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News Article
Millions of patients 'avoiding calls to GP' during COVID-19 pandemic
Patient Safety Learning posted a news article in News
Four in ten people are not seeking help from their GP because they are afraid to be a burden on the NHS during the pandemic, polling by NHS England reveals. The findings – from a survey of 1,000 people – are the latest in a wave of evidence that fewer people are seeking care for illnesses other than those related to coronavirus during the pandemic. GP online reported on 20 April that data collected by the RCGP showed a 25% reduction in routine clinical activity in general practice, and figures from Public Health England (PHE) and the British Heart Foundation show that A&E attendances overall and patients going to hospital for heart attacks are down 50%. Warnings that patients' reluctance to come forward could put them at risk come as leading charities warned that suspension of some routine GP services during the pandemic could also lead to a 'future crisis' if control of conditions such as asthma and COPD deteriorate. Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges, said: 'We are very concerned that patients may not be accessing the NHS for care because they either don’t want to be a burden or because they are fearful about catching the virus. 'Everyone should know that the NHS is still open for business and it is vitally important that if people have serious conditions or concerns they seek help. This campaign is an important step in ensuring that people are encouraged to get the care they need when they need it.' Read full story Source: GP online, 25 April 2020 -
News ArticleUK medicines agencies have changed their advice on ibuprofen to say that the drug can be used to treat patients with symptoms of COVID-19, although the evidence that prompted the revision has not been made public. The change follows a review by the Commission on Human Medicines’ expert working group on COVID-19 which, along with previous reviews of evidence, concluded that there is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and contracting or worsening of COVID-19. The group’s review has not been published, but prompted the Medicines and Healthcare Products Regulatory Agency (MHRA), NHS England, and the National Institute for Health and Care Excellence (NICE) to update their advice to say that patients can take paracetamol or ibuprofen for symptoms of COVID-19, such as fever and headache. This is a change to NICE’s recommendation on 3 April that paracetamol should be used in preference to NSAIDs for managing fever in patients with suspected COVID-19 until more evidence is available. Read full story Source: BMJ, 17 April 2020
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News Article
Coronavirus: Plasma treatment to be trialled
Patient Safety Learning posted a news article in News
The UK is gearing up to use the blood of coronavirus survivors to treat hospital patients ill with the disease. NHS Blood and Transplant is asking some people who recovered from COVID-19 to donate blood so they can potentially assess the therapy in trials. The hope is that the antibodies they have built up will help to clear the virus in others. The US has already started a major project to study this, involving more than 1,500 hospitals. A statement from the organisation said: "We envisage that this will be initially used in trials as a possible treatment for Covid-19. If fully approved, the trials will investigate whether convalescent plasma transfusions could improve a Covid-19 patient's speed of recovery and chances of survival." "All clinical trials have to follow a rigorous approval process to protect patients and to ensure robust results are generated. We are working closely with the government and all relevant bodies to move through the approvals process as quickly as possible." Read full story Source: BBC News, 20 April 2020 -
News Article
Coronavirus: 'Difficult' cancer care decisions taken
Patient Safety Learning posted a news article in News
Cancer doctors say difficult decisions are having to be made to postpone some patients' care during the coronavirus crisis. Some treatments such as chemotherapy can weaken the immune system, and potentially put patients at greater risk from COVID-19. Some of those affected have been expressing concern. Roisin Pelan is 38 and lives in Lancashire. She has incurable breast cancer and had been taking chemotherapy tablets every day. Every three months she also visits the hospital to receive the drug intravenously. Last month she was told her chemotherapy treatment would be stopped for 12 weeks. "It's terrifying they've stopped treatment that I know is keeping me alive," she says. "To have that taken away is just unbearable. How do we know it's only going to be 12 weeks? This pandemic could go on a lot longer." NHS England has told trusts that all essential and urgent cancer treatments must continue but specialists should discuss with patients whether it is riskier for them to undergo it or delay. Read full story Source: BBC News, 13 April 2020 -
