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Found 46 results
  1. Content Article
    The Health and Social Care Select Committee is currently holding an inquiry to consider the preparedness of the UK to deal with the coronavirus pandemic. MPs will focus their discussion on measures to safeguard public health, options for containing the virus and how well prepared the NHS is to deal with a major outbreak. At Patient Safety Learning we are gathering #safetystories from both staff and patients to highlight the challenges for safety in healthcare that are resulting from the pandemic. Ahead of the Committee’s next oral evidence session we have raised several urgent safety issues with the Chair, Jeremy Hunt MP. The Committee should seek answers and actions from NHS leaders and politicians on the issues identified to ensure the safety of staff and patients. Below is a summary of our submission to the Committee, a full copy of which can be found here. Personal Protective Equipment (PPE) for staff There has been an increasing number of concerns raised by staff through the media over the past week around problems accessing appropriate PPE. While at a senior level there has been assurances about the availability of appropriate PPE for NHS staff, we are concerned that this is not being borne out by their experiences on the front-line, undermining trust and confidence that staff safety is being treated as a priority. In our submission we’ve cited several issues raised by healthcare workers in this regard, such as discrepancies in the amount of PPE available to staff in some roles (e.g. ambulances) as opposed to others (e.g. emergency departments). There have also been concerns about the guidance provided on what PPE is required. We’ve been advised of incidents where this has been downgraded to reflect the availability of supplies; this is clearly highly risky and does not reflect a science-based response to the pandemic. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What is being done to ensure all ‘at risk’ staff have access to PPE, not only in the Intensive Treatment Units (ITUs) but Emergency Departments, Wards, Ambulances, in the community, everywhere? Who is in charge in every organisation to ensure that PPE is available and in use, according to robust guidelines? How do staff report concerns and to whom? What assurances are there that the safety of staff is paramount and that the cost of PPE is not preventing staff from having access to life-saving protection? How is the NHS supply chain communicating with trusts over likely lead times for PPE and availability of supplies? Is there transparency in this so that trusts can plan effectively how to use the stocks they have left? Testing There has been a number of reports about how the UK’s approach to testing differs from World Health Organization guidance and we’ve had concerns raised directly with us by staff who are genuinely fearful that they are infected and spreading the virus to their friends, family and the general public without knowing. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What is the policy for testing and tracing patients for Covid-19 in the UK? What are the requirements for test production and testing capacity in this country? What are the plans and timescales to deliver this? We think that the scale of testing is compromising our ability to track the spread of the virus and isolate those that are infected. Non Covid-19 care Understandably the healthcare system is focusing its attention on the deadly effects of the coronavirus and we believe that we need to pay attention to patient safety now more important than ever. We are hearing stories of patients whose planned tests, elective operations, diagnostic procedures are being postponed or delayed while the health care system focuses on responding to the pandemic. It is important to assess the impact the coronavirus will have on other areas of care and ensure it does not magnify or exacerbate existing patient safety issues. We’re asking patients to share their safety stories with us to highlight weaknesses or safety issues that need to be addressed and share solutions that are working, so we can seek to close the close the gaps that might emerge as a result of the pandemic. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What arrangements are being put in place to inform patients and families of any changes in non Covid-19 care during the pandemic? How are UK patients and families being informed about any such changes in their care? What should patients do if they notice new signs and symptoms? References [1] UK Parliament, Health and Social Care Committee: Preparations for Coronavirus, Last Accessed 25 March 2020. [2] HSJ, Staff in ‘near revolt’ over protective gear crisis, Last Accessed 25 March 2020.
  2. Content Article
    RCEM’s recommendations An additional 4,500 beds across the United Kingdom be made available between now and next Winter, and approximately 8,500 more over the next five years. The allocation of additional beds should be made available based on a local assessment of population needs and not worsen health inequalities. Hospitals should define thresholds for occupancy, and justify if they exceed 85% (sometimes this is appropriate, but more often, not) • Any new hospital buildings should increase the proportion of side rooms in order to restrict the number of beds made unavailable through infection and reduce nosocomial infections. There needs to an increase in Mental Health bed capacity. Assessment areas for short term, resource intensive assessment of people suffering a mental health crisis would improve care and patient experience.
