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Hospital 'deeply sorry' after 12-year-old's death
Patient Safety Learning posted a news article in News
A hospital boss has apologised "unreservedly" after the death of a 12-year-old girl which led a coroner to raise concerns about the "discrimination of disabled children". Rose Harfleet died at Royal Surrey County Hospital, in Guildford, on 30 January 2024, having attended its emergency department the day before with abdominal pain and vomiting. Assistant coroner for Surrey, Karen Henderson, said in a recent report that there was a failure of the medical and nursing staff to appreciate Rose was clinically deteriorating. The coroner said Rose, who from birth was diagnosed with mosaic trisomy 17 with global developmental delay, was "wholly reliant on her mother to advocate on her behalf". But she said at the hospital no history was taken from Rose's mother and that the severity of her signs and symptoms were underestimated. She said poor clinical decisions contributed to Rose's death. "This gives rise to a concern that by not listening to parents or guardians as a matter of course leads to discrimination of disabled children," she added. Read full story Source: BBC News, 4 June 2025- Posted
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In this podcast interview series, NHS whistleblower Peter Duffy and Patient Safety Learning’s Chief Executive Helen Hughes explore how the healthcare system responds when its staff raise concerns about patient safety. In each episode, Helen and Peter interview someone who has spoken up about patient safety issues in healthcare organisations, or who works to help staff raise concerns where they see unsafe care. In this episode, emergency medicine doctor Chelcie Jewitt describes why and how she co-founded Surviving in Scrubs, a campaign that shares survivor stories of sexism, harassment and sexual assault in the healthcare workforce. She outlines the work the campaign is doing with professional regulators to set clear behavioural standards that will more effectively hold perpetrators to account. She also describes the training and support that Surviving in Scrubs offers healthcare staff and organisations on how to respond to harassment and abuse. Subscribe to our YouTube podcast to keep up to date with the latest episodes. View a transcript of this interview Read a blog from Peter and Helen about the interview series- Posted
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In this blog, Laura Evans discusses the impact the recent UK Supreme Court judgment on the meaning of ‘sex’ in the Equality Act 2010 may have on access to health and care services for transgender people. Last month, the UK Supreme Court ruled in the For Women Scotland v Scottish Ministers case that the protected characteristic of ‘sex’ under the Equality Act 2010 relates to biological sex. This judgment, followed recently by an update from the Equality and Human Rights Commission on its practical implications, will impact many different organisations in the UK.[2] This includes healthcare providers, where the judgment comes with numerous potential patient safety risks for transgender people. Transgender people already encounter various barriers to accessing health and care, including long waits to access NHS gender dysphoria services, lack of training in transgender health, and discrimination.[3] [4] [5] [6] [7] There are also emerging concerns, now the subject of research, on how the algorithms used to assess disease risk and to help make decisions on treatment fail to take transgender patients into account, reinforcing health inequalities.[8] There are very practical and, somewhat ironically, biological issues to consider when looking at the potential impact of this ruling. Transgender people who have not undergone full gender reassignment surgery will still have sex organs and genitalia of the sex they were assigned at birth. In the case of trans men, this may mean they continue to require gynaecological and reproductive healthcare despite identifying and presenting as male.[9] Trans men can develop gynaecological cancers or medical conditions and trans women can develop testicular or other cancers.[10] Even where transgender people have undergone surgery, the clitoris and prostate are generally retained therefore trans men could develop vaginal or vulval cancers and trans women could develop prostate cancer.[11] Preventing discrimination Under the Equality Act 2010, people with the protected characteristic ‘gender reassignment’ are protected from discrimination, harassment and victimisation on the grounds of this characteristic when accessing services and public functions, such as medical services, buildings and premises, including onsite facilities like toilets and changing rooms. Public sector providers like the NHS are additionally under the Public Sector Equality Duty to: Eliminate discrimination, harassment and victimisation. Advance equality of opportunity between people with the protected characteristic of gender reassignment and those who do not. Foster good relations between groups who share a protected characteristic and those who do not. It is difficult to see how public sector providers will be able to meet the Public Sector Equality Duty if they refuse transgender people access to services in the gender with which they identify. There are also implications under data protection legislation. Under the UK General Data Protection Regulations (UKGDPR) 2018, health, genetic and biological data, where it is used for identification purposes, are all 'special category' data forms subject to enhanced protections. Access to services In light of the judgment, NHS England has stated that it is now reviewing its guidance on same sex accommodation because previous guidance advised that transgender patients should be accommodated according to their gender identity.[12] We know the health service remains heavily under pressure and is often at its capacity limits, as highlighted by the ongoing normalisation of arrangements such as corridor care in hospitals across the country.