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A woman with dementia was effectively left housebound for the last eight years of her life due to surgical delays, an investigation found. The Public Services Ombudsman for Wales said the individual worried about being "caught short" due to incontinence and it affected her family relationships. Her son complained about the care she received at Glan Clwyd Hospital in Denbighshire, in particular. Betsi Cadwaladr University Health Board has since apologised to the family. Ombudsman Nick Bennett said it was clear there was "significant injustice" in the case of the individual, who was identified in the report findings as Mrs B. The patient's son complained there had been surgical delays for a rectal prolapse issue dating back to 2011, concerns over inpatient medical care provided by an elderly care consultant, and a delayed diagnosis of terminal ovarian cancer during a hospital stay. The ombudsman found that clinical decision-making by colorectal surgeons "was not in keeping with accepted clinical practice". Read full story Source: BBC News, 2 March 2021

Hospitals across London are racing to tackle a backlog of tens of thousands of urgent operations that need to be carried out in the coming weeks to prevent patients dying or losing limbs, The Independent has learnt. The slow decline in Covid patient numbers means many hospitals across the capital are warning they will still be relying on extra staff, and “surge” beds opened at the height of the crisis, well into March. NHS bosses have been briefed that across the city there are about 15,000 priority two (P2) patients. These are classed as needing urgent surgery, including for cancer, within 28 days, or they could die or be at risk of losing a limb. But the lack of available operating theatres, nurses and anaesthetists mean the city has a shortfall of more than 500 half-day surgical lists a week. The Independent has spoken with multiple NHS insiders and seen briefing documents detailing the challenges facing the capital’s hospitals, which are expected to last up to 21 March in some areas. One briefing warned: “Hospitals have insufficient capacity to meet urgent elective demand for P2. P2 demand is intended to be seen within 28 days, the surge has occurred for over 28 days. Patients who would normally have been seen are waiting longer than clinically advisable." Read full story Source: The Independent, 25 February 2021

The Care Quality Commission has ordered immediate improvements to a trust after it reported six never events inside eight months. The watchdog has issued a warning notice to Royal Cornwall Hospitals Trust after it carried out an announced inspection which focused on the trust’s surgical care group – where six never events had occurred between February and October last year. In November, HSJ reported that a total of eight never events had been recorded in 2020, with trust chief executive Kate Shields saying it had raised fears the trust had not fully embedded safety improvements initiated as part of the special measures regime. The inspectors visited three of the trust’s sites where the never events had happened. These were: Royal Cornwall Hospital in Truro, St Michael’s Hospital in Hayle and West Cornwall Hospital in Penzance. The inspectors reported that governance processes were “not effective enough” to ensure that changes were made across the trust, and that lessons from incidents and near misses were “not shared with the whole team and wider service to ensure patient safety”. Their report also stated the trust’s safety checklist for surgical procedures had improved but was not fully compliant with the World Health Organisation’s standards. However, the CQC found staff apologised and provided patients with information when things had gone wrong, and that there was an open culture in which staff felt able to raise concerns. Read full story (paywalled) Source: HSJ, 17 February 2021

More than 100,000 people were waiting for ‘urgent’ priority two operations in late January, as planned care rates plummeted amid the covid third wave, according to NHS data seen by HSJ. However, the rate of elective procedures carried out last month appears to have been a lot higher than in the spring wave of coronavirus, despite there being more covid patients in hospital this time. In the three weeks to 20 December, the NHS was reporting around 110,000 day cases and 18,000 planned overnight admissions each week. But during January these totals dropped to around 85,000 day cases and 10,000 planned overnight admissions per week. This equates to a reduction of 23% and 44%, respectively. Regions that were more severely impacted by the third wave of coronavirus saw steeper reductions as covid pressures forced staff working in routine care services to be redeployed. In London and the South East, day case activity reduced by around 40% between the same periods, while elective overnight admissions fell by around 57%. Read full story (paywalled) Source: HSJ, 10 February 2021

Patients are missing out on potentially life-saving organ transplant surgery because hospital intensive care beds are filled by coronavirus patients, The Independent has learnt. Major organ transplant centres in London, as well as the Queen Elizabeth Hospital in Birmingham and Addenbrooke’s Hospital in Cambridge, have been forced to close their doors to transplant cases because of a lack of beds, the increased risk to patients, and the need to redeploy doctors and nurses to the coronavirus front line. The impact on organ transplant services follows hundreds of urgent cancer operations being delayed in London and across the country, as NHS trusts run out of spare beds to treat non-Covid patients. Most routine operations have also been stopped in the hardest-hit areas. Teacher Shona McFadyen was diagnosed with liver cancer in December 2018 and needs an urgent liver transplant at the Queen Elizabeth Hospital in Birmingham. She has already waited 22 months for her surgery. She told The Independent: “It’s not the hospital’s fault. I get that. But it just adds to the feeling of hopelessness and it feels like as patients we have been forgotten about. It is life and death for us.” Read full story Source: The Independent, 13 January 2021