  3. News Article
    The NHS is facing a shortage of laundry supplies that could have a “knock-on effect” on bed numbers, an industry leader has warned, with staff at one trust recently told to “only change linen if essential”. The Textile Services Association (TSA), which represents multiple laundry businesses that provide supplies to the NHS, said Brexit and the pandemic had caused large labour shortages which were making it difficult to meet demand across the healthcare and hospitality sectors. David Stevens, chief executive of TSA, told The Independent that “shortages of linen and laundry will have a knock-on effect on the provision of beds in trusts”, adding that the “bounce back post-Covid created a high demand for product and the supply chain was not able to deliver”. In an internal email circulated to staff last month at Oxford University Hospitals NHS Trust, one senior official said both the trust and the NHS were “currently experiencing severe issues with the supply chain for linen deliveries,” adding that the situation is “currently very serious”. The email reads: “Please follow good Infection Prevention and Control practices, but only change linen if essential. For example, always change bed linen between patients, but do not change inpatients’ bed linen daily if at all possible.” Read full story Source: The Independent, 30 June 2022
  4. Content Article
    The Covid-19 pandemic has had a significant impact on service delivery, including the use and availability of beds, due to: infection control measures placing limits on ward space. reduced elective capacity. staffing redeployment. For this reason, this analysis uses the pre-pandemic year of 2019/20 as the comparator, to fairly illustrate long-term trends. As a result of the bed shortage demonstrated by this analysis, the BMA is calling for: an increase in core bed stock adequate funding to increase the workforce, ensuring that additional beds can be staffed safely.
  5. Content Article
    Key messages The total number of NHS hospital beds in England has more than halved over the past 30 years, from around 299,000 in 1987/88 to 141,000 in 2019/20, while the number of patients treated has increased significantly. Most other advanced health care systems have also reduced bed numbers in recent years. However, the UK has fewer acute beds relative to its population than many comparable health systems. Since 1987/88, the largest percentage reductions in bed numbers have occurred in mental illness and learning disability beds as a result of long-term policies to move these patients out of hospital and provide care in the community. The number of hospital beds for general and acute care has fallen by 44 per cent since 1987/88; the bulk of this fall is due to closures of beds for the long-term care of older people. Medical innovation, including an increase in day-case surgery, has also had an impact by reducing the time that many patients spend in hospital. Research shows that initiatives to moderate demand for hospital care often struggle to succeed. Progress depends on having sufficient capacity to provide appropriate care outside hospital, yet evidence suggests that intermediate care capacity is currently only enough to meet around half of demand and cuts in funding have led to significant reductions in publicly funded social care. Before the Covid-19 pandemic there was widespread evidence of a growing shortage of beds. In 2019/20, overnight general and acute bed occupancy averaged 90.2 per cent, and regularly exceeded 95 per cent in winter, well above safe levels. It is not yet clear when and at what level hospital beds will stabilise after the pandemic. How hospital beds are used depends on the availability of other services, yet national data does not provide a full picture of NHS bed capacity and requirements. As the health and care system emerges from the pandemic, greater clarity from NHS national bodies is needed on their expectations for overall health and care bed capacity over the medium term, and the consequences of these choices.
