commissioning Group in 2019. Papers for next week’s governing body meeting of West Sussex CCG — which has absorbed Coastal West Sussex CCG — reveal the review found 29 cases of severe or moderate harm. According to the NHS’ National Recording and Learning System, moderate harm is that where a patient needs further treatment or procedures but the harm is short-term. Severe harm results in permanent or long-term harm. Both require NHS bodies to exercise the duty of candour. Read full story (paywalled) Source: HSJ, 6 April 2021
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News Article
PHIN responds to Government update on the Paterson Inquiry
Patient Safety Learning posted a news article in News
Following the statement from Nadine Dorries MP, Minister for Patient Safety, providing an update on the Paterson Inquiry, Matt James, Chief Executive of the Private Healthcare Information Network, said: “Although we were expecting the Government’s full response by now, it’s reassuring to know that this is still firmly on the agenda. The updates provided today are all welcome, but perhaps most telling is what remains to be addressed – most notably whole-practice information and better information for patients (recommendations one and three). “While it’s disappointing not to see more specifics, it is crucial that the recommendations are implemented properly and with the right consideration, resisting the temptation to create new systems from scratch and instead build on the excellent progress made by organisations such as NHS Digital, GIRFT, NCIP and PHIN. “We will continue to work with our partners across the NHS and private sector to make positive changes which improve transparency, accountability and information for patients. We will continue to liaise with the Department of Health and Social Care when invited to do so.” Press release Source: PHIN, 23 March 2021 -
Content ArticleThis week Nadine Dorries MP, Minister for Patient Safety, Suicide Prevention and Mental Health, provided an update on the Government’s response to the Independent Inquiry into the Issues raised by Paterson.[1] Here, Patient Safety Learning reflects on this statement and the need for the Government to urgently prioritise providing a full response to the Inquiry’s findings.
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News ArticleMinisters have been accused of “knowingly exposing” NHS and private patients to safety risks after delaying again a full response to the inquiry into the Ian Paterson scandal. Victims of rogue surgeon Ian Paterson, who was jailed in 2017 for carrying out unnecessary surgery on patients, told The Independent there was a “clear and present danger” of similar crimes being committed without urgent action being taken. On Tuesday, the government released a partial response to an independent inquiry, led by Reverend Graham James, which reported in February last year. It revealed Paterson was able to carry out unnecessary surgery on more than 1,000 patients over a 14 year period due to a “dysfunctional” health system and the wilful blindness of managers. The government response addressed only three recommendations directly with ministers promising a full response later this year. David Rowland, director at the Centre for Health and the Public Interest criticised the lack of action as the NHS sends more patients to private hospitals in the wake of the coronavirus pandemic. Read full story Source: The Independent, 23 March 2021
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News ArticlePatients with learning disabilities were pushed and dragged across the floor while others had their arms trapped in doors by staff working at a private hospital, the care watchdog has found. The Care Quality Commission said instances of abuse caught on CCTV had now been reported to police and staff working at St John’s House, near Diss in Norfolk, have been suspended. Police have said no further action will be taken. The regulator has rated the home, part of The Priory Group, inadequate and put it into special measures after inspectors found a string of failures at the 49-bed home during an inspection in December. According to the CQC’s report, inspectors reviewed CCTV footage of seven patient safety incidents between August and December last year. This showed “issues such as prolonged use of prone restraint, a patient being dragged across the floor despite attempting to drop their weight, a patient being pushed over and the seclusion room door trapping a patients arm and making contact with a patient’s head when closed”. The report said that although some staff had been suspended the hospital had not reported all the incidents to the police or the local council. It added: “Following CQC raising this as a concern, the provider has now reported incidents to the police, the safeguarding team and has suspended further staff pending investigation.” Read full story Source: The Independent, 5 March 2021
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News ArticleSome NHS dental patients have been asked to pay for private care "if they want any treatment", according to a watchdog. Others are facing waits of up to two years for an NHS appointment, Healthwatch England has warned. One patient was in so much pain he decided to extract his own teeth, said its chairman Sir Robert Francis QC. The NHS said over 650 urgent dental hubs have been set up so patients can access a dentist. Hundreds of people contacted Healthwatch England between October and December last year complaining about dentistry issues. A briefing document from the watchdog said that "a lack of NHS dentist appointments" remains the most common issue - with people asked to wait for up to two years. Read full story Source: BBC News, 8 February 2021
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Content Article
Are agency healthcare practitioners adequately covered to work in private hospitals?