[13] [14] The practical impact of potentially having to provide entirely separate facilities for transgender patients to ensure they can access specific services is hard to judge at this stage. However, it would seem highly likely that this may have unintended consequences of delaying access to care and treatment for these patients, resulting in avoidable harm. Conclusion Overall, the climate of misunderstanding, exclusion and fear that has followed the judgment is likely to leave intersex, transgender and non-binary people afraid to access health services altogether. This would lead to worsening health outcomes as illness may be diagnosed too late. Fear and shame, and the inability to live freely as yourself, are all known triggers for mental ill health and suicidal thoughts, leading to increased need across mental health services that are already stretched with long waiting lists. References For Women Ltd v The Scottish Ministers, UKSC 16 [2025] (On appeal from CSIH 37 [2023]), 16 April 2025. Equality and Human Rights Commission. An interim update on the practical implications of the UK Supreme Court Judgement, 25 April 2025. Mikulak M, Ryan S, Ma R, et al, Health professionals’ identified barriers to trans health care: a qualitative interview study, Br J Gen Pract 2021; 71 (713): e941-e947. DOI: https://doi.org/10.3399/BJGP.2021.01792021. Safer JD, Coleman E, Feldman J et al. Barriers to Health Care for Transgender Individuals. Curr Opin Endocrinol Diabetes Obes 2016; 1; 23(2):168-71. Murry R. Acting on the evidence; ensuring the NHS meets the needs of trans people. The King's Fund 26 September 2022. London Assembly. Trans health matters: improving access to healthcare for trans and gender-diverse Londoners, February 2022. BBC News. Life on a NHS transgender waiting list, 20 March 2024. The Guardian. NHS treatment algorithms ‘not taking transgender patients into account’, 5 May 2023. Sbragia JD, Vottero B. Experiences of transgender men in seeking gynaecological and reproductive health care: a qualitative systematic review. JBI Evidence Synthesis. 18(9):p 1870-1931, September 2020. de Nie I, Wiepjes CM. de Blok CJM, et al, Incidence of testicular cancer in trans women using gender-affirming hormonal treatment: a nationwide cohort study. BJU International, 2021. https://doi.org/10.1111/bju.15575 Bertoncelli Tanaka M, Sahota K, Burn J, et al, Prostate cancer in transgender women: what does a urologist need to know? BJU International 2022; 129: 113-22. BBC News. NHS will be pursued if gender policies don’t change, equalities watchdog says, 17 April 2025. Royal College of Nursing. On the frontline of the UK’s corridor care crisis, 16 January 2025. Patient Safety Learning. Response to RCN report: on the frontline of the UK’s corridor care crisis, 17 January 2025.- Posted
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Top picks: Race and ethnic health inequalities
Patient Safety Learning posted an article in Health inequalities
Race and ethnic inequalities in health are widely recognised, with much work needed to improve care, diagnosis and treatment, and outcomes for patients. Racism is also evident within healthcare organisations and the impact on staff can be devastating. In this blog, we’ve collated a wide range of resources, including the latest research, the barriers patients face, improvement initiatives, health inequalities in maternity, and staff discrimination to evidence some of the key patient safety issues and the need for greater investment in this area. Barriers to diagnosis and treatment 1 Perceived barriers to accessing mental health services among black and minority ethnic communities: a qualitative study In most developed countries, substantial disparities exist in access to mental health services for black and minority ethnic populations. This study sought to determine perceived barriers to accessing mental health services among people from these backgrounds to inform the development of effective and culturally acceptable services to improve equity in healthcare. 2 ‘Mistreatment’ due to the colour of your skin A blog highlighting the barriers in healthcare faced by patients due to the colour of their skin. Impacting factors can include explicit racial bias, which includes discrimination and prejudice; implicit racial bias; missing data; lack of trust; and reduced access. These can lead to misdiagnoses and delays in treatment, which can ultimately cause harm and preventable death. 3 95% of healthcare professionals do not feel confident diagnosing dermatology conditions across skin tones This blog by Pastest, a provider of medical exam preparation resources, explores how different organisations are developing transformative initiatives to diversify clinical practice. It highlights the results of a global survey that reveals a critical gap in dermatological diagnosis across skin tones and explores the need for a multifaceted approach to anti-racist medicine. 4 Equity in medical devices: independent review A core responsibility of the NHS is to maintain the highest standards of safety and effectiveness of medical devices available for all patients in its care. Evidence has emerged, however, about the potential for racial and ethnic bias in the design and use of some medical devices commonly used in the NHS, and that some ethnic groups may receive sub-optimal treatment as a result. In response to these concerns, the UK Government commissioned this independent review on equity in medical devices. In its final report, the Review sets out the need for immediate action to tackle the impact of ethnic biases in the use of medical devices. 5 Skin assessment in patients with dark skin tone This article in the American Journal of Nursing provides basic information about the assessment of dark skin tone and calls for action in academia and professional practice to ensure the performance of effective skin assessments in all patients. 6 “We’re not taken seriously”: Describing the experiences of perceived discrimination in medical settings for Black women Cervical cancer disparities persist for Black women despite targeted efforts. Reasons for this vary; one potential factor affecting screening and prevention is perceived discrimination in medical settings. Inequalities in maternity 1 For black women in the UK, a fear of pregnancy is far from irrational In this blog for Refinery 29, journalist L'Oréal Blackett discusses the additional risk and associated worries faced by black pregnant women in the UK. With black women four times more likely to die in childbirth than white women, and 40% more likely to suffer a miscarriage, she examines what action the government is taking to improve outcomes for black women and their babies. She speaks to a number of campaigners who highlight the importance of including black women at every stage of research and policy to tackle race-based health inequalities. 2 Five X More campaign: Improving maternal mortality rates and health outcomes for black women In this interview, Patient Safety Learning talks to Tinuke, co-founder of the Five X More campaign and founder of the mothers group, Mums and Tea. Tinuke started the Five X More campaign as a response to the MBRRACE 2018 report which highlighted that black women in the UK are five times more likely to die in pregnancy and childbirth in comparison to a white woman. 3 Review of neonatal assessment and practice in Black, Asian and minority ethnic newborns: Exploring the Apgar score, the detection of cyanosis, and jaundice The results of a commissioned review undertaken by Sheffield Hallam University highlights a number of ‘reliability concerns’ around three current neonatal assessments and perinatal practices – the Apgar score and the detection of cyanosis and jaundice. It calls for immediate update of maternity guidelines that refer to assessments by skin colour and the increased use of screening tool devices, including oximeters and bilirubinometers. Urgent research is also needed which focuses on enhancing the reliability of these tools especially for darker skinned babies. 