  6. News Article
    An acute trust in the Midlands is planning to move patients to chairs on wards to free up beds for people waiting in its emergency department, following one of its “most challenged” days. In an email sent to staff at Nottingham University Hospitals on Tuesday, interim chief operating officer Rachel Eddie and chief medical officer Keith Girling wrote: “We are asking wards to transfer [patients confirmed as ready for discharge] to the discharge lounge, or if that isn’t possible, move them to a chair on the ward so that a patient waiting for a bed in ED or in an emergency pathway assessment area can be brought up.” “This is referred to as going ‘one over’,” the email added. “We will ensure that on each ward that has been designated as being able to go ‘one over’, a chair has been added to their Nervecentre ward layout so patients are all visible.” The email describes how Monday was one of the “most challenged Mondays we have seen” and confirmed the trust remains in ‘Opel 4’, the most severe level of operational pressure. It also said nursing staff have “shared concerns” about the amount of time they are able to spend with their patients. “This does mean that at times you will be asked to work at a higher patient to nurse ratio than we would like,” the email said. “We know this isn’t where any of us want to be, but it is unfortunately the reality of balancing risk.” Read full story (paywalled) Source: HSJ, 1 December 2021
  7. News Article
    · Trusts told to identify actions to “immediately stop all delays” · Letter calls for issue to be discussed at every board meeting · It follows concern over harm to patients from delays Trusts and integrated care systems are being told by NHS England and Improvement to take urgent action to ”immediately stop all delays” to ambulance handovers, which will require “difficult choices”. A letter yesterday from NHS England’s medical director, director for emergency and elective care, and its regional directors was sent to all local chief executives and chairs yesterday. It also says they should discuss the issue of ambulance handovers at every board meeting they hold, warns that “corridor care” is “unacceptable as a solution”, and says ambulances should not be used as “additional ED cubicles”. The move comes amid signs of large numbers of very long handover delays, and concern about the risk to patients from this and the knock-on damage to ambulance response times. Read the full article here (paywalled) Original source: Health Service Journal
  8. News Article
    Many feared that the UK leaving the EU would cause shortages and limitations to the medicine supply throughout England, Scotland, Wales and Northern Ireland. Now ten months on from Brexit are we finally seeing the short fallings? Ninety percent of the UK's medicines are imported from abroad meaning disruptions caused by the outcomes of Brexit and a lack of HGV drivers has caused a significant problem in transporting drugs into the country. Leaked Department of Health and Social Care documents revealed two hundred and nine medicines had supply “issues” in 2019, more than half of these remained in short supply for over three months. Drugs such as hepatitis vaccines and anti-epileptic drugs, faced “extended” problems. A document published by the NHS Nottinghamshire Shared Medicines Management Team compiled a list of shortages and disruptions to supply due to COVID. The following 5 products had long-term manufacturing issues: AstraZeneca’s Zyban (bupropion, anti-smoking drug) Par’s Questran (colestyramine, a bile acid sequestrant) Diamorphine (a painkiller, used for cancer patients) Metoprolol (used for high blood pressure) Co-Careldopa (given to people with Parkinson’s disease) A further thirty medicines had short-term manufacturing issues, including end of life medicines such as morphine and anti-vomiting drug, levomepromazine. NHS Scotland and NHS Wales have published lists of drugs in low supply which are available to view on their NHS websites. NHS England consider this to be ‘sensitive information’ and have not published any shortfalls. An amendment to The Human Medicines Regulations 2019 legislation has added a ‘Serious Shortage Protocol’ (SSP). This allows for pharmacists and contractors to supply patients with a ‘reasonable and appropriate substitute’ if their prescription has an active SSP. Currently, shortages on Fluxoetine, (anti-depressive drug) and Estradot patches, (hormonal replacement therapy) have active SSP’s according to the NHS Business Service Authority. Original source: National Health Executive
  9. News Article
