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Content Article
Can the NHS live with Covid? (Independent, 3 May 2022)
Patient Safety Learning posted an article in Exit strategies
Across the NHS, from routine care to emergency treatment, health leaders tell Rebecca Thomas in this special Independent report that pressure brought on by the pandemic has become unsustainable – with patients’ lives on the line as a result -
News Article
Respiratory syncytial virus kills 100,000 under-fives every year
Patient Safety Learning posted a news article in News
Respiratory syncytial virus is killing 100,000 children under the age of five every year worldwide, new figures reveal as experts say the global easing of coronavirus restrictions is causing a surge in cases. RSV is the most common cause of acute lower respiratory infection in young children. It spreads easily via coughing and sneezing. There is no vaccine or specific treatment. RSV-attributable acute lower respiratory infections led to more than 100,000 deaths of children under five in 2019, according to figures published in the Lancet. Of those, more than 45,000 were under six months old, the first-of-its-kind study found. More children are likely to be affected by RSV in the future, experts believe, because masks and lockdowns have robbed children of natural immunity against a range of common viruses, including RSV. “RSV is the predominant cause of acute lower respiratory infection in young children and our updated estimates reveal that children six months and younger are particularly vulnerable, especially with cases surging as Covid-19 restrictions are easing around the world,” said the study’s co-author, Harish Nair of the University of Edinburgh. “The majority of the young children born in the last two years have never been exposed to RSV (and therefore have no immunity against this virus).” Read full story Source: The Guardian, 19 May 2022 -
News Article
Sharp rise in child development issues in wake of covid
Patient Safety Learning posted a news article in News
Families are being ‘left without the support they need’, as overstretched services struggle to handle ‘a significant and growing minority’ of children not developing as expected. Figures published by the Office for Health Improvement and Disparities earlier this month show 79.6% of children who received a two-to-two-and-a-half year review with an ages and stages questionnaire during quarter three of 2021-22 met the expected level in all five areas of development measured. The five areas assessed by the screening questionnaire are communication skills, gross motor skills, fine motor skills, problem solving, and personal-social. A lower-than-expected score in any of the five areas will likely mean some sort of intervention, which may include further monitoring from health visitors or referral to a specialist service. However, health visitor numbers are declining. ber 2015. Alison Morton, Institute of Health Visiting executive director, said: “The latest national child development data highlight a worrying picture with fewer children at or above the expected level of development at two-to-two-and-a-half years. While the majority of children are developing as expected, a significant and growing minority are not. “The pandemic and its impacts are not over. In many areas, despite health visitors’ best efforts, they are now struggling to meet growing levels of need and vulnerability and a backlog of children who need support. In our survey, health visitors reported soaring rates of domestic abuse, mental health problems, child behaviour and development problems, poverty, and child safeguarding. “In addition, onward referral services like speech and language therapy, and mental health services, also have long waiting lists and families are left without the support that they need.” Read full story Source: HSJ, 16 May 2022 -
Content ArticleThe impact of COVID-19 on mortality can be broadly split into three categories: direct impacts; indirect impacts; and wider social and economic impacts. Indirect impacts represent excess deaths due to stresses on the health system or changes in the health-seeking behaviour of individuals. These are the focus of this bulletin from the COVID-19 Actuaries Response Group. At this stage of the pandemic, the mortality impacts are shifting from direct to indirect. Analysing emerging data can help to identify the magnitude of these impacts and the extent to which they are asymmetric across the population. If care pathways do not rapidly return to pre-pandemic levels, then the COVID-19 pandemic will affect the standard of healthcare, morbidity and mortality across the UK for years to come.