4 Addressing critical gaps in Black maternal mental healthcare: a new partnership project is launched Sandra Igwe is the Founder and CEO of The Motherhood Group. In this interview Sandra tells us about a new partnership project, bringing together The Motherhood Group, Centre for Mental Health, and the Maternal Mental Health Alliance to address critical gaps in Black maternal mental healthcare. Staff discrimination 1 NHS Confederation - Shattered hopes: black and minority ethnic leaders’ experiences of breaking the glass ceiling in the NHS This report by NHS Confederation looks at the lived experience of senior black and minority ethnic leaders in the NHS. The report highlights that more than half of those surveyed considered leaving the health service in the last three years because of their experience of racist treatment while performing their role as an NHS leader. Colleagues, leaders and managers seemed to be a particular source of racist treatment, more so than members of the public. This suggests that more focused efforts are required at every level to reduce the incidence of racist behaviour and to improve awareness among all staff of the impact of this type of discrimination. 2 Resource for nursing and midwifery professionals to combat racial discrimination against minority ethnic nurses, midwives and nursing associates Racism is unacceptable and it has no place in health and care. But we know that it exists and that the impact on staff can be devastating. All registered professionals have responsibility under the Nursing and Midwifery Council (NMC) Code to challenge discriminatory behaviour, creating an environment where people are treated as individuals and with dignity and respect. This resource is designed to support nurses, midwives and nursing associates, providing advice on the action you can take if you witness or experience racism. It also supports those in leadership roles to be inclusive leaders. 3 Too hot to handle? Why concerns about racism are not heard... or acted on This report aims to understand the NHS response to racism, what trusts and healthcare organisations do about it and how effective they are at addressing it. It brings together key learning from a number of significant tribunal cases and responses from 1,327 people to a survey about their experiences of raising allegations of racism within their organisations. 4 Closing the gap: A guide to addressing racial discrimination in disciplinaries A guide from NHS Providers to help health service trusts tackle racial discrimination in disciplinary procedures and promote inclusivity. 5 Nursing narratives: Racism and the pandemic This report describes the findings of a study that collected stories of the working lives of Black and Brown healthcare staff during the Covid-19 pandemic. The study asked them to reflect on their experiences and highlight the changes they would like to see. It highlights a number of issues around victimisation, access to PPE, speaking up and risk assessments. 6 Racism which impacts healthcare staff endangers patient care As well as a moral issue, tackling racism affecting NHS staff is a crucial part of improving patient safety and care, says MDX Research Fellow Roger Kline. In this blog, Roger looks at the risks of racism on patient safety. Improvement initiatives 1 How Lambeth is closing the health inequality gap for Black and minority ethnic patients with high blood pressure Black and minority ethnic patients with high blood pressure have benefited from a project which was run by two Lambeth GP practices. The project aimed to reduce the very significant difference in blood pressure control (hypertension) between Black and minority ethnic patients and white patients. The year-long project resulted in the two practices achieving some of the best outcomes ever seen in South East London for overall hypertension control, with a 12% inequality gap for blood pressure control between black and white patients completely eradicated. In addition, over 300 patients from the local community were newly diagnosed with hypertension. 2 Patient and Carer Race Equality Framework - community This video provides an introduction to Sheffield Health and Social Care NHS Foundation Trust's (SHSCFT's) Patient and Carer Race Equality Framework (PCREF). The PCREF aims to help the Trust's staff and communities understand how to have sensitive conversations with patients and carers and to get better information from them. This will mean the Trust is more culturally aware and able to offer culturally appropriate care by understanding the barriers ethnic minority communities face in getting healthcare services for diagnosis and treatment. 4 Excellence through equality: Anti-racism as a quality improvement tool This report from the BME Leadership Network comprises examples of anti-racist initiatives from BME Leadership Network members, to help advance equality within the workforce and for service users. 5 Be the Change: How to tackle racial inequalities in health and care charities A few years ago, National Voices created an inclusion action plan to try to narrow the gaps in racial inequalities by driving improvements in their recruitment practices, organisational culture, influencing activities and work with people with lived experience. A key part of that plan was convening their members to learn from each other, so they organised a series of four members-only roundtables for focused, pragmatic and open discussion. This report, highlights the main learnings in each of the areas, and draws out general advice from all these conversations. They hope it will give colleagues in the health and voluntary sectors ideas for what they could do, alongside practical tools to take action. 6 Mind the Gap: A handbook of clinical signs in Black and Brown skin Mind the Gap is a Handbook to raise awareness of how symptoms and signs can present differently on darker skin as well as highlighting the different language that needs to be used in descriptors. The aim of this booklet is to educate students and essential allied health care professionals on the importance of recognising that certain clinical signs do not present the same on darker skin. 7 The Health Foundation: Bringing an anti-racism approach to quality improvement in maternity care Black Maternity Matters is a collaboration supporting perinatal staff to reduce the inequitable maternity outcomes faced by Black mothers and their babies. Through a ground-breaking programme of training, including anti-racist education, peer support, and quality improvement, it supports maternity systems to provide safer, equitable care. In a recent episode of the Leading Improvement in Health and Care podcast, Penny Pereira, Q Managing Director, spoke to three improvement leaders from the Black Maternity Matters programme. Structural racism 1 Institute of Health Equity: Structural racism, ethnicity and health inequalities in London Racism in London is widespread and persistent causing damage to individuals, communities and society as a whole. Its impacts are experienced in different ways and to varying levels of intensity related to individual experiences, socioeconomic position and other dimensions of exclusion such as disability, age and gender. The intersections with other dimensions of exclusion can amplify the effects of racism. The focus of this review is on the effects of racism on health and its contribution to avoidable inequalities in health between ethnic groups – a particularly unacceptable form of health inequity. It is urgent that society tackle the damage to health and wellbeing as a result of racism. 