A team of world-leading medical experts have collaborated to improve patient safety and outcomes following high-risk surgery. The endeavour, which includes industry specialists such as anaesthetists, surgeons, and patient representatives, is called the Improving Patient Outcomes (ImPrOve) Think Tank. The ImPrOve team has recently published its European report that highlights and looks to address a severe patient safety and health issue in which death and serious complication rates in the 30-days following high-risk surgery are alarmingly high. The insightful report outlines an array of practices and innovations in the health sector that can improve patient safety and outcomes. These include calling for better physician training on the latest guidelines, funding for modern digital monitoring, utilisation of data from current technologies in health policies, and the right for patients to be involved in the discussion of the management of their procedure. Perils of high-risk surgery Around 2.4 million patients undergo high-risk surgery annually in Europe alone, with UK evidence indicating that 80% of postoperative deaths occur in a 10% sub-population of high-risk patients. If this startling trend continues throughout Europe, it is estimated that a staggering 192,000 people will die within the 30-day period following their surgery, demonstrating the immense dangers posed to patient safety and outcomes. There is an array of challenges during high-risk surgery; however, the ImPrOve Think Tank believes that potentially the most alarming complication is haemodynamic instability, which manifests as drops in blood pressure (known as IOH). Mitigating risks and increasing patient safety Professor Olivier Huet, the ImPrOve Chair and Professor of Anaesthesia and Intensive Care Medicine, said: “Our mission is to work collaboratively with patient representatives, clinicians and policymakers to improve perioperative patient safety and experience with the help of advanced haemodynamic monitoring technologies. Full article here Source: Health Europa

Surgical hubs, new technology and innovative ways of working will help tackle waiting lists and treat around 30% more elective care patients by 2023 to 2024. Backed by a new £36 billion investment in health and social care over the next 3 years, ‘doing things differently’ and embracing innovation will be the driving force to get the NHS back on track. The funding will see the NHS deliver an extra 9 million checks, scans and operations for patients across the country, but it’s not enough to simply plug the elective gaps. The NHS will push forward with faster and more streamlined methods of treatments. Surgical hubs already being piloted in a number of locations, including London, are helping fast-track the number of planned operations, including cataract removal, hysterectomies and hip and knee replacements, and will be expanded across the country. Located on existing hospital sites, surgical hubs bring together the skills and resource under one roof while limiting infection risk and providing a COVID-secure environment, with more planned to open in the coming year. The NHS has been trialling a range of new ways of working in 12 areas, backed by £160 million, to accelerate the recovery of services. This includes setting up pop-up clinics so patients can be treated quickly, in person, and discharged closer to home, as well as virtual wards and home assessments to allow patients to receive medical support from the comfort of their home, freeing up beds in hospitals. GP surgeries are using artificial intelligence to help prioritise patients most in need and identify the right level of care and support needed for patients on waiting lists. The latest cancer tests being deployed across the NHS are also helping speed up diagnosis and spot cancer early on. Thanks to the hard work of staff, a quarter of a million people were checked for cancer in June – the second highest number on record – and more than 27,000 people started treatment for cancer in the same period. Professor Steve Powis, NHS England medical director, said: "Although the pandemic is still with us and we will have to live with the impact of COVID for some time, the NHS has already made effective use of additional resources to recover services. From adopting the latest technologies to more evening and weekend working, NHS staff are going to great lengths to increase the number of operations carried out. The further funding announced this week will support staff to deliver millions more vital checks, tests and operations, so if you have a health concern, please do come forward to receive the care and treatment you may need." Read full story Source: 8 September, Department of Health and Social Care

A hospital in Yorkshire has suspended all routine inpatient surgeries amid overcrowding in A&E caused by a lack of beds. Staff at the Mid Yorkshire Hospitals NHS Trust were told in an email that this had been a "critical issue for too long." “It is with regret that this decision has had to be made given that it will result in less patients receiving surgical treatment, slowing down our progress on reducing waiting times. However, the extreme pressure on beds has to be reduced and quickly. The trust consistently has between 25 and 50 patients waiting for a bed at any one time at Pinderfields emergency department, causing serious overcrowding and long delays [and] contributing to an unacceptable patient and staff experience.” Martin Barkley, chief executive of the trust, told staff. Read full story. Source: The Independent, 14 August 2021