    Community and mental health service providers have warned the ongoing fuel crisis and other traffic disruption is starting to impact the care of vulnerable patients. Warnings about a HGV drivers shortage have prompted the panic-buying of fuel, with many petrol stations running out or heavily congested. Julia Winkless, a senior social worker and approved mental health professional in Suffolk, told HSJ clinical visits had to be cancelled as people were unable to get to work. Ms Winkless said: “We work over a very rural area, none of these petrol stations where [staff] live have got any fuel and we don’t know when there is going to be deliveries. Today, there were four mental capacity assessments cancelled.” There is also disruption to patient transport. A senior source at a West Midlands patient transport provider which often conveys people to mental health services told HSJ: “It’s been a bit of a nightmare in all honesty. We turned down a request this morning for a patient going to London because of the fuel and because of the [climate protesters disrupting motorways]… ultimately those patients are either at home and distressed carrying a big risk in the community or [accident and emergency] departments which [are not] the right settings.” Read full story (paywalled) Source: HSJ, 28 September 2021
  10. News Article
    GP surgery staff are facing abuse from patients who are “angry and upset” that their blood test has been cancelled because of the NHS-wide chronic shortage of sample bottles. “Patients are angry when we ring them up and say, ‘Sorry we can’t do your blood test after all’. A lot of people are quite angry and concerned about their own health,” Dr David Wrigley, the deputy chair of council at the British Medical Association, said. “Patients are quite rightly upset and some get quite aggressive as well. They are worried because they don’t know what the implications of their cancelled test are for their health.” GP practices in England had begun cancelling appointments because the NHS’s main supplier could not deliver stocks as planned for one to two weeks because of “unforeseen road freight challenges”. NHS England has responded to the shortage of blood sample bottles by telling GPs to cancel all but clinically urgent blood tests and hospitals to cut back the tests they do by at least 25%. Read full story Source: The Guardian, 6 September 2021
  11. News Article
    Becton Dickinson (BD), which manufactures most of the blood tubes used by the NHS, has alerted NHS England and NHS Improvement (NHSE/I) to a global shortage of some of its products, including two types of blood tubes: those with a yellow or purple top. BD says that the COVID-19 pandemic created the most unpredictable demand it has seen in the past 70 years. The company says that it has also been difficult for customers to predict the types and quantities of blood tubes they will be using from month to month, which affects manufacturers’ abilities to meet demand. “Adding to the issue are global transportation delays that have resulted in more products being tied up in transportation than is normal, creating additional delays in deliveries,” BD said in a statement. “Raw material suppliers are also challenged to keep up with demand for materials and components.” In the UK, BD has been authorised to import blood tubes that are approved for use in other regions of the world, including the United States. It plans to deliver nine million of these additional blood tubes to the NHS for immediate distribution. Read full story (paywalled) Source: BMJ, 3 September 2021
  12. News Article
    Local NHS organisations are increasing their efforts to conserve ubiquitous blood collection products amid concerns current measures are not working and stocks may run even lower. There is also a concern in east London that the message to reduce routine tests is not being heeded, with GPs not cutting back enough. However, this week the British Medical Association raised concerns over suspending routine tests, including “NHS Health Checks, monitoring of quality of care, and medication reviews”. The union said: “It would also be unreasonable to ask healthcare staff to simply delay these tests until a later date — not only for the sake of our patients, but also the entire system, which is already tackling an enormous backlog of care.” Read full story. Source: HSJ, 25 August 2021
  13. News Article
    According to NHSE guidance today, non-essential blood tests should be stopped and GPs should prioritise genomic tests over others. Vitamin D testing should also be stopped in all, but "exceptional circumstances" amid shortages in the blood collection tube stocks. The guidance, issued by the NHSE has advised genomics for testing of unwell neonates, prenatal screening and cancer diagnoses are “a high priority". NHSE have also said changes to testing “should be made in consultation with individual patients” and that “it is important to make clear that routine tests will be deferred only where it is clinically safe to do so”. Read full story (paywalled). Source: HSJ, 10 August 2021
  14. News Article