2 Structural racism as a contributor to lung cancer incidence and mortality rates among Black populations in the United States Although racial disparities in lung cancer incidence and mortality have diminished in recent years, lung cancer remains the second most diagnosed cancer among US Black populations. Many factors contributing to disparities in lung cancer are rooted in structural racism. To quantify this relationship, Robinson-Oghogho et al. examined associations between a multidimensional measure of county-level structural racism and county lung cancer incidence and mortality rates among Black populations, while accounting for county levels of environmental quality. 3 Interrogating and uprooting systemic racism in the emergency department Systemic racism refers to systems in which norms and practice patterns reinforce racial and ethnic inequalities even in the absence of individual intentions to do so. Uncovering subtle, overt and pervasive instances of racism that influence and change the trajectory of patient care is important. Emergency departments (EDs) offer a distinct environment where equity is not just a concept, but a fundamental practice that should be woven through all interactions between the patient, healthcare professionals and the system. For this reason, EDs are poised to lead health equity advocacy in the delivery of high-quality care. This JAMA Health Forum viewpoint article looks at evidence relating to ED systems’ vulnerability to systemic racism and maps a path forward to dismantle racism in the ED. 4 Women from ethnic minorities face endemic structural racism when seeking and accessing healthcare Women from ethnic minorities are voicing their concerns that they face endemic structural racism when seeking and accessing healthcare, and they feel that their symptoms and signs are more often dismissed. It is vital that patients are listened to when they say that they feel this is also due to structural racism in healthcare. 5 Structural racism — A 60-year-old Black woman with breast cancer This study uses the case study of a 60-year-old Black woman with breast cancer as an example of structural racism and propose three critical strategies for addressing structural racism in health care. These strategies hinge on shifting the focus of work on racial differences in health outcomes from biologic or behavioural problems to the design of health care organisations and other social institutions. Research 1 Language-based exclusion associations with racial and ethnic disparities in thyroid cancer clinical trials Racial and ethnic disparities in thyroid cancer care may be reduced by improving enrolment of more diverse patient populations in clinical trials. This study in the journal Surgery looked at trial eligibility criteria and enrolment to assess barriers to equitable representation. 2 Differences in care team response to patient portal messages by patient race and ethnicity The use of patient portals to send messages to healthcare teams is increasing. This JAMA Network Open cross-sectional study of nearly 40,000 US patients aimed to find out whether there are differences in how care teams respond to messages from Asian, Black and Hispanic patients compared with similar White patients. The authors found that messages asking for medical advice sent by patients who belong to minoritised racial and ethnic groups were less likely to receive a response from doctors and more likely to receive a response from registered nurses. This suggests these patients receive lower prioritisation during triaging. The differences observed were similar among Asian, Black and Hispanic patients. 3 Racial implicit bias and communication among physicians in a simulated environment This JAMA Network Open study aimed to explore whether standardised patients in a simulated environment can be effectively used to explore racial implicit bias and communication skills among doctors. For this cross-sectional study, 60 doctors were placed in an environment calibrated with cognitive stressors common to clinical environments. The results reflected expected communication patterns based on prior research (performed in actual clinical environments) on racial implicit bias and physician communication. The authors believe that this simulation and the process of its development can inform interventions that provide opportunities for skills development and assessment of skills in addressing racial implicit bias. 5 Racial differences in shared decision-making about critical illness This US study looked at how critical care doctors approach shared decision-making with Black compared with White caregivers of critically ill patients. The authors found that racial disparities exist in critical care clinicians' approaches to shared decision-making and suggest potential areas for future interventions aimed at promoting equity. 6 Impact of healthcare algorithms on racial and ethnic disparities in health and healthcare This systematic review conducted for the Agency for Healthcare Research and Quality (AHRQ) aimed to examine the evidence on whether and how healthcare algorithms exacerbate, perpetuate or reduce racial and ethnic disparities in access to healthcare, quality of care and health outcomes. The results showed that algorithms potentially perpetuate, exacerbate and sometimes reduce racial and ethnic disparities. Disparities were reduced when race and ethnicity were incorporated into an algorithm to intentionally tackle known racial and ethnic disparities in resource allocation (for example, kidney transplant allocation) or disparities in care (for example, prostate cancer screening that historically led to Black men receiving more low-yield biopsies). 7 Characteristics of publicly available skin cancer image datasets: a systematic review Artificial intelligence (AI) is increasingly being used in medicine to help with the diagnosis of diseases such as skin cancer. To be able to assist with this, AI needs to be ‘trained’ by looking at data and images from a large number of patients where the diagnosis has already been established, so an AI programme depends heavily upon the information it is trained on. This review, published in The Lancet Digital Health, looked at all freely accessible sets of data on skin lesions around the world. These are just a selection of the resources we have on the hub, read more in the health inequalities section of the hub. Share your insights We'd like to hear from patients about your experiences and how it has impacted your care. Or perhaps you are clinician or researcher with a perspective to share on health inequalities? Please leave a comments below (sign up here first for free), or contact us directly at [email protected].- Posted