Anonymous posted an article in Occupational health and safety
I would like to share with you my experience of an injury I sustained when working as an agency nurse doing bank shifts in a private hospital and highlight to colleagues the importance of knowing your entitlements when working for an Agency. Please make sure you are adequately covered for injury. -
News Article‘Surge’ clauses allowing the NHS to again take over private hospitals — as it did in the spring — have been triggered in some areas, HSJ has learned. An email from NHS England to private hospitals in London, seen by HSJ, was sent last week, triggered a seven-day notice period under NHSE’ covid contracts with the providers. The letter said the London region had requested the move after taking into account “critical care capacity, the doubling rate [and the] forecast acute admission rate related to local prevalence.” The letter refers to the north central London health system, but HSJ understands similar arrangements have been triggered for north east London. The two areas have a combined population of 3.9m people and have been some of the hardest hit by covid admissions. The clause is also thought to have been triggered in other parts of south east England, but it is not known which ones. The letter listed six hospitals, five owned by BMI Healthcare and one by Aspen Healthcare, which would, from Friday, commit “100 per cent” of their capacity to NHS use. Read full story (paywalled) Source: HSJ, 20 January 2021
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Content Article
Fatigue and alertness: Keeping the rail industry alert
Patient Safety Learning posted an article in Techniques
Whether you work in an office or on the front line, drive your car home from work or a train full of passengers, you need to be awake and alert to do your job safely and efficiently. Managing fatigue is everybody’s responsibility. RSSB's aim is to make sure that everyone, at all levels, understands their role in managing fatigue. Based on their research and consultation with the rail industry, RSSB have put together a range of resources to help with this. -
News ArticlePrivate hospitals are ‘pushing back’ on requests from NHS trusts to send them more NHS patients, following a change to the national contract with the independent sector, and amid high pressure from COVID-19. Manchester University Foundation Trust, one of the largest NHS providers, has reported difficulties in accessing capacity at its local Spire, BMI and Ramsay hospitals this month. It comes as the NHS is facing “unthinkable” pressures from coronavirus patients, with dozens of hospitals on the brink of being overwhelmed. Throughout most of 2020, the bulk of private providers in England were on a national block contract whereby the NHS could use as much capacity as it needed. But a new contract, agreed with oversight from the Treasury last month, is now in place between January and April, and only offers trusts a minimum volume of activity which equates to activity provided in October and November. Pressures on the NHS have since intensified to unprecedented levels, with many areas now in far greater need of the private capacity than they were two months ago. And there appears to be a misunderstanding or lack of clarity in some areas about the extent to which they can now call on private capacity. Read full story (paywalled) Source: HSJ, 13 January 2021
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News Article
Cancer care under threat as NHS loses covid private sector back-up
Patient Safety Learning posted a news article in News
Cancer surgery in London is under threat as rising covid admissions put pressure on services that no longer have back-up capacity from the independent sector, HSJ has learned. Research by HSJ has discovered that NHS England ended contracts with HCA, The London Clinic and the Cromwell Hospital at the end of August, after concerns about underutilisation. Under the previous deal with the private sector, rules were in place to make sure low-priority private patients were not treated ahead of NHS patients who needed surgery urgently. HCA and The Cromwell have confirmed the contracts were ended in August and were not renewed. The London Clinic did not respond to a request for comment. As of 19 December, there were 2,909 covid inpatients being treated in London hospitals, a rise of 39% over the previous seven days. Barts Health Trust and Barking, Havering and Redbridge University Trust in the east of the city are under particular pressure. Should the number of covid patients reach a level that requires the capital to instigate surge protocols, theatre space set aside for cancer operations is likely to be commandeered. Under this scenario, the NHS in the capital would no longer have the option to transfer cancer patients to private facilities as it did during the first wave of the pandemic. A senior London-based source said: “This is a real and imminent threat to London’s ability to perform cancer surgery." Read full story (paywalled) Source: HSJ, 21 December 2020 -
News ArticleBBC News investigation has uncovered failures in the diagnosis of serious medical issues during private baby scans. More than 200 studios across the UK now sell ultrasound scans, with hundreds of thousands being carried out each year. But the BBC has found evidence of women not being told about serious conditions and abnormalities. The Care Quality Commission says there is good quality care in the industry but it has a "growing concern". Private baby scanning studios offer a variety of services. Some diagnose medical issues while others market themselves as providers of souvenir images or video of the ultrasound. Most sell packages providing a "reassurance scan" to expectant mums. Many women BBC News spoke to said they had positive experiences at private studios, but we have also learned of instances where women said they were failed. Charlotte, from Manchester, attended a scan in Salford with one of the biggest franchises, Window to the Womb, to record her baby's sex for a party and check its wellbeing. BBC News has learned the sonographer identified a serious abnormality that meant the baby could not survive, where part or all of its head is missing, called anencephaly. But rather than refer her immediately to hospital and provide a medical report, Charlotte was told the baby's head could not be fully seen and recommended to book an NHS anomaly scan. She was also given a gender reveal cannon and a teddy bear containing a recording of its heartbeat as a present for her daughter. "I was distraught," Charlotte said. "You've bonded with that baby." "It's like a deep cut feeling," she added. "All of it could have just been avoided, we could have processed the news all together as a family because I was with my mum and dad, I would have had the support there." Read full story Source: BBC News, 18 November 2020