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News Article
US faces deficit of 450,000 nurses by 2025
Patient Safety Learning posted a news article in News
The United States could see a deficit of 200,000 to 450,000 registered nurses available for direct patient care by 2025, a 10 to 20% gap that places great demand on the nurse graduate pipeline over the next three years. The new estimates and analysis come from a McKinsey report published this week. The shortfall range of 200,000 to 450,000 holds if there are no changes in current care delivery models. The consulting firm estimates that for every 1% of nurses who leave direct patient care, the shortage worsens by about 30,000 nurses. To make up for the 10 to 20%, the United States would need to more than double the number of new graduates entering and staying in the nursing workforce every year for the next three years straight. For this to occur, the number of nurse educators would also need to increase. "Even if there was a huge increase in high school or college students seeking nursing careers, they would likely run into a block: There are not enough spots in nursing schools, and there are not enough educators, clinical rotation spots or mentors for the next generation of nurses," the analysis states. "Progress may depend on creating attractive situations for nurse educators, a role traditionally plagued with shortages." Read full story Source: Becker's Hospital Review, 12 May 2022 -
Content ArticleAnalysis suggests potential instability and workforce gaps in the US healthcare sector. A call to action for all stakeholders could help. COVID-19 has altered many US nurses’ career plans. Over the past two years, McKinsey has found that nurses consistently, and increasingly, report planning to leave the workforce at higher rates compared with the past decade. Even as COVID-19 cases fluctuate, US healthcare providers are still experiencing the workforce and operational challenges exacerbated by the pandemic. Patient demand is expected to rise, given the growing and aging population of the United States. Without addressing this potentially wider divide between patient demand and the clinical workforce, with a specific focus on nurses, the US health sector could face substantial repercussions. If no actions are taken, there will likely be more patients in the United States who will need care than nurses available to deliver it. This report from McKinsey& Company provides context for how COVID-19 changed the nursing workforce, the long-term implications for nurses and healthcare stakeholders, and actions to consider to increase the odds of closing the gap. In the last section, it highlights how healthcare providers, federal and state governments, the private sector, the nursing workforce, and broader society could encourage those who are training to be nurses.
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Content Article
This blog is written in time for the WHO's World Immunisation Week. It explores vaccination programmes, in particular that for COVID-19 – it's uptake, both in the UK and globally, and the negative impact the pandemic has had on vaccination programmes for other diseases. -
News ArticleAt least 200,000 people missed out on essential surgery as a result of the Covid-19 pandemic, with many enduring “misery and daily pain” as a result, a conference has heard. Both scheduled and emergency surgery levels dropped by 20% during the pandemic, suggesting there is now significant pent-up demand for treatment, according to the national clinical lead in surgery, Prof Deborah McNamara. Almost 343,000 people are waiting to see a surgeon for the first time, 100,000 of whom have been on a waiting list for more than 18 months, she told the conference on outcomes from the pandemic at the Royal College of Surgeons in Ireland (RCSI). This was only the start of delays for patients, she pointed out, as they have to wait again for their procedure to be carried out. Currently, more than 71,000 patients are waiting for surgery, a fifth of whom have been on the list for more than a year. Long-waiting patients needing complex surgery have been disproportionately affected, she said, as the system focused on treating “quick-win” procedures such as endoscopies. The amount of day-case work carried out by hospitals is back to 84 per cent of 2017 levels, yet complex care remains at only 67 per cent, she pointed out. Patients waiting for surgery were enduring a “huge amount of misery” that remains unquantified, according to Prof McNamara. The pandemic resulted in some positive changes, she said, including shorter hospital stays, a greater role for physician associates and a generational change in the use of IT. However, it also led to greater constriction in the capacity for scheduled surgery, and greater seasonal variations in demand. Read full story Source: The Irish Times, 26 April 2022
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News Article
Fear over high rates of diabetes foot amputations
Patient Safety Learning posted a news article in News
Major differences in the rate of foot amputations for people with diabetes in England are incredibly concerning, patient groups say. Such amputations are a sign patients have not received adequate care, as poorly controlled diabetes increases the risk of foot ulcers and infections. One in 10 areas had "significantly higher rates", government data shows. There was nearly a five-fold difference between the best and worst when taking into account risk factors such as age. The government data - published by the Office for Health Improvement and Disparities - looked at the three years leading up to the pandemic. It is believed up to 80% of foot amputations could be avoided with better care. Diabetes UK said the figures "shined a light on the scale of the crisis facing diabetes care" and it warned access to support was likely to have become worse during the pandemic. A report produced by the charity earlier this month said lives would be needlessly lost because of disruption to services over the past two years. Diabetes UK chief executive Chris Askew said the latest figures were "incredibly concerning". "The majority of these major amputations are preventable, but many people living with diabetes are struggling to access the care they need - and in areas of higher deprivation, people are experiencing worse outcomes. These inequalities must be addressed." Read full story Source: BBC News, 27 April 2022 -