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Artificial intelligence in healthcare has left experts urging caution that a focus on predictive accuracy over treatment efficacy could lead to patient harm. Researchers in the Netherlands warn that while AI-driven outcome prediction models (OPMs) are promising, they risk creating “self-fulfilling prophecies” due to biases in historical data. OPMs utilise patient-specific information, including health history and lifestyle factors, to assist doctors in evaluating treatment options. AI’s ability to process this data in real time offers significant advantages for clinical decision making. However, the researchers’ mathematical models demonstrate a potential downside, namely, if trained on data reflecting historical disparities in treatment or demographics, AI could perpetuate these inequalities, leading to suboptimal patient outcomes. The study highlights the crucial role of human oversight in AI-driven healthcare. Researchers emphasise the “inherent importance” of applying “human reasoning” to AI’s decisions, ensuring that algorithmic predictions are critically evaluated and do not inadvertently reinforce existing biases. The team then created mathematical scenarios to test how AI may harm patient health and suggest that these models “can lead to harm”. “Many expect that by predicting patient-specific outcomes, these models have the potential to inform treatment decisions and they are frequently lauded as instruments for personalised, data-driven healthcare,” researchers said. “We show, however, that using prediction models for decision making can lead to harm, even when the predictions exhibit good discrimination after deployment. “These models are harmful self-fulfilling prophecies: their deployment harms a group of patients, but the worse outcome of these patients does not diminish the discrimination of the model.” Read full story Source: The Independent, 12 April 2025- Posted
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Racism is a fundamental determinant of health, contributing to health inequities globally. It is a frequent experience for Aboriginal and Torres Strait Islander peoples and shapes their experience of cultural safety in healthcare and other settings. This policy brief outlines the importance of cultural safety in addressing racism, the need for clarity and understanding about cultural safety, and creating pathways for embedding cultural safety in health and human services through establishing national training standards and a linked accreditation process, combined with dedicated organisational action. -
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Discrimination hits record high for second year running
Patient Safety Learning posted a news article in News
Discrimination against NHS employees reached its highest level for the second year in a row, while one in seven experienced physical violence from the public, according to the 2024 annual staff survey. Results published for England showed the percentage of staff who had faced discrimination from the public in the past 12 months had risen from 8.5% in 2023 to 9.3% cent in 2024. The figure has reached its highest level since the question was first asked in 2019, when it was 7.2%, and has risen year-on-year post-pandemic. This has also increased among managers, team leaders and colleagues, from 8.4% in 2020 to 9.2% in 2024. More than half of respondents (54%) said the discrimination was due to their ethnic background. Survey results also found 14.4% of staff had faced violence from patients, their relatives or other members of the public in 2024. This figure has increased slightly from 13.9% in 2023 but is below levels seen during covid. More than 774,000 staff in England responded to 2024 survey between September and November 2024, the highest in its 20-year history, at a response rate of 50 per cent. This is up from 707,000 the previous year and 636,000 the edition before, out of a 1.5 million workforce. Read full story (paywalled) Source: HSJ, 13 March 2025 Read Patient Safety Learning's response to the NHS Staff Survey- Posted
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Antisemitic abuse rises within NHS and staff are the ‘worst culprits’
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NHS staff are more likely than members of the public to perpetrate antisemitic abuse in hospitals and doctors’ surgeries since the October 7 Hamas attacks, according to complaints compiled by an influential charity. The file includes a Jewish doctor being given a hijab as a secret santa present and a patient having pro-Palestine stickers plastered across his room as he lay fighting for his life. Meanwhile, a group of therapists who complained about a colleague posting messages supporting Hamas online were subject to a countercomplaint for “micro-aggressions”. A patient waiting to be discharged from hospital was told: “Get your Jewish ambulance to come and get you.” Dave Rich, policy director at the Community Security Trust, said: “It is essential that hospitals and NHS trusts deal with this trend of rising antisemitism quickly and firmly and set a clear example that anti-Jewish prejudice has no place in the NHS.” Read full story (paywalled) Source: The Times, 6 March 2025- Posted
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Inside the fight to improve outcomes for Black cancer sufferers
Patient Safety Learning posted a news article in News
Getting tested for prostate cancer should’ve been easy for Paul Campbell. He wanted a check-up after seeing an advert on TV calling for men in their 40s to get thorough health checks. He asked his GP but was immediately questioned about why he – a man who seemed otherwise healthy – would want a check-up. “I had to fight my ground, I had to raise my voice. And eventually, I got the test,” Mr Campbell told The Independent. He was later diagnosed with aggressive prostate cancer. “Had I not been assertive and pushy, by the time I found out, it would have been stage 4.” Mr Campbell is far from being alone in his experience. New research from the NHS Race and Health Observatory found “alarming levels” of discrimination towards patients from ethnic minorities and huge levels of mistrust in the NHS system. The survey of 2,680 people found only 55% trusted primary care to meet their health needs most or all of the time, while a third of south Asian participants said they either rarely or never trusted primary care to meet their health needs. On Friday, the NHS Race and Health Observatory roundtable brought together 20 key partners from local communities, the volunteer sector, the government and broader NHS to discuss the findings. Professor Habib Naqvi, chief executive, NHS Race and Health Observatory, said: “We cannot have a two-tier NHS based upon patient ethnicity, background or circumstances. This report reflects the clear need to bring speed and urgency to reform the NHS, so that patients do not face discrimination and systemic barriers when seeking healthcare.” These issues have a real impact on health outcomes. Read full story Source: The Independent, 9 March 2025 -