News ArticleDoctors have been reminded not to prioritise coronavirus patients at the expense of others in new ethical guidance backed by royal colleges. There are increasing concerns that patients are not getting treatment for serious problems, including strokes or heart attacks, because they are afraid to go to hospitals. The guidelines were drawn up by the Royal College of Physicians (RCP) amid worries that a shortage of ventilators and beds could force doctors to make difficult decisions on which patients get lifesaving treatment. Read full story (paywalled) Source: The Times, 2 April 2020
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News Article
Coronavirus: 'Frailty score' plan angers special needs parents
Patient Safety Learning posted a news article in News
New guidelines for assessing people with coronavirus who go to hospital were amended after an outcry from parents of children with special needs. The emergency guidelines published by the National Institute for Health and Care Excellence (NICE) are designed to help determine how much treatment a patient will receive. Those deemed "completely dependent for personal care for whatever reason" will be offered end-of-life care rather than restorative treatment. This now excludes people with learning difficulties or cerebral palsy. In a statement NICE said the system was "not perfect" but was designed to support hospital medics "during this very difficult period of intense pressure". "We welcome the recent clarification that the Clinical Frailty Score should not be used in certain groups," it said. The updated guidelines now state that it "may not perform as well in people with stable long-term disability" and suggests that it is not used in those cases. Read full story Source: BBC News, 26 March 2020 -
News Article
Coronavirus: Cancer patient's chemotherapy put on hold
Patient Safety Learning posted a news article in News
A woman with brain cancer has been told her chemotherapy has stopped because of the coronavirus outbreak. Nancy Carter-Bradley, 44, from Hampshire, said the health secretary should ring-fence cancer treatment. She said her treatment at a London hospital had paused as it was at full capacity and oncologists were helping with the response to coronavirus. Imperial College Healthcare NHS Trust said it was "exploring use of private healthcare facilities". Mrs Carter-Bradley, from Penwood, said she had been dealing with "unbelievable stress" since she was informed her chemotherapy at Charing Cross Hospital for stage three brain cancer would be paused. Read full story Source: BBC News, 26 March 2020 -
News Article
Cancer treatment delayed as patient priority lists drawn up
Patient Safety Learning posted a news article in News
Delays have begun to cancer treatments, as patients are reprioritised ahead of capacity becoming overwhelmed by the coronavirus crisis. In three separate developments: A London trust announced it was cancelling chemotherapy and routine cancer operations for a fortnight due to coronavirus pressure; An NHS England covid-19 guidance document indicated palliative care cancer patients will be less likely to receive appropriate treatment; and Cancer waiting times guidance has been changed to provide for some urgent referrals for suspected cancer to be sent back to GPs without diagnosis. Read full story (paywalled) Source: HSJ, 23 March 2020 -
News ArticleSouthampton researchers are trialling an inhaled drug that could prevent worsening of COVID19 in those most at risk. The trial, led by Tom Wilkinson, Professor of Respiratory Medicince in the Faculty of Medicine and a consultant in respiratory medicine at University Hospital Southampton, will involve 100 patients at Southampton and up to ten other NHS hospitals taking part. Those patients will receive the best current COVID19 care, whilst inhaling either a placebo or SNG001, a special formulation of the naturally occurring antiviral protein interferon beta 1a (IFN-β), for 14 days. The trial will be undertaken with Synairgen, a drug development company founded by University of Southampton Professors Stephen Holgate, Donna Davies and Ratko Djukanovic. Professor Wilkinson said, “COVID19 cis presenting a major challenge to vulnerable patients, the health service and wider society whilst a vaccine will be key, that could some time away. Right now we need effective frontline treatments to give doctors the tools to treat the most vulnerable and to help patients recover quickly as the pressure on health systems mounts." Read full story Source: University of Southampton, 18 March 2020
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News Article
Health experts criticise NHS advice to take ibuprofen for Covid-19
Patient Safety Learning posted a news article in News