Content Article
HSJ Primer: Breaking point (25 April 2022)
Patient Safety Learning posted an article in Workforce and resources
Recently the Financial Times health and data reports produced an incisive piece showing the world what is all too readily apparent to people in the NHS: bed capacity has been stretched to breaking point. The report said this “calls into question [the NHS’s] ability to meet a commitment to increase non-urgent hospital treatment by 30 per cent above pre-pandemic levels over the next three years”. It also demonstrates the dangerous congestion that is causing ambulances to stack up outside emergency departments and medically fit patients to languish in vital beds past their due time for discharge. This congestion is causing dangerous delays, leading to a rising number of serious incidents in ambulances queuing to get to the front door of the ED. There is doubtless much that can be done inside hospitals to improve efficiency, alleviate bottlenecks and improve patient flow. -
News Article
Families banned from Covid wards during lockdown ‘left with PTSD’
Patient Safety Learning posted a news article in News
Relatives of intensive care Covid patients were left traumatised by being banned from visiting their seriously ill loved ones during the pandemic, a study has found. Researchers found two-thirds of family members of patients in intensive care were still suffering high levels of symptoms of post traumatic stress disorder (PTSD) three months after their relative was admitted. Symptoms of PTSD include flashbacks, nightmares and physical sensations such as pain, sweating, feeling sick or trembling. Before the Covid pandemic, symptoms of PTSD in family members of intensive care patients were between 15 and 30 per cent, depending on the condition. The team from the University of Colorado School of Medicine said visitation restrictions may have inadvertently generated a secondary public health crisis of stress-related disorders in family members of Covid patients. At the height of the pandemic, hospitals across Britain restricted access to patients, with many people forced to say goodbye to dying loved ones over Skype, or behind screens or windows. Even as late as last winter, a Telegraph investigation showed that a quarter of trusts were still imposing restrictions on visitors. The findings suggest that the rates of PTSD may be higher in relatives than in patients. A previous study by Imperial College and the University of Southampton found that only one-third of patients on ventilators suffer symptoms. Read full story (paywalled) Source: The Telegraph, 25 April 2022 -
Content ArticleRemote, at-home patient monitoring was widely used during the Covid-19 pandemic due to lack of hospital beds. This article in JAMA Network looks at the benefits of remote monitoring and how it can be used safely. Studies have shown that the use of remote telemonitoring reduced length of hospitalisation for Covid patients requiring oxygen, and the number of patient visits to emergency departments. The authors look at how the combined use of telehealth, home health and remote monitoring could bring hospital-level–monitoring services to patients in their home, and what barriers need to be overcome to achieve this.
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News Article
Pandemic disrupted routine vaccinations of US kindergarteners
Patient Safety Learning posted a news article in News
Yet another hidden cost of Covid-19 was revealed on Thursday as the Centers for Disease Control and Prevention presented new data showing how the pandemic has dramatically impeded the US effort to vaccinate kids for other diseases. According to the CDC’s report, national vaccine coverage among American children in kindergarten dropped from 95% to below 94% in the past year – which may seem like a small amount but meant 350,000 fewer children were vaccinated against common diseases. “Overall, today’s findings support previous data showing a concerning decline in childhood immunizations that began in March 2020,” Shannon Stokley, the CDC’s immunization services deputy division director, said in a press conference on Thursday. Some of the reasons for the lower vaccination rates included reluctance to schedule appointments, reduced access to them, so-called “provisional” school enrollment, the easing of vaccination requirements for remote learners, fewer parents submitting documents and less time for school nurses to follow up with unvaccinated students. States and schools also told the CDC that there were fewer staff members to assess kindergarten vaccination coverage, and a lower response rate from schools, both due to Covid-19. “The CDC provides vaccines for nearly half of America’s children through the Vaccines for Children program,” Stokley said. “And over the last two years, orders for distribution of routine vaccines are down more than 10% compared to before the Covid-19 pandemic. “We are concerned that missed routine vaccinations could leave children vulnerable to preventable diseases like measles and whooping cough which are extremely dangerous and can be very serious, especially for babies and young children.” Read full story Source: The Guardian, 21 April 2022 -
Content ArticleDiabetes UK are calling on government for a recovery plan to tackle 'devastating’ diabetes care delays – before it’s too late Diabetes is serious and people living with diabetes have been ‘pushed to the back of the queue’ during the coronavirus pandemic and a national recovery plan is needed to support front-line healthcare teams in getting vital services back on track. Diabetes UK warn that despite the tireless efforts of the NHS through the pandemic, many people living with the condition are still struggling to access the care they need, putting them at risk of serious complications, which can lead to premature death. This new report published by Diabetes UK as part of our Diabetes Is Serious campaign, shows the scale of the problem and sets out a series of calls to UK Government to tackle it.
