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News Article
Physician associates told they must not call themselves doctors
Patient Safety Learning posted a news article in News
Staff without medical training who fill gaps in the NHS workforce must tell patients they are “not a doctor” when introducing themselves, under new guidance. The advice has been issued to “physician associates” (PAs), a type of clinical role that requires less training than doctors receive, amid a row over their use in the NHS. PAs complete a two-year postgraduate qualification, but no medical degree, and can diagnose and treat patients. They can work in A&E or GP surgeries. NHS England has set out plans to expand the number of PAs to deal with staff shortages, with a workforce of 10,000 PAs wanted over the next decade. The plan has been met with opposition from doctors’ leaders, who say the growing use of PAs instead of fully qualified doctors is leading to missed diagnoses and deaths. Guidance published by the Faculty of Physician Associates, a part of the Royal College of Physicians, said that PAs must not mislead patients into thinking they are doctors. Read full story (paywalled) Source: The Times, 6 October 2023 -
Content ArticlePhysician associates (PAs) are healthcare professionals who work as part of a multidisciplinary team under the supervision of a named senior doctor (a General Medical Council (GMC)-registered consultant or GP). While they are not medical doctors, PAs can assess, diagnose and treat patients in primary, secondary and community care environments within their scope of practice. PAs are part of NHS England’s medical associate professions (MAPs) workforce grouping. MAPs add to the breadth of skills within multidisciplinary teams, to help meet the needs of patients and enable more care to be delivered in clinical settings. PAs do not fall under the allied health professions (AHPs) or advanced practice groups. The Faculty of Physician Associates has created this guidance to provide clarity around the role of PAs. It provides practical examples of how physician associates should describe their role and is aimed at increasing understanding for patients, employers, other healthcare professionals and the public. It is important that PAs take all reasonable steps to inform patients and staff of their role and to avoid confusion of roles. This includes considering the potential for verbal and written role titles to be misunderstood and taking the time to explain their role in any clinical interaction.
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News Article
Strikes now endangering heart and cancer patients, NHSE warns BMA
Patient Safety Learning posted a news article in News
The impact of successive doctors’ strikes is now ‘causing significant disruption and risk to patients’, including to those needing urgent heart and cancer treatment, NHS England leaders have told the BMA in their strongest warnings yet. A letter to the union’s council chair on Tuesday evening, leaked to HSJ, said: “We are increasingly concerned that the cumulative impact of this action is causing significant disruption and risk to patients… “We are extremely concerned that Christmas Day cover is insufficient to ensure appropriate levels of patient safety are being maintained across local health systems. This is particularly the case in the current period of industrial action, with three consecutive Christmas Day levels of service.” Although Christmas Day includes cover for emergency care, the officials said that in practice – with demand above Christmas Day levels, and with successive days and repeated strikes – it was not protecting patients needing urgent care. The letter, signed by NHSE leaders including chief medical officer Sir Steve Powis, and chief nurse Dame Ruth May, goes on: “Secondly, we are becoming increasingly concerned that combined periods of industrial action are impacting on our ability to manage individuals who require time-sensitive urgent treatment, for example cardiac, cancer or cardiovascular patients, or women needing urgent caesarean sections.” Read full story (paywalled) Source: HSJ, 3 October 2023 -
Content ArticleHarold Pedley, known as Derek, attended his GP surgery during the late afternoon on 21.12.22 and after spending most of that day feeling unwell with symptoms including abdominal pain and vomiting. He was appropriately referred to the hospital and travelled there with his friend after his GP had discussed his case with doctors. Due to a lack of available beds in the assessment unit, Derek needed to remain in the emergency department. Following his arrival at 20.07 hours, doctors were not notified of his attendance. He remained in the emergency department waiting area for almost two hours during which time due to significant pressures faced by the department he was not assessed or spoken to by a medical professional. At 21.59 hours a triage nurse called for him. By then, Derek had been unresponsive for some time and had died, his death confirmed at 22.26 hours. A subsequent post mortem examination revealed he died from the effects of non-survivable extensive small bowel ischaemia caused by a significantly narrowed mesenteric artery. His death was contributed to by heart disease.