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In this BMJ article, Mala Rao, director at the Ethnicity and Health Unit and Imperial College London, and Victor Adebowale, Chair of NHS Confederation, share their perspectives on whether racism has improved in the NHS and UK medicine since 2020.- Posted
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When doctors tried to work out whether Marie Tidball would need a specially designed birth plan, one asked her to lie fully clothed on the bed and spread her legs in the air so they could see how far they could open. The incident was one of several occasions when Tidball, now a Labour MP, felt neglected during her pregnancy and early motherhood because of the NHS’s failure to adapt on account of her physical disabilities. Tidball has physical impairments affecting all four of her limbs and had major surgeries on both her hips and legs as a child. She is speaking publicly about her experiences for the first time to highlight a report showing that disabled mothers and their children have significantly worse neonatal and postnatal NHS care than others. Speaking about the doctor’s request to open her legs, Tidball told the Guardian: “I was shocked, really, that that was their approach, rather than actually looking properly at some of my medical history and the notes around my hips. “They didn’t think about how that orthopaedic surgery might interact with birth, but also [about] carrying the baby and the way the baby was lying in uterus. They just hadn’t really thought those intersections through.” Read full story Source: The Guardian, 5 March 2025 Related reading on the hub Diagnostic safety: accessibility and adaptations– a (un)reasonable adjustment?- Posted
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California warns hospitals not to withhold trans youth healthcare
Patient Safety Learning posted a news article in News
As Donald Trump seeks to block transgender youth healthcare across the country, California’s attorney general has sent a clear message to providers, reminding them of their duty to provide gender-affirming treatment under the state’s nondiscrimination laws. “The law requires [hospitals] to continue to provide gender-affirming care to our transgender community,” Rob Bonta, a Democrat who heads the California justice department, told the Guardian on Wednesday. “We will have the transgender community’s back. We will fight for their rights, for their protections, for their freedoms.” His comments come a week after Trump issued an executive order decreeing that medical institutions that receive federal funding and grants do not provide gender-affirming care, including hormone therapy and puberty blockers, to youth under age 19. In response, some hospitals have paused treatments, which are considered part of the standards of care for gender dysphoria endorsed by all major US medical associations. Trans patients, their families and civil rights groups have said the interruption of care could have dire consequences for patients’ physical and mental health. They’ve also argued that Trump’s order is unlawful, violating patients’ constitutional rights and parental rights, and that hospitals have no legal obligation to preemptively deny care, particularly while the policy is being challenged in court. On Tuesday, Children’s Hospital Los Angeles (CHLA), a major local provider, said it was pausing the initiation of hormone treatments for trans youth. The hospital told the LA Times it was not starting new patients’ gender-affirming care while it evaluated Trump’s order “to fully understand its implications”, but said treatment for existing patients would continue. On Wednesday, Bonta wrote a letter to CHLA warning that “withholding services from transgender individuals based on their gender identity or their diagnosis of gender dysphoria” would violate the state’s Unruh Civil Rights Act, a longstanding law that prohibits discrimination against LGBTQ+ people. Read full story Source: The Guardian, 5 February 2025 -
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US hospitals suspend healthcare for transgender youth after Trump order
Patient Safety Learning posted a news article in News
In the wake of Donald Trump’s executive order threatening to withhold federal funding from hospitals that offer gender-affirming care to individuals under the age of 19, several major hospitals across the US have stopped providing such treatments. The 28 January executive order directed federal departments and agencies to ensure that hospitals and medical institutions receiving federal research or education grants stop providing puberty blockers, hormone therapy or surgical procedures to transgender youth under the age of 19. “It is the policy of the United States that it will not fund, sponsor, promote, assist or support the so-called ‘transition’ of a child from one sex to another and it will rigorously enforce all laws that prohibit or limit these destructive and life-altering procedures,” the order reads. In response, several hospitals around the country have stopped providing gender-affirming care procedures for those under 19 while they evaluate and assess the order. A spokesperson for Denver Health in Colorado told the Associated Press that the hospital had stopped providing gender-affirming surgeries for individuals under the age of 19, to comply with the executive order and continue receiving federal funding. In a statement posted to its website, Denver Health said that it was “working to understand and comply with the full implications of the broadly worded order” and that “guidance on changes to medical care is being handled privately so that we can best support our patients and their families”. The Denver hospital said it was “deeply concerned for the health and safety of our gender diverse patients under the age of 19”. “We recognize this order will impact gender-diverse youth, including increased risk of depression, anxiety and suicidality,” the hospital stated. Read full story Source: The Guardian, 3 February 2025 -