NHS Blood and Transplant have estimated that almost 7,000 people are waiting for lifesaving transplants in the UK, the highest number in six years. During the first peak of the pandemic last year, several key services have had to be closed reveals the analysis from April 2020 to March 2021, although most were rapidly reinstated and 80% of NHS transplant work went ahead. Figures from the report found 474 patients died while waiting for organs, a higher number than the year before and the majority of patients were waiting for kidney transplants. Read full story. Source: BBC News, 15 July 2021

A new study has been published focusing on surgical innovation and how it could be made safer. The research set out to develop a 'core outcome set', an agreed minimum set of outcomes to measure and report for safe surgical techniques in all audits, research, and clinical practice. The study, co-led by Dr Kerry Avery, a Senior Lecturer at the University of Bristol and NIHR Bristol Biomedical Research Centre (BRC) has said "It may surprise many people to learn that surgical procedures haven’t traditionally been subject to the kind of regulation we see in other areas of medicine. But to ensure safety and improve efficiency, a core outcome set is an important step". Read full story. Source: University of Bristol, 13 July 2021

Millions of people may be affected for years to come by the disruption to surgery across England and Wales, possibly for many years ahead. It has been reported that hospitals have performed around 1.5 million fewer surgeries which may also be in part because people have not attended for their operation or treatment. Those who have not come forward for their surgeries or treatments it had been found, could be due to fear of contracting COVID-19, or that there were fewer accidents that caused significant injury requiring surgery. Findings showed surgeries that involved gall bladders, burn reconstructions and hip and knee replacements were among those that experienced the shortest fall. Read full story Source: BBC News, 18 June 2021

Surgeons are calling for specialist hubs in England to help tackle what they call a "colossal backlog" of non-urgent operations because of COVID-19. The Royal College of Surgeons (RCS) wants a network of hospital sites focused on routine surgery, such as hip and knee replacements. The government says it is working "to accelerate the recovery of services". In March, around five million patients were waiting for surgery - the highest number since modern records began. Prof Neil Mortensen, president of the RCS, said the pandemic has had a devastating impact on surgical services - and that it must not be allowed to happen again. "Surgery must be available on the NHS all year round, not stop and start," he said, adding that a "New Deal for Surgery" was required to help weather future pandemics. If a dangerous new variant of COVID-19 takes hold, or another bad flu arrives in the autumn, we cannot allow surgery to grind to a halt again or waiting lists will become insurmountable." Read full story Source: BBC News, 28 May 2021

“Human error” resulted in a man having the wrong leg amputated at a major Austrian hospital. The error occurred when a healthcare employee marked the wrong leg for amputation during pre-surgical procedures. The mistake was not noticed anytime during the surgery, or even during the immediate postoperative period. It was recognised during a routine wound dressing change, about 48 hours postoperatively. “A disastrous combination of circumstances led to the patient’s right leg being amputated instead of his left,” the hospital’s statement said. “We would also like to affirm that we will be doing everything to unravel the case, to investigate all internal processes and critically analyze them. Any necessary steps will immediately be taken.” Read full story Source: Lansing Injury Law News, 24 May 2021

NHS England has asked hospitals to prepare for a potential further surge of covid cases reaching around half the level of first wave of the virus last year – and to seek to deliver 80% of normal elective activity throughout it, HSJ has learned. Well-placed sources said NHSE officials have held meetings in recent weeks discussing the possibility of a fourth wave of covid later this year, which modelling suggests could see up to 50% of the patient numbers seen in April last year. Trusts have been asked by NHSE officials, as part of the planning process, what resources they would need to run at 80 per cent of previous volumes of elective work if this scenario occurred. They are also taking into account that it is likely to come on top of greater non-covid emergency care demand, which has been lower then normal over the past 15 months. Read full story (paywalled) Source: HSJ, 21 May 2021

A new wave of coronavirus infections could throw into jeopardy efforts to clear a backlog of surgery in the NHS, experts have warned. They say the relaxation of Covid restrictions is expected to cause a rise in infections, while at least some resurgence in hospital admissions and deaths is also expected at some point. However, the sharp rise in cases of a variant of concern first discovered in India, B.1.617.2, has caused consternation, with modelling suggesting that if it is as transmissible as some estimates suggest, it could fuel a serious “third wave”. Now experts have said that a new wave of infections may cause further problems, exacerbating what has already been described as “a truly frightening backlog” of care. “We are anticipating that as lockdown is eased that cases are going to go back up slightly, that is with or without the Indian variant,” Dr David Strain, a senior clinical lecturer at the University of Exeter medical school, told the Guardian. “The biggest concern we’ve got is that if these [Covid case] numbers do start to go up, it will put a strain on trying to get other services up and running.” “GPs are crying out under the stress at the moment … we still have people not having their operations: we have had procedures postponed for over 12 months, and we have got longer waiting lists that ever before,” he said. Read full story Source: The Guardian, 20 May 2021