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News Article
University Hospitals Birmingham: Half of staff felt bullied
Patient Safety Learning posted a news article in News
More than half of staff at a hospital trust that has been under fire for its "toxic culture" have said they felt bullied or harassed. The findings come from an independent review commissioned by University Hospitals Birmingham (UHB) NHS Trust. It has been at the centre of NHS scrutiny after a culture of fear was uncovered in a BBC Newsnight investigation. UHB has apologised for "unacceptable behaviours". It added it was committed to changing the working environment. Of 2,884 respondents to a staff survey, 53% said they had felt bullied or harassed at work, while only 16% believed their concerns would be taken up by their employer. Many said they were fearful to complain "as they believed it could worsen the situation," the review team found. Read full story Source: BBC News, 27 September 2023 -
News Article
NHS whistleblower tells tribunal he faced ‘brutal retaliatory victimisation’
Patient Safety Learning posted a news article in News
A consultant obstetrician has claimed he was sacked from his hospital for raising whistleblowing concerns about patient safety over fears they would cause “reputational damage”. Martyn Pitman told an employment tribunal in Southampton that managers dismissed his concerns and he was “subjected to brutal retaliatory victimisation” after he criticised senior midwife colleagues. He said: “On a daily basis there was evidence of deteriorating standards of care. We were certain that the situation posed a direct threat to both patients’ safety and staff wellbeing. Concern was expressed that there was a genuine risk that we could start to see avoidable patient disasters.” Rather than addressing these, Pitman said the trust had considered it “the path of least resistance to take out [the] whistleblower”. Pitman was dismissed this year from his job at the Royal Hampshire County hospital (RHCH) in Winchester, where he had worked as a consultant for 20 years. He is claiming he suffered a detriment due to exercising rights under the Public Interest Disclosure Act. He said he “fought against [an] absolute barrage of completely unprofessional assaults on me” after he raised concerns about foetal monitoring problems that resulted in the death of a baby and the delivery of another with severe cerebral palsy. Read full story Source: The Guardian, 26 September 2023- Posted
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News Article
CEO warns of ‘significant increase’ in patient anxiety over doctors’ strikes
Patient Safety Learning posted a news article in News
A trust chief executive has warned of a ‘really significant increase’ in patient anxiety and frustration created by the ongoing doctors’ strikes. Lance McCarthy, the chief executive officer of Princess Alexandra Hospital Trust, made the comments during the most recent four-day junior doctors’ strike, which also coincided with two days of consultant strike action. The trust leader told Hertfordshire and West Essex integrated care board on Friday: “We shouldn’t underestimate the impact industrial action is having.” Mr McCarthy said this impact was not just confined to strike days but also affected the run-up and aftermath of each bout of industrial action. He said every series of strike days caused service disruption for at least another 72 hours. He said: “We are seeing increasing frustration [from] our colleagues around it, because we are constantly duplicating work, cancelling patients, rebooking the same patients, etc. “We are [also] quite understandably starting to see in the last two months a really significant increase in anxiety and concern and frustration from our patients, who took it quite well the first couple of rounds but are understandably really frustrated. It is having a really significant impact.” In a further statement to HSJ, Mr McCarthy reiterated comments that trust staff had noticed an increase in anxiety, concern and frustration among both patients and colleagues in recent months. Read full story (paywalled) Source: HSJ, 25 September 2023 -
Content ArticleThe report from the International Labour Organization describes the results of a special analysis of data from the Labour Force Surveys (LFS) of 56 countries which provided data about health and social care workers in sufficient detail to distinguish between different occupational groups within the workforce. The report covers analyses for 29 countries in Europe and 27 from other regions of the world. This analysis can help to highlight specific occupation groups and countries which are at heightened risk of decent work deficits and demographic imbalances.