    A national shortage in blood collection tubes has meant trusts are having to limit blood tests, with some trusts advising doctors to only order blood tests if they deem it absolutely necessary or using the same tubes for different tests rather than using a different tube of blood for each test. It has also been reported that the global disruption to the supply chain may mean shortages could continue before the supply lines recover. The NHS Supply Chain, has said there was “some improvement in the supply position in September” but that controls on the products "are likely to continue to be applied beyond this until supply stabilises”. Read full story (paywalled). Source: HSJ, 9 August 2021
  15. News Article
    A hospital in the South East today declared a level of critical care alert meaning that it may be forced into ‘refusal or withdrawal of critical care due to resource limitation’ because it has been ‘overwhelmed’ — but later claimed it was an ”administrative error”. Data from an internal NHS dashboard for critical care, seen by HSJ, showed today Darent Valley Hospital, near Dartford in Kent, declared it was at “CRITCON level four”. CRITCON level four declarations are extremely rare. In guidance they are known as “Triage - emergency” and defined as: “Resources overwhelmed. Possibility of triage by resource (non-clinical refusal or withdrawal of critical care due to resource limitation).” The definition continues: “This must only be implemented on national directive from [NHS England] and in accordance with national guidance.” Dartford and Gravesham Trust, which runs the hospital, replied to HSJ more than five hours after it was contacted, and after publication of the story, to say: “This was a purely administrative error which was quickly rectified.” The level has not however been changed so far on the live dashboard, HSJ has confirmed. Read full story (paywalled) Source: HSJ, 7 January 2021
  16. News Article
    Concerns are mounting over the number of coronavirus patients being admitted to hospitals in London as another NHS trust in the capital issued an urgent warning over its oxygen supplies. On Tuesday afternoon, the North Middlesex University Hospital Trust warned clinicians the numbers of coronavirus patients it was treating “was putting a strain” on the oxygen system, sparking several alarms. The trust currently has around 200 patients using oxygen with the trust consuming 2,400 litres of oxygen a minute. It normally uses around 1000 litres a minute and has a limit of 3,000 above which the system could cut out. It is only the latest hospital to face the problem – which is caused by the sheer demand for oxygen by sick Covid patients, which is more than the hospital piping can physically deliver. Read full story Source: The Independent, 30 December 2020
  17. News Article
    A major incident has been declared in Essex amid fears the number of COVID-19 cases could overwhelm the county's health services. The Essex Resilience Forum (ERF) said "growing demand" was putting stress on hospitals and social care settings. On Tuesday Mid and South Essex NHS Trust placed all three of its hospitals on critical alert. All of Essex is in tier four and the south of the county has some of the worst-affected districts in England. Essex Police Chief Constable BJ Harrington, who is co-chairman of the ERF, said declaring a major incident allowed it "to seek further support from the government to address the severe pressures which the health system is under". The forum said the number of patients being treated for Covid in the county had exceeded the levels seen at the peak of the first wave and "these levels are likely to increase further in the coming days". The ERF - comprised of health services, blue light responders and councils - said issues included "critical care and bed capacity, staff sickness/self-isolation levels and the system's ability to discharge patients quickly into safe environments". Mr Harrington urged the public to continue only dialling 999 or attending A&E in an emergency. Read full story Source: BBC News, 30 December 2020
  18. News Article
    One of England’s largest hospital trusts has been forced to divert ambulances and cancel operations, after seeing a very steep increase in covid-19 admissions over the past week. Whipps Cross Hospital in north east London, part of Barts Health Trust, declared a critical incident over the weekend, the trust has confirmed. The trust has also declared a “high pressure phase” of covid response. A well placed source said Whipps Cross had been forced to divert ambulances in recent days, because of pressure on its emergency services, while a message to staff said it was deferring some planned operations, along with other steps aimed at protecting safety. It is also understood to be attempting to further speed up discharges from hospital. Read full story (paywalled) Source: HSJ, 16 December 2020
  19. News Article