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This report from the All Party Parliamentary Group (APPG) on Eating Disorders highlights the urgent need for a national strategy to address the growing eating disorder crisis in the UK. It is based on evidence given by people with eating disorders, carers, healthcare professionals, managers and academics, alongside information obtained from Freedom of Information requests and data analysis. You can find out more about this report in this blog by Hope Virgo, author and Secretariat of the APPG. The report reveals that: people face significant barriers to accessing treatment. healthcare providers are insufficiently trained. care pathways are fragmented. there is a lack of standardised data around eating disorders. there is a postcode lottery in service provision. patients are at times being discharged from services with dangerously low BMIs. The report makes five recommendations that call on the Government to: develop a national strategy for eating disorders. provide additional funding for eating disorder services This funding should address the demand for both adult and children’s services. launch a confidential inquiry into all eating disorder deaths. increase research funding for eating disorders: The aim is to enhance treatment outcomes and ultimately discover a cure for eating disorders. ensure non-executive director oversight for adult and children's eating disorder services. This oversight and accountability should be implemented in all NHS Trusts and Health Boards in the UK.- Posted
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Treat eating disorders as an emergency, MPs urge
Patient Safety Learning posted a news article in News
Lives are being lost and families torn apart because of "woefully inadequate care" for people with eating disorders, according to a group of MPs. The "alarming" rise in disorders such as anorexia and bulimia, over the past decade, has now become an "emergency", the All-Party Parliamentary Group on Eating Disorders says in a report. And greater awareness about different types of eating disorders and how they affect males and females of all ages and ethnicities is urgently needed. The MPs, external spent six months listening to "harrowing" experiences from patients, bereaved families, clinicians and academics. Eating disorders are often misunderstood and seen as a lifestyle choice affecting only white teenage girls, the report says. In reality, they are serious but treatable mental illnesses. The report says services are "grossly" underfunded, there are barriers to accessing treatment and wide variations in care quality across the UK. Campaigner Hope Virgo worries some people with long-term and complex eating disorders are being viewed as "untreatable" and "being sent home to die". Read full story Source: BBC News, 22 January 2025 Read the blog from Hope Virgo published on the hub today: Hope Virgo: What needs to happen to stop people with eating disorders being failed by the healthcare system?- Posted
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This article in JAMA Health Forum examines how the growing use of clinical algorithms exacerbates health disparities through perpetuating discrimination. Anirban Basu discusses five critical issues that should be considered when developing and using clinical algorithms to minimise algorithmic discrimination:Should race belong in a clinical algorithm?Do we then have to develop two separate algorithms for decision-making invoking compensation vs reward?What happens if there is differential mismeasurement of race?What happens when there are differential measurement errors in other predictors, including biological variables?What happens when differential measurement errors exist in the clinical outcomes for which the algorithm is being developed?- Posted
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Trust orders external review into medical training ‘concerns’
Patient-Safety-Learning posted a news article in News
University Hospitals Birmingham has ordered an independent review into a major international medical training programme, after concerns the scheme may be routinely underpaying overseas doctors. The foundation trust confirmed to HSJ it was “now in the process of commissioning an independent review” into its three international medical training programmes. A spokesman said the decision to order an external review had been sparked by an earlier internal review of its medical training, which itself followed “concerns raised by clinical and non-clinical colleagues”. And a bulletin sent to UHB staff today from chief medical officer Kiran Patel, seen by HSJ, said “pay parity” issues had come to light through the internal reviews. It follows previous reports that overseas doctors were being paid substantially less than domestic peers working at a comparable level. Details about who will carry out the external review, how long it will take, and the terms of reference are yet to be confirmed. Read full story (paywalled) Source: HSJ, 9 January 2025- Posted
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This is a 2013 progress report that follows up on the Parliamentary and Health Service Ombudsman and Local Government Ombudsman’s 2009 ‘Six Lives’ report which investigated the deaths of six people with learning disabilities, first highlighted by Mencap in their 2007 report ‘Death by Indifference’. The report covers: what has happened since the publication of the report in October 2010 in the areas the Department of Health said it would give immediate priority to. These areas include early learning from the Learning Disabilities Public Health Observatory, monitoring progress in the Confidential Inquiry into the premature deaths of people with learning disabilities, supporting improvements in the take-up of annual health checks for people with learning disabilities and promoting good practice. what the regulators – CQC, Monitor and the Equality and Human Rights Commission – have reported at the Ombudsmen’s request on what has happened in this area since 2010. progress and key developments in other areas since the 2010 report, which we believe will be very important in continuing to improve the healthcare of people with learning disabilities. These include new responsibilities for improving the healthcare of people with learning disabilities following changes to the health system since 2010. The report then looks at three other developments that will help to improve the health and wellbeing of people with a learning disability: work on identifying the determinants of good healthcare, addressed in the Health Equalities Framework for People with Learning Disabilities 2013. the development of Personal Health Budgets, including the commitment that everyone receiving Continuing Health Care will be offered a Personal Health Budget by 2014 developments on safeguarding in the Care Bill, crucial for this vulnerable group. The report includes an easy read summary.- Posted