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News ArticleSenior doctors say female medics have felt pressured into sexual activity with colleagues. Four women who head up medical royal colleges in Wales have written an open letter describing misogyny, bullying and sexual harassment in the workplace. They told BBC Wales that female staff had been asked for sex by male colleagues while on shift. The Welsh government said: "Harassment and sexual violence is abhorrent and has no place in our NHS." Chairwoman of the Royal College of Psychiatrists in Wales, Dr Maria Atkins, said: "I've heard from multiple women over the years that during night-time shifts, they've been propositioned by male colleagues and felt pressured to engage in sexual acts. "When they've refused they are penalised. "It can be very damaging to some less experienced or younger women, because they will be discouraged from engaging with a team, which might have been the specialty of medicine that they wanted to progress their career in." Read full story Source: BBC News, 22 September 2023
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News ArticleA cancer patient with months to live has spoken of her fear and anger after chemotherapy was delayed by this week’s strikes. Flora White, 51, began chemotherapy last month, which is required fortnightly to shrink a tumour so it can be surgically removed. But it has now been set back, after the appointment she was due to have with her oncologist the day before was cancelled as a result of strikes. Ms White said that until she got the devastating news about her own delays she had thought cancer patients would be protected from the impact of industrial action. “It’s hard to deal with as it is, let alone the extra worry and stress,” she said. “Your treatment being cancelled and delayed, they don’t understand how they’re affecting some people.” Earlier this week, Prof Karol Sikora, a leading consultant oncologist, said it was “against the ethics of medicine” for doctors to strike, as he urged medics to think again. “If you miss cancer and someone goes for another two years without a diagnosis, it’s as good as leaving someone in the gutter bleeding ... people will die,” he said. Read full story (paywalled) Source: The Telegraph, 21 September 2023
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News Article
Fears more doctors’ strikes in England will push NHS ‘close to breaking point’
Patient Safety Learning posted a news article in News
Hospital bosses fear that further strikes by doctors will push the NHS “close to breaking point” as it struggles to cope with its winter crisis in the months ahead. NHS leaders are concerned that medics’ plans to continue their campaign of stoppages until February will make it even harder for the service to manage what is always its toughest period. Four days of strikes this week in England have included the first-ever 24-hour joint strike over pay on Wednesday by consultants and junior doctors. This latest series of stoppages – two days by consultants and three days by junior doctors – has forced hospitals to reschedule many thousands of outpatient appointments and non-urgent operations because of the lack of staff. “Winter pressures, respiratory illness and rising Covid again mean that the next six months will be exceptionally difficult. Winter always is,” said one hospital trust chief executive, who asked not to be named. “The NHS is effective at absorbing pressure but the industrial action may, at times, take us close to breaking point and often patient harm and the impact on NHS staff is not fully recognised,” he said. Read full story Source: The Guardian, 20 September 2023 -
News Article
Strikes caused 22 ‘critical incidents’, government claims
Patient Safety Learning posted a news article in News
The NHS has declared 22 ‘critical incidents’ due to disruption caused by industrial action since December, including having to transfer critical care patients, according to the Department for Health and Social Care. Critical care and gynaecology patients have had to be moved to other hospitals due to staffing shortages, urgent cancer surgery and chemotherapy appointments have had to be rescheduled and urgent surgery on trauma patients “could not go ahead” during critical incidents declared in periods of strike action since December, the Department of Health and Social Care said. There have been strikes by both doctors and Agenda for Change staff over pay during 2023, and Wednesday sees junior doctors and medical consultants strike on the same day for the first time. The DHSC has not previously revealed critical incidents caused by strikes, nor details of them. Trusts typically have different triggers for declaring critical incidents, but they indicate severe strain on services, and it is not unusual for them to happen during high winter pressures. Read full story (paywalled) Source: HSJ, 20 September 2023 -
News ArticleRegulation of managers must not lead to a disbarring process without also introducing ”developmental” and supportive measures, NHS England’s national patient safety director has said. Speaking at HSJ’s Patient Safety Congress, Aidan Fowler was asked whether NHS board members and managers should be regulated, amid calls for this in the wake of the Lucy Letby scandal. He said: “I think there are pros and cons to regulation… What I would say is that you just have to be cautious that you do not lead to a disbarring process without the developmental side of regulation, and the support side of regulation. For staff, to support them to do a good job. “We have seen that there is a gap in patient safety training for boards, which we need to work on, for them to understand and to encourage them to talk about it more. “I think there is a developmental part of regulation, which is really important… in any discussion. I know because we are already having discussions around it. That is a key part to pay attention to.” Read full story (paywalled) Source: HSJ,18 September 2023
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Content Article
The Forgiveness Project
Patient Safety Learning posted an article in Suggest a useful website
The Forgiveness Project shares stories of forgiveness in order to build hope, empathy and understanding. -
News Article
‘Biggest walkout NHS has ever seen’ will put patients at risk, health body warns
Patient Safety Learning posted a news article in News