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News ArticleThe prevalence of sexually transmitted diseases (STDs) and deaths from drug overdoses increased in the US over the past two years, showing the pandemic’s effect on public health. “Even in the face of a pandemic, 2.4 million cases of chlamydia, gonorrhoea, and syphilis were reported,” the US Centers for Disease Control and Prevention (CDC) said. STDs declined during the early months of the pandemic in 2020 but then increased rapidly. Cases of gonorrhoea increased by 10% during 2020 compared with 2019. Cases of primary and secondary syphilis increased by 7% and congenital syphilis in newborns increased by 13%.2 New data suggest that primary and secondary syphilis—the most infectious stages of the disease—continued to increase during 2021, the CDC said. Jonathan Mermin, director of CDC’s national centre for HIV, viral hepatitis, STD, and tuberculosis prevention, said, “The unrelenting momentum of the STD epidemic continued even as prevention services were disrupted.” His colleague, Leandro Mena, director of CDC’s division of STD prevention, said, “The pandemic increased awareness of a reality we’ve long known about STDs. Social and economic factors—such as poverty and health insurance status—create barriers, increase health risks, and often result in worse health outcomes for some people.” Another disturbing trend during the pandemic has been the increase of deaths from drug overdoses, especially among teenagers. Just over 100 000 Americans died of drug overdoses during the year to April 2021, according to the CDC’s national centre for health statistics—an increase of 28.5% from the previous year. Read full story Source: BMJ, 19 August 2022
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Content ArticleAfter two years under siege from COVID, many nurses in the United States are reconsidering the profession.
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News Article
Covid disruption to NHS in England wreaks havoc with surgery backlog
Patient Safety Learning posted a news article in News
Operations are being cancelled across England as Covid causes “major disruption” inside the NHS, the country’s top surgeon has said, as doctors and health leaders say the government’s backlog targets look increasingly unachievable. Six million people are on the waiting list for NHS hospital care, including more than 23,000 who have waited more than two years. Boris Johnson said in February that he had launched “the biggest catch-up programme in the history of the health service”, but in the same month he dropped every domestic Covid restriction. Now record-high Covid rates are wreaking havoc with the ability of the NHS to catch up with surgery that was delayed or cancelled before and during the pandemic. More than 28,000 staff are off work every day due to Covid, recent figures show, while more than 20,000 patients are in hospital with Covid, which has dramatically reduced the number of beds and space available for planned surgery patients. “Unfortunately, Covid-19 continues to cause major disruption in the NHS, with high staff absences in recent weeks,” Prof Neil Mortensen, the president of the Royal College of Surgeons of England, told the Guardian. “We have heard that planned surgery is being cancelled again in different parts of the country due to staff being off sick with the virus. This is understandably frustrating for surgical teams who want to help their patients by getting planned surgery up and running again. It’s also very distressing for patients who need a planned operation.” Read full story Source: The Guardian, 14 April 2022 -
EventuntilThe Healthier Nation Index (HNI) is Nuffield Health’s annual survey of the nation’s physical and mental health. The HNI aims to understand how people are feeling, how they are managing their own physical and mental health, and explore some of the factors that are impacting the health of the nation. This session run by Public Policy Projects will explore the findings of the HNI and provide useful insights into the issues policymakers and stakeholders within the health sector should be focusing on as we move on from the pandemic and into the ‘levelling up’ landscape. The findings of this year’s HNI survey show the long-term impact of the pandemic on the nation’s physical and mental health, including how waiting times and the elective care backlog are having a detrimental effect on people’s wellbeing, as well as changing traditional models of healthcare. As we emerge from the pandemic, what lessons can be learned? How can we rebuild the nation’s health? Discussion points 1. What role can prevention and interventions outside the hospital setting play in relieving pressure? The HNI adds to a growing body of evidence which demonstrates that people are finding it difficult to access health services. What role can prevention and interventions outside the hospital setting play in relieving pressure on an overburdened NHS and tackle the elective care backlog? 2. What is the effect of the pandemic on how people use the NHS? What impact are long NHS waiting lists having on mental and physical health? Has the pandemic changed the way that people seek health advice and access healthcare? 3. How can we address health inequalities? How can we widen access to healthcare? Are the ‘Levelling Up’ health missions the right ones to improve the health of under-served populations? 4. What are the opportunities of Integrated Care Systems and Partnerships? As the fledgling bodies are brought into statutory footing in July 2022, what should the new structures be focusing on? Register for this webinar