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Tackling increased discrimination faced by gay and trans staff must be a priority for the NHS if it wants to maximise workforce productivity, according to the CEO of one of the service’s largest providers. Mark Cubbon, CEO of Manchester University Foundation Trust and chair of the NHS Confederation’s LGBTQ+ leaders network, told HSJ there is an “awful lot more” to do to ensure the health service is more inclusive. A new survey by the network found that members had experienced higher rates of direct or indirect discrimination compared to the workforce as whole, while only 14% felt their organisation acted swiftly and appropriately to these incidents. A quarter of respondents said they had experienced homophobia while 20% reported encountering transphobia. Mr Cubbon said: “[Some people] ask the question about, ‘why are all these things important’, with the breadth of the agenda that we’re facing across the NHS. “As I’ve said, not only is it morally the right thing to do, there’s an imperative here for us all." “It’s really important for the individuals, morally the right thing to do, and it’s really important for the taxpayer so that we can get people to come to work. We employ more than a million people across the NHS, and we want people to be at their best when they come to work.” Read full story (paywalled) Source: HSJ, 5 December 2024- Posted
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In this article, doctor and researcher Rageshri Dhairyawan discusses how the medical practice of silencing is a systemic issue that extends further than global health to every level of healthcare and research. She outlines how it predominantly affects the same minoritised communities that experience health inequities as well as other forms of social injustice, and exacerbates them.- Posted
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‘Racist and misogynistic’ behaviour called out by regulator
Patient Safety Learning posted a news article in News
A teaching trust has been warned it could see resident doctors removed unless it addresses a raft of concerns, including racist and misogynistic behaviour. The General Medical Council has placed conditions on Norfolk and Norwich University Hospital Foundation Trust following a period of “enhanced monitoring”. The concerns cover the trust’s medicine and surgical departments, and involve all grades of resident doctors (formerly known as junior doctors). The trust said it was taking the issues “very seriously” and is “resolved to make this a great place to work, train and develop”. The medical regulator’s director for education and standards Professor Colin Melville said: “Despite ongoing work with the trust for two years, doctors in training in these departments continue to report a range of concerns, including racist and misogynistic behaviours, which need to be addressed as a priority. “There are also concerns around the clinical supervision of doctors in training, handover processes and access to educational opportunities.” The trust was told to adequately cover rotas, and make sure trainees were not subjected to “behaviours including racist and misogynistic behaviours”. Read full story (paywalled) Source: HSJ, 21 November 2024- Posted
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In this Independent article, author and podcaster Lorraine Candy comments on a recent BBC Panaroma episode which looked into private menopause clinics. She criticises the programme for creating fear around hormone replacement therapy (HRT) and misrepresenting the issues facing women's health services in the UK. She argues that rather than focusing on the practice of one private clinic, the question being asked should be why private clinics need to exist in the first place. The answer, she states, is that GPs are ill-informed about menopause, leading to women being patronised, gaslit and not having their symptoms taken seriously. She also highlights the dangers of GPs wrongly prescribing antidepressants instead of HRT, leaving women taking drugs with serious side-effects that don't appropriately treat the cause of their symptoms.- Posted
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This review by the UCL Institute of Health Equity (IHE) concludes that racism damages health and wellbeing and drives inequalities in London. Racism in the capital is widespread and persistent causing damage to individuals, communities and society as a whole. Its impacts are experienced in different ways and to varying levels of intensity related to individual experiences, socioeconomic position and other dimensions of exclusion such as disability, age and gender. The intersections with other dimensions of exclusion can amplify the effects of racism. The focus of this review is on the effects of racism on health and its contribution to avoidable inequalities in health between ethnic groups – a particularly unacceptable form of health inequity. It is urgent that society tackle the damage to health and wellbeing as a result of racism. The review is part of a series of evidence reviews funded by the Greater London Authority (GLA) to build the evidence for reducing health inequalities in London through action on specific social determinants of health. The other three reviews cover housing, the cost of living and adult skills.- Posted
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Drawing on The King’s Fund’s five-year programme of work on health inequalities and tackling the worst health outcomes, which includes insights from stakeholders, partners and people with lived experience, this long read outlines what the King's Fund think the anticipated 10-year health plan should focus on to help the NHS do more to tackle these challenges. It includes a video from Stella O'Brien describing the barriers she has faced when accessing health and care services as a deaf person, and the importance of recognising patients and carers as assets. Seven priorities for the new 10-year health plan: Develop a cross-government health inequalities strategy for the 10-year health plan to feed into. Reorientate the NHS to focus on prevention. Radically change the relationships the NHS has with people and communities, from ‘power over’ to ‘power with’. Tackle racism and discrimination in the NHS and cultivate a culture of compassion. Enable staff to identify and act on health inequalities and capture learning. Empower place-based partnerships to take more decisions about how NHS money is spent. Actively support local voluntary, community and social enterprise (VCSE) organisations through changes in financial planning and commissioning.- Posted
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Research published in the British Journal of Surgery demonstrates that sexual harassment and sexual assault are commonplace within the surgical workforce and rape happens. This report from the Working Party on Sexual Misconduct in Surgery is a call to action, with a series of recommendations, for healthcare institutions to face up to the shocking reality of sexual misconduct within their organisations. Further reading: Sexual harassment, sexual assault and rape by colleagues in the surgical workforce, and how women and men are living different realities: observational study using NHS population-derived weights Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign GMC's Good medical practice 2024- Posted
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