More patients than ever before will be put at risk when consultants and junior doctors begin the “biggest walkout the NHS has ever seen”, the body that speaks for health trusts has warned. The latest round of industrial action in England, when consultants will strike in a dispute over pay on Tuesday and Wednesday and junior doctors on Wednesday, Thursday and Friday, would force hospitals to cancel a higher number of appointments and operations than ever before, the NHS Confederation revealed. Among the patients who were being placed in the greatest danger were the increasing number of people who have already had their operations cancelled due to strike action, and now face having their rescheduled appointments cancelled again, health officials have warned. That included growing numbers of cancer patients, who were expected to be more affected than in previous rounds of strikes. The government will launch a consultation on Tuesday over plans to impose new regulations on striking doctors and nurses to ensure hospitals provide a minimum level of cover. The regulations, which would cover urgent, emergency and “time-critical” hospital-based health services, would mean that employers could issue a “work notice” compelling doctors and nurses to work during industrial action, in order to maintain “necessary and safe levels of service”. Clinicians who still take industrial action could run the risk of losing their job. Read full story Source: The Guardian, 19 September 2023 -
News Article
Mackey: regulation of NHS managers ‘is coming’
Patient Safety Learning posted a news article in News
A national NHS leader has said regulation of managers ‘is coming’, and the service should ‘just go with it and make it as effective’ as possible. Sir Jim Mackey, national director for elective recovery and the chief executive of Northumbria Healthcare Foundation Trust, also told HSJ that regulation could offer better “protection” for management staff if implemented properly. NHS England is considering additional regulation of NHS management after being asked to “revisit” the idea by health and social care secretary Steve Barclay in the wake of the murder of babies by nurse Lucy Letby at the Countess of Chester Hospital. In an interview with HSJ, Sir Jim said: “Honestly, I think it’s coming. So we just need to go with it and make it as effective as it can be. It’s completely understandable in the current context for politicians and the public to want people in these positions to be regulated.” He continued: “There’s potentially some protection for people in being regulated in an effective way, as well as [being subject to] clear rules, clear processes. If somebody makes an allegation and it’s found to be wrong [and] you’ve been through a thorough regulatory process, it’s going to help you to move on and put it behind you.” Read full story (paywalled) Source: HSJ, 18 September 2023 -
News Article
‘We’ve got no magic fix’ admits director of trust with ‘culture of fear’
Patient Safety Learning posted a news article in News
The deputy leader of a trust rated ‘inadequate’ by a health watchdog four times in the past decade has admitted the necessary changes to its culture may take a further four years. Norfolk and Suffolk Foundation Trust staved off calls to break it up earlier this year after the Care Quality Commission raised its rating from “inadequate” to “requires improvement”. However, it has come under increased scrutiny in recent months after a review found it lost track of patient deaths, and a subsequent BBC Newsnight investigation discovered the report was edited to remove criticism of its leadership. The BBC found earlier drafts removed references to a “culture of fear” highlighted by some staff. Now deputy CEO Cath Byford has addressed growing concerns about the morale of staff working at the organisation, and their ability to speak up, at a meeting of Norfolk County Council’s health overview and scrutiny committee. During the meeting, she revealed the results of an anonymous survey which received 18,000 staff interactions. Most feedback was “not positive” admitted Ms Byford. She said many staff reported bullying and harassment, unfairness, inequality, and nepotism. This was particularly the case in recruitment, with staff feeling jobs were being lined up for certain individuals. Read full story (paywalled) Source: HSJ, 15 September 2023 -
Content Article
The SACCIA approach by Professor Annagret Hannawa
Patient-Safety-Learning posted an article in Culture
Achieving shared interpersonal understanding between healthcare professionals, patients and families is a core patient safety challenge around the world. The SACCIA model promotes safe communication practice amongst healthcare teams and between providers patients. It was developed by Professor Annagret Hannawa, Director of the Center for the Advancement of Healthcare Quality & Safety in Switzerland. The interpersonal processes that are captured in the SACCIA acronym are considered 'safe' because they lead to a shared understanding between all care participants: Sufficiency Accuracy Clarity Contextualization Interpersonal Adaptation The five SACCIA competencies emerged from a communication science analysis of hundreds of critical healthcare incidents. They were identified as common deficient interpersonal processes that often cause and contribute to preventable patient harm and insufficient care. They therefore represent an evidence-based set of core competencies for safe communication, which constitute the vehicle to patient care that is safe, efficient, timely, effective and patient-centred. -