Experts have criticised NHS advice that people self-isolating with Covid-19 should take ibuprofen, saying there is plausible evidence this could aggravate the condition. The comments came after French authorities warned against taking widely used over the counter anti-inflammatory drugs. The country’s health minister, Olivier Véran, a qualified doctor and neurologist, tweeted on Saturday: “The taking of anti-inflammatories [ibuprofen, cortisone … ] could be a factor in aggravating the infection. In case of fever, take paracetamol. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.” NHS guidance states that people managing Covid-19 symptoms at home should take paracetamol or ibuprofen. “I would advise against that,” said Prof Ian Jones, a virologist at the University of Reading. “There’s good scientific evidence for ibuprofen aggravating the condition or prolonging it. That recommendation needs to be updated.” Read full story Source: The Guardian, 16 March 2020 -
News ArticleAlthough community-based treatment can improve outcomes for people with eating disorders, it must not be at the expense of vital inpatient services, says Lorna Collins in an article today in the Guardian supporting Eating Disorders Awareness Week. No single treatment or approach works for every patient experiencing an eating disorder and it is extremely hard to get help; there is too little money in the system to provide enough care. "Speaking to patients, carers and clinicians, I am struck by the sheer desperation of so many people saying the system has failed them. Too many find that nothing is done until they are at death’s door. Others say no one talks about binge-eating disorder, which is still too often seen as a weakness or a problem that dieting can fix, rather than a real eating disorder," says Lorna. Clinicians, too, paint a gloomy picture of the state of services. Oxford-based eating disorder consultant Agnes Ayton, who chairs the faculty of eating disorders at the Royal College of Psychiatrists, is frank about the problems. She believes NHS eating disorder services are on their knees and desperately need more money after years of austerity. However, there are some encouraging signs. In West Yorkshire and Harrogate, consultant psychiatrist William Rhys Jones, who works for the Connect community and inpatient eating disorders service, says he is seeing real change. Connect’s community outreach teams deliver home-based treatment for people with severe and enduring eating disorders. This is one of the NHSE new care models and Jones says results so far have been very positive. Clinical community services and early intervention result in a good prognosis, he says – and it is cost effective. While inpatient treatment costs about £434 a day, community treatment costs about £20 to £35 a day, with similar or even improved clinical outcomes. While there are concerns about limiting inpatient treatment and prioritising community treatment simply because it may be cheaper, positive examples like this can help hold the NHS to its promise to make treatment truly open to all who need it. Read full story Source: The Guardian, 2 March 2020
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News Article
Young people put at risk by delays for treatment
Patient Safety Learning posted a news article in News
More than 70 children and young people have been put at risk by long delays in treatment by mental health services in Kent and Medway, HSJ has learned. According to a response to a Freedom of Information request submitted by HSJ, 205 harm reviews have been carried out for patients waiting for treatment following a referral to the North East London Foundation Trust, which runs the child and adolescent mental health services in Kent and Medway. Of those, 76 patients, who had all waited longer than the 18 week target time for treatment, were found to be at risk of harm. One patient had to be seen immediately as they were judged to be at “severe” risk. Seven were found to be at “moderate” risk and 68 at “low” risk. The trust said “risk” meant a risk of harm to themselves or others. But it said none of the 76 patients had come to actual harm. Read full story (paywalled) Source: HSJ, 25 February 2020 -
News Article
Fast response to terror attacks saves lives. UK medics should not be held back
Patient Safety Learning posted a news article in News
The Streatham terrorist attack has again highlighted one of the most difficult decisions the emergency services face – deciding when it is safe to treat wounded people. In the aftermath of the stabbings by Sudesh Amman, a passer-by who helped a man lying on the pavement bleeding claimed ambulance crews took 30 minutes to arrive. The London Ambulance Service (LAS) said the first medics arrived in four minutes, but waited at the assigned rendezvous point until the Metropolitan police confirmed it was safe to move in. Last summer, the inquest into the London Bridge attack heard it took three hours for paramedics to reach some of the wounded. Prompt treatment might have saved the life of French chef Sebastian Belanger, who received CPR from members of the public and police officers for half an hour. A LAS debriefing revealed paramedics’ frustration at not being deployed sooner. A group of UK and international experts in delivering medical care during terrorist