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News Article
This Easter will be worse than any winter for the NHS
Patient Safety Learning posted a news article in News
Two years ago the first wave of the covid pandemic reached its peak. The NHS had reacted with impressive speed to prepare for an influx of patients with an infectious disease that few knew much about, had no cure for, and for which there was no known vaccine. However, now the NHS goes into the Easter break in a more fragile state than in any previous winter since, at least, the 1990s. This is not just the direct result of covid hospitalisation, of course – although the distracting narrative of ‘with rather than because of covid’ has obscured how hugely damaging any kind of infectious disease that is as widespread in the community as covid is now can be to effective hospital care. For someone who has just undergone an operation, for example, the greatest threat is not from catching covid itself, but from the impact the virus may have on how quickly their wound may heal. Perhaps covid’s greatest continuing impact is on growing staff absences and the pernicious impact it is having on the long-term health of those who had the disease – even in some cases where it has been relatively mild. For the tens of thousands who have been hospitalised with covid, the consequences for their long-term health look more serious every day. Much of this new workload is ending up at the doors of primary and community care – and displacing other needs and services just when they are most required after two years of coping with the pandemic. There is usually one thing you can confidently say about the NHS, which is that in any crisis it will make sure the life-saving decisions are made on time. However, in the South West, and probably other regions too, that is not happening. People are dying because the NHS cannot – despite its best efforts – save them. Read full story (paywalled) Source: HSJ, 8 April 2022 -
News Article
Swamped NHS mental health services turning away children, say GPs
Patient Safety Learning posted a news article in News
Children and young people who are anxious, depressed or are self-harming are being denied help from swamped NHS child and adolescent mental health services, GPs have revealed. Even under-18s with an eating disorder or psychosis are being refused care by overstretched CAMHS services, which insist that they are not sick enough to warrant treatment. In one case, a crisis CAMHS team in Wales would not immediately assess the mental health of an actively suicidal child who had been stopped from jumping off a building earlier the same day unless the GP made a written referral. In another, a CAMHS service in eastern England declined to take on a 12-year-old boy found with a ligature in his room because the lack of any marks on his neck meant its referral criteria had not been met. The shocking state of CAMHS care is laid bare in a survey for the youth mental health charity stem4 of 1,001 GPs across the UK who have sought urgent help for under-18s who are struggling mentally. CAMHS teams, already unable to cope with the rising need for treatment before Covid struck, have become even more overloaded because of the pandemic’s impact on youth mental health. Mental health experts say young people’s widespread inability to access CAMHS care is leading to their already fragile mental health deteriorating even further and then self-harming, dropping out of school, feeling uncared for and having to seek help at A&E. “As a clinician it is particularly worrying that children and young people with psychosis, eating disorders and even those who have just tried to take their own life are condemned to such long waits”, said Dr Nihara Krause, a consultant clinical psychologist who specialises in treating children and young people and who is the founder of stem4. “It is truly shocking to learn from this survey of GPs’ experiences of dealing with CAMHS services that so many vulnerable young people in desperate need of urgent help with their mental health are being forced to wait for so long – up to two years – for care they need immediately. Read full story Source: The Guardian, 3 April 2022 -
Content ArticleThis Health Foundation long read explores how the NHS in England can better use routine health data to help address current challenges, including winter pressures, the ongoing coronavirus response and the growing elective care backlog. It examines the longstanding barriers to widespread use of data and data science, consider what actions might help to overcome these, and explore whether the data strategy for health and social care will deliver the change needed.