News ArticleThe family of a student who died after hospital staff missed that she had developed sepsis despite a string of warning signs have claimed she was the victim of a “lack of care”, as a coroner ruled there were “gross” failures in her treatment. Staff at Southmead hospital in Bristol failed to carry out the sepsis screening and observations needed to keep 20-year-old Maddy Lawrence safe after she was taken to hospital with a dislocated hip sustained in a rugby tackle. Outside court, the student’s mother, Karen Lawrence, said: “It has been a constant struggle to understand how a healthy, strong and fit 20-year-old could lose her life to sepsis which was allowed to develop under the care of professionals. “Her screams of pain and our pleas for help were merely managed, temporarily quietened with painkillers while the infection progressed unnoticed by hospital staff. “Our daughter was failed by a number of nurses and medical staff; symptoms were ignored, observations were not taken, on one occasion for 16 hours. There was no curiosity, basic tests were not completed even when hospital policy required them. “Maddy herself expressed concern on multiple occasions but her pain was not being taken seriously. As well as failing to fulfil their duty, those nurses and medical staff offered no sympathy, no compassion and little attention. “This failure meant Maddy was not given the chance to beat sepsis. Significant delays in its discovery meant the crucial window for treatment was missed. Maddy did not die due to under-staffing or a lack of money. Her death was the result of a lack of care.” Read full story Source: The Independent, 8 September 2023
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News Article
YouTube starts verifying health workers in the UK
Patient Safety Learning posted a news article in News
YouTube has launched a verification system for healthcare workers in the UK as it battles disinformation online. In 2022, health videos were viewed more than three billion times in the UK alone on the video-sharing platform. Doctors, nurses and psychologists have been applying for the scheme since June and must meet rigorous criteria set by the tech giant to be eligible. Successful applicants will have a badge under their name identifying them as a genuine, licensed healthcare worker. But YouTubers have warned the system is only meant for education purposes, not to replace medical advice from your GP. Vishaal Virani, who leads health content for YouTube, said it was important simply due to the sheer number of people accessing healthcare information on the video-sharing platform. "Whether we like it or not, whether we want it or not, whether the health industry is pushing for it or not, people are accessing health information online," he told the BBC. "We need to do as good a job as possible to bring rigour to the content that they are subsequently consuming when they do start their care journey online." Read full story Source: BBC News, 8 September 2023 -
News Article
Junior doctors and consultants to strike together
Patient Safety Learning posted a news article in News
Junior doctors and consultants in England are to coincide strikes during the autumn in an escalation of the pay dispute with the government. It will be the first time in this dispute they have walked together and comes after junior doctors voted in favour of continuing with strikes. In the British Medical Association ballot 98% voted in favour, giving the union a fresh six-month mandate. Junior doctors have already staged five walkouts this year. They will strike on 20 to 22 September - the first day of which coincides with a walkout by consultants. They will then walkout on 2 to 4 October, which is when consultants will also be striking. When the two groups strike together cover will be provided to staff emergency services as well as a small amount of cover on the wards. Read full story Source: BBC News, 31 August 2023 -
News ArticleMore than half of NHS staff believe bosses would ignore whistleblowers amid fresh concerns hospitals could be covering up potential scandals following the Lucy Letby case. New national figures seen by the The Independent reveal that in the majority of hospitals, most doctors and nurses do not believe their concerns would be acted upon if they were raised with senior managers. It comes after The Independent revealed that NHS bosses accused of ignoring complaints about Letby were the very same people later appointed to act on whistleblower concerns at the hospital where she murdered seven babies and tried to kill six more. Several doctors who worked alongside her during the killing spree say they attempted to raise the alarm with hospital managers – only to have their pleas ignored. They believe the lack of action by bosses resulted in more babies being killed, stating managers who failed to act were “grossly negligent” and “facilitated a mass murderer”. In nearly three-quarters of general hospitals – such as the Countess of Chester where Letby worked – fewer than half of staff believed their trust would act on a concern, according to results from the latest NHS staff survey. Read full story Source: The Independent, 27 August 2023
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Content ArticleFollowing the Lucy Letby case, letters to the Times discuss workplace rights and safety in hospitals. Keith Conradi, former chief investigator, Healthcare Safety Investigation Branch, highlights a current NHS workforce too frightened to raise safety concerns, working in a toxic and bullying culture, where the predominance of HR approaches undermine the culture of safety. And Andrew Harris, professor of coronial law, William Harvey Research Institute, Queen Marys University London, writes that there is a duty on medical practitioners to report the circumstances of a death and not to limit disclosure to avoid investigation. In his letter he questions whether medical examiners across the country are acting independently of their trusts and properly notifying such cases.
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Content ArticleIn the early 21st century, the patient safety movement began to talk about system safety. Recognising that people are inherently fallible, advocates for patient safety proposed that it was wrong to blame individual clinicians for poorly designed systems that were full of error traps. However, in a 2013 BMJ editorial, Kaveh G Shojania and Mary Dixon-Woods argue that we must also take seriously the performance and behaviours of individual clinicians if we are to make healthcare safer for patients. They draw on research showing that ‘bad apples’—individuals who repeatedly display incompetent or grossly unprofessional behaviours—clearly exist. This is never more evident than today, when we read about the conviction of nurse Lucy Letby.
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Content ArticleThe Maternity Survey 2022, run by Ipsos on behalf of the Care Quality Commission, looked at the experiences of women and other pregnant people who had a live birth in early 2022. In this article Anita Jefferson from Ipsos looks at the results of this and considers what they tell us about experiences of maternity services.