attacks have highlighted alternative approaches in the BMJ. In Paris in 2015, the integration of doctors with specialist police teams enabled about 100 wounded people in the Bataclan concert hall to be triaged and evacuated 30 minutes before the terrorists were killed. The experts writing in the BMJ believe the UK approach would have delayed any medical care reaching these victims for three hours. These are perilously hard judgment calls. Policymakers and commanders on the scene have to balance the likelihood that long delays in intervening will lead to more victims dying from their injuries against the increased risk to the lives of medical staff who are potentially putting themselves in the line of fire by entering the so-called 'hot zone'. First responders themselves need to be at the forefront of this debate. As the people who have the experience, face the risks and want more than anyone to save as many lives as possible, their leadership and insights are vital. In the wake of the Streatham attack the government is looking at everything from sentencing policy to deradicalisation. Deciding how best to save the wounded needs equal priority in the response to terrorism. Read full story Source: The Guardian, 7 February 2020 -
News Article
Surgeons withdraw support for heart disease advice
Patient Safety Learning posted a news article in News
European clinical guidelines on how to treat a major form of heart disease are under review following a BBC Newsnight investigation. Europe's professional body for heart surgeons has withdrawn support for the guidelines, saying it was "a matter of serious concern" that some patients may have had the wrong advice. Guidelines recommended both stents and heart surgery for low-risk patients, but trial data leaked to Newsnight raises doubts about this conclusion. Thousands of people in the UK and hundreds of thousands worldwide will be treated for left main coronary artery disease each year. This is a narrowing of one of the main arteries in the heart. The guidelines on how to treat it were largely based on a three-year trial to compare whether heart surgery or stents – a tiny tube inserted into a blocked blood vessel to keep it open – was more effective. The trial called Excel started in 2010 and was sponsored by big US stent maker, Abbott. Led by US doctor Gregg Stone, the study and aimed to recruit 2,000 patients. Half were given stents and the other half open heart surgery. Success of the treatments was measured by adding together the number of patients that had heart attacks, strokes, or had died. The research team used an unusual definition of a heart attack, but had said that they would also publish data for the more common "Universal" definition of a heart attack alongside it. There is debate around which is a better measure and the investigators stand by their choice. In 2016, the results of the trial for patients three years after their treatments were published in the New England Journal of Medicine. The article concluded stents and heart surgery were equally effective for people with left main coronary artery disease. But researchers had failed to publish data for the common, "Universal" definition of a heart attack. Newsnight has seen that unpublished data and it shows that under the universal definition, patients in the trial that had received stents had 80% more heart attacks than those who had open heart surgery. The lead researchers on the trial have told Newsnight that this is "fake information". But Newsnight has spoken to experts who say they believe the data is credible. Read full story Source: BBC News, 9 December 2019 -
Content ArticleNearly half of all adults and approximately 8% of children (aged 5-17) worldwide have a chronic condition. Yet, studies have consistently shown that adherence to medication is poor; estimates range from under 80% to under 50%, with an average of 50%. There could be a considerable improvement in health outcomes (and consequently longevity), not only by developing new drugs, but by helping people adhere to existing treatment regimens that have already been researched, tested and prescribed for them. But adherence isn’t usually prioritised by governments, health providers or healthcare professionals (HCPs). Adherence isn’t measured at a national level for any disease, apart from in Sweden where hypertension is recorded. And as governments don’t prioritise adherence, health providers aren’t measured or incentivised for improving it, meaning HCPs may not have the time and resources (or reminders) to focus on it during consultations. This report from the International Longevity Centre-UK (ILC) makes a series of recommendations.
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Content ArticleHealthcare professionals need clearer guidance on responding to racism in paediatric settings, argue Zeshan Qureshi and colleagues.
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Content ArticleTo mark Rare Disease Day 2022, the Department of Health and Social Care has published England’s first Rare Diseases Action Plan.