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Content ArticleSweden was well equipped to prevent the pandemic of COVID-19 from becoming serious. Over 280 years of collaboration between political bodies, authorities, and the scientific community had yielded many successes in preventive medicine. Sweden’s population is literate and has a high level of trust in authorities and those in power. During 2020, however, Sweden had ten times higher COVID-19 death rates compared with neighbouring Norway. In this report, Nele Brusselaers et al. try to understand why, using a narrative approach to evaluate the Swedish COVID-19 policy and the role of scientific evidence and integrity. We argue that that scientific methodology was not followed by the major figures in the acting authorities—or the responsible politicians—with alternative narratives being considered as valid, resulting in arbitrary policy decisions.
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News Article
‘Disproportionate’ infection control holding back electives, say NHS bosses
Patient Safety Learning posted a news article in News
Infection control rules in hospitals are ‘now disproportionate to the risks’ posed by covid and should be relaxed, some of the NHS’s most senior leaders have warned. The government rules – such as not allowing covid-positive staff to work, and separating out services for covid, non-covid and covid-contact patients – make a big dent in hospital capacity and slows down services. Glen Burley, who is chief executive of three Midlands trusts and involved in national-level discussions on elective matters, told HSJ: “Pretty much every pathway has a covid and non-covid route, which slows down flow and staff productivity. “There is a growing argument that these rules are now disproportionate to the risks. With covid cases in the community also rising now, we may have to question again the relative risks of continuing to isolate staff.” NHS Confederation director of policy Layla McCay told HSJ: “Healthcare leaders are concerned the current [IPC] measures are having a serious knock-on effect on capacity and that the measures in their current form are reducing efficiency and capacity within healthcare settings. “We need more clarity on if and how current measures can be safely adjusted so [the NHS] can further increase bed capacity and patient throughput, as well as the ability to transport patients more quickly and efficiently.” But NHS Providers, which has previously said relaxing the IPC guidance would not enable a “rapid” increase in the NHS’ capacity to tackle the elective care backlog and could pose significant “risks”, remains more cautious. Read full story (paywalled) Source: HSJ, 21 March 2022 -
Content ArticleThis is the report and formal minutes of a House of Commons Public Accounts Committee session that examined the issues surrounding NHS backlogs and waiting times in England. The session particularly focused on accountability in how NHS England and the Department for Health and Social Care manage workforce and resources. At the end of December 2021, 6.07 million patients were waiting for elective care, the biggest waiting list since records began. Only 64% (3.87 million) of these patients had been waiting for less than 18 weeks, compared with the performance standard which requires 92% to have been waiting for less than 18 weeks. Similarly, in December 2021, only 67% of patients with an urgent referral for suspected cancer were treated within 62 days compared with a requirement for 85% to be treated within that time. The report highlights that although the Covid-19 pandemic had a significant effect on the backlog, NHS waiting time performance had declined steadily in the years before the pandemic.
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Content ArticleRecovering services from the covid crisis is the big task for NHS leaders for the foreseeable future. HSJ's Recovery Watch newsletter tracks prospects and progress. This week HSJ bureau chief and performance lead James Illman discusses virtual wards and why staffing pressures are ‘likely to be under-estimated’ and are a patient safety risk.