    The most comprehensive picture so far of how covid’s second wave has hit the NHS in the north of England is revealed in new figures obtained by HSJ. The latest data confirms that parts of the North West region now have more coronavirus patients in hospital beds than they did in the spring. It comes amid intense public debate about the best way to fight covid, and whether or not it is close to swamping the NHS. Collected from local NHS sources in a joint HSJ and Independent investigation, the information shows for example that: Lancashire and South Cumbria had 544 confirmed covid hospital patients yesterday (around 15-18% of the bed base), about 20 more than during the April peak. Liverpool University Hospitals – which remains the most severely affected trust – had 408 confirmed covid patients yesterday (20-25% of bed base), whereas it never topped 400 in the spring. The data is sent routinely by trusts to NHS England but most of it is not published – something some politicians are now calling for. As of yesterday, there were nearly 6,100 confirmed-covid patients across England, about 650 of whom were in critical care, and 560 receiving mechanical ventilation, according to information shared with HSJ. The number of “unoccupied” hospital beds is much lower now than in the spring, when they were cleared out in anticipation of a major hit. In the North West, up to 5,500 acute beds were reported as “unoccupied” in the spring, whereas the figure now is about 2,500 (around 14-18% of the bed base). However, critical care is the major pinch point in the most affected areas, with nearly half of the mechanical ventilation beds open at Liverpool’s hospitals (29 of 62) occupied by confirmed covid patients; and a third of those across the North West (178 of 556). However, hospitals in the area have opened very few extra critical care “surge” beds so far. The total numbers of mechanical ventilation (a subset of critical care) beds open in LUH and the rest of the region has not increased much in recent weeks, and falls well short of what they have declared they could open as potential surge capacity, if they cancelled large amounts of non-urgent care and reorganised staffing and wards. Read full story Source: HSJ, 23 October 2020
  20. News Article
    A lack of coronavirus tests for NHS staff is leading to staff absences and services being put at risk, hospital bosses have warned. NHS Providers, which represents hospital trusts in England, said staff are having to self-isolate rather than work because they cannot get tests for themselves or family members. It comes after widespread reports of people struggling to get tested. The home secretary defended the system, saying capacity was increasing. The government's testing system - part of its test, track and trace operation which Prime Minister Boris Johnson promised would be "world-beating" - has faced criticism in recent weeks. An increase in demand for coronavirus tests has led to local shortages - with some people being directed to test sites hundreds of miles from their homes. One doctor working in a coronavirus hotspot said she applied for a test for herself and her partner after they developed coughs and fevers. After refreshing the website for five hours, she managed to get an appointment but on arrival was told no booking had been made. She had taken screenshots of a confirmation code but was not sent a QR code to scan. "I showed the screenshots but I was told that the appointments weren't happening," she said. "I have to say I burst into tears. I was meant to be seeing patients and I feel guilty." Dr Rachel Ward, a GP in Newbury, told BBC Breakfast she was seeing a lot of patients who were struggling to get tests, saying a lot of families were "at the end of their tether" as it was "very stressful when you are faced with two weeks off work". She said if the staff at her practice were unable to get tests and had to self-isolate it would have a "huge impact" on patients as some of their healthcare workers are booked in to administer 100 flu jabs in a day. Read full story Source: BBC News, 14 September 2020
  21. News Article
    Plans for up to 150 new community diagnostic hubs to tackle the NHS’ ballooning diagnostic waiting lists are included in NHS England ‘blue print plans’ leaked to HSJ. The document pointed out the hubs “were highlighted in the phase 3 letter [from Sir Simon Stevens] and will be recommended as part of new service models for diagnostics in the forthcoming [Sir Mike] Richards’ Review of Diagnostics Capacity”. It said “at least 150 community diagnostic hubs should be established in the first instance (broadly equivalent to the number of acute hospitals)” although it appears many of these may be temporary facilities. The phase 3 letter said systems should mange the “immediate growth in people requiring cancer diagnosis and/or treatment returning to the service by… the development of community diagnostic hubs” among other measures The Richards review was commissioned by NHS England in 2019 as it had long been recognised that England has one of the lowest levels in Europe of diagnostic equipment as well as a shortage in facilities and staff. Last month think-tanks warned of significant worsening of cancer outcomes because of the backlog in diagnosis and treatment created by a fall in referrals during the pandemic..." Read full story (paywalled) Source: HSJ, 4 September 2020