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Content ArticleWaiting is a feature of public healthcare systems but must be managed to avoid adverse impacts on patients. The NHS sets performance standards for waiting times for elective and cancer care. Its performance against these was deteriorating before the COVID-19 pandemic and has worsened since it began. Millions of patients’ care was disrupted, meaning backlogs increased. This report looks in detail at backlogs and waiting times for elective and cancer care in the NHS in England. It explains how the current increased backlogs and waiting times have arisen, including the impact of the COVID-19 pandemic. The report sets out: how waiting times performance for elective and cancer care are tracked in the NHS, and how long patients have been waiting relative to the performance standards; the causes of increasing longer waits before the pandemic and the disruption caused by the pandemic; and the steps the Department and NHSE&I have already taken to address the increasing backlogs and waiting times, and the constraints and challenges the NHS faces in making a full recovery.
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Content ArticleThere are many respects in which the modern medical system is not fit for purpose and poses a threat to human health. In so many situations, our superficial assumptions about medicine are wrong. Having more tests to identify disease is often not better than leaving those “well enough” alone, labelling people with a specific disease may not be helpful, and more medicine may not be better than less medicine or no medicine at all. In our eagerness to intervene, we can end up doing harm. This fits with the estimation that around 30% of medical care is ineffective and another 10% is harmful. But why do doctors recommend tests, or diagnose and prescribe treatments that don’t help people? Ian A Harris, an orthopaedic surgeon, and Rachelle Buchbinder, a professor of clinical epidemiology, discuss in this BMJ opinion article.
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Content ArticleThis report by The Hearts, Minds and Genes Coalition for Eating Disorders aims to highlight the cost of eating disorders in the UK. It examines: the financial cost of eating disorders to the NHS the financial, social and emotional impact on individuals, families and wider society the ongoing loss of lives to treatable illnesses. It estimates the costs of eating disorders, highlights current gaps in data and gives recommendations for change.
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Content ArticleMany elective orthopaedic procedures were cancelled due to the Covid-19 pandemic and the number of patients on waiting lists for surgery is rising. This study looks at the disparities between inpatient and day-case orthopaedic waiting list numbers and the ‘hidden burden’ that exists due to reductions in elective secondary care referrals. The authors looked at elective procedures at a single District General Hospital in the UK between 1 April and 31 December 2020 and compared data with the same nine-month period from 2019. The study found: a 52.8% reduction in elective surgical workload in 2020 the total number of patients on waiting lists had risen by 30.1% in just 12 months inpatient waiting lists have risen by 73.2%, compared to a 1.6% rise in the day-case waiting list new patient referrals from primary care and therapy have reduced by 49.7%. The authors highlight the disparity between inpatient and day-case waiting lists and predict an influx of new referrals as the pandemic eases. They call for robust planning and allocation of adequate resources to deal with the backlog.
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Content Article
CQC. Dental mythbuster: Safe and effective conscious sedation
Patient Safety Learning posted an article in Dentist
Conscious sedation can help a patient undergo dental treatment. There are several reasons why they may need sedation – anxiety, medical needs or complex treatment. The Care Quality Commission (CQC) outlines the regulations and standards of conscious sedation. -
Content ArticleWhile COVID-19 has worsened patient waiting times across the NHS, patients with pelvic disorders have long been an under-served population experiencing unacceptable delays in care. Pelvic floor disorders are varied and can be complex, but treatment is available. However, patients, particularly those requiring surgery, can wait years from presentation before receiving the treatment they need.
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Content ArticleThe recording of harm and adverse events in psychological trials is essential, yet the types of harm being captured in trials for talking treatments involving children and young people have not been systematically investigated. The aim of this review from Daniel Hayes and Nur Za’bawas was to determine how often harm and adverse events are recorded in talking treatments for children and young people, as well as the metrics that are being collected.
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Content ArticleNICE will speed up patients’ access to the latest and most effective treatments, and dynamic guideline recommendations will be put in the hands of healthcare professionals more quickly under plans unveiled by National Institute for Health and Care Excellence (NICE) in its 5-year strategy.
