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Found 203 results
  1. Content Article

    Walk on by...

    It's midnight on the acute floor, just before Christmas. As I walk through the Emergency Department (ED), I can hear the ambulances reverse up to the door, people shouting, doors opening and closing, phones ringing and the general white noise of the department. You wouldn’t know it was night-time at all, the lights are beaming and it's as noisy now as it is in the day. I am a junior doctor. I’m on my fourth night shift of six. I have a patient on the acute medical admission unit that I need to check up on. I take the opportunity to seek some darkness and quiet away from the hustle and bustle of the ED. As I go into the unit, I spot a young man in his 20s. He has a carer at his bedside. I stop. I say "hi"’ to the carer and just take a quick glance at the saturation probe that is on the young man’s finger. It’s reading 94% (normal is >95%). "Is that number of 94% normal for Eddie*?" I ask the carer. "Yes" he confirms. "What about the heart rate, that’s reading 140?" I asked, but didn’t want to come across alarmed, as this is quite high. "No. It usually reads 90. I was worried, but assumed you were dealing with it". My time is limited, I should be checking on my patient I originally came in to see. I have now seen a vulnerable adult with an abnormally high heart rate. However, the nurses are here… they can act on it , can’t they? I need to see my patient. I have patients backing up in ED, what about the four-hour target? Those thoughts go through my head in a split second. I now find myself pulling up a chair alongside Eddie and his carer. I find out that he has been admitted as his feeding tube had fallen out; he is here to have it replaced in the morning in theatre. I find out that it had fallen out 18 hours ago. As Eddie is unable to swallow without the risk of choking, he relies on the tube for all his medication and fluids. I take a look at the observations. Respiratory rate 18, heart rate 140, blood pressure 89/48, aprexial, not confused. He has a NEWS2 Score of 6. I see a sepsis screening tool that has been completed. It has been deemed that Eddie has a high suspicion of sepsis. But... he’s only come in for a tube change? I use the expertise of the carer. I find out that Eddie hasn’t had any fluids all day and his pads have been dry. At this point he should have had 3 litres of fluid via his tube. He also has not had his medication for his seizures. This is vitally important as it is highly likely he will seize this admission. I put some fluids up. I need to be quite aggressive with replacing his fluids as he may go into acute kidney injury. I write up his epilepsy medication, this time via his cannular. I explain to the nurses to give hourly observations and to call me if there are any problems. I check on Eddie that morning. He’s bright as a button. Smiling and ready for his tube replacement. If I walked on by, what might have happened? Eddie would continue to be treated for sepsis when he wasn’t septic and received antibiotics he didn’t need. Eddie would become more dehydrated and possibly acquired an acute kidney injury. Eddie may have suffered a seizure that could have been prevented. Due to these complications, Eddie may not have been fit for his tube replacement. Eddie's length of stay may have been increased, therefore increasing his risk of contracting a hospital acquired infection. What stopped me from walking by? Eddie reminded me of my brother, *Sam. My brother has cerebral palsy and needs 24-hour care. He’s funny, he can wrap mum around his little finger, he can play pranks on you, he is still my annoying little brother but coming into hospital always poses such a huge stress on us as a family, not to mention Sam. He always has people around him that know him. So, coming into this environment is alien. Due to his physical problems, he doesn’t ‘fit the normal patient mould'. Will he get the right treatment? Will he get his medication on time? Will there be anywhere for the carer to stay? Will the nurses know how to re-position Sam? How will they communicate to Sam? Will they read his patient passport? Will they act on his patient passport? Or will they walk on by? *Names in this blog have been changed for confidentiality purposes.
  2. News Article
    Public confidence in the health service is being undermined by a lack of transparency from hospitals about patient complaints, the man who led the investigation into one of the NHS’s worst care disasters has warned. Sir Robert Francis QC, who chaired the public inquiry into the Mid Staffordshire hospital scandal, has called for a new national organisation with powers to set standards on the handling of patient complaints after research found seven in eight hospital trusts do not follow existing rules. The prominent barrister is now chair of Healthwatch England, a statutory body, which analysed 149 hospitals’ handling of complaints. Under current legislation every hospital is required to collect and report on the number of complaints they receive, what they were about and what action has been taken. Healthwatch England found just 12% of NHS trusts were compliant with all the rules. Only 16% published the required complaints reports while just 38% reported any details about learning or actions taken after a grievance. Speaking to The Independent, Sir Roberts said better reporting, including the outcome and changes made after a complaint, would create a “collaborative” environment to improving the system with patients and staff alike seeing complaints as a valuable resource. One persistent problem remained the gap, he said, between hospitals and the national Parliamentary and Health Service Ombudsman. Sir Robert argued commissioners of NHS services should be more involved. Read full story Source: The Independent, 15 January 2020
  3. News Article
    One in six women who lose a baby in early pregnancy experiences long-term symptoms of post-traumatic stress, a UK study suggests. Women need more sensitive and specific care after a miscarriage or ectopic pregnancy, researchers say. In the study of 650 women, by Imperial College London and KU Leuven in Belgium, 29% showed symptoms of post-traumatic stress one month after pregnancy loss, declining to 18% after nine months. The study recommends that women who have miscarried are screened to find out who is most at risk of psychological problems. "For too long, women have not received the care they need following a miscarriage and this research shows the scale of the problem," says Jane Brewin, Chief Executive of miscarriage and stillbirth charity Tommy's. "Miscarriage services need to be changed to ensure they are available to everyone and women are followed up to assess their mental wellbeing with support being offered to those who need it, and advice is routinely given to prepare for a subsequent pregnancy." Read full story Source: BBC News, 15 January 2020
  4. News Article
    A coroner has criticised an ambulance trust after it took nearly four hours to reach a woman who had taken an overdose. Taking the unusual step of publishing a prevention of future deaths report before an inquest had concluded, coroner for Gateshead and South Tyneside Terence Carney said “the real and imminent danger of [the deceased Maureen Wharton’s] admitted actions does not appear to have been appreciated and readily reacted to in a meaningful way”. Ms Wharton called North East Ambulance Service Trust to say she was dying of cancer and had taken prescribed drugs, including an opioid-based medication and sleeping pills. She threatened to take more and later called back, appearing drowsier. North East Ambulance Service graded the 61-year-old’s call as “category three”, which meant she should have received a response within two hours. It took three hours and 45 minutes for the ambulance service to access her flat, by which time she was already dead. Mr Carney pointed out no attempts had been made to identify family or other support for her, or to contact other agencies which could have responded. The inquest into her death is expected to conclude later this year. In a statement, NEAS said it has already made changes to safeguard patients in mental health cases, including implementing greater oversight in its control rooms, improving call transfers to crisis teams, mapping available local mental health services, introducing more staff training, and telling patients in a crisis but not at risk of physical harm about other, more appropriate, services. Read full story (paywalled) Source: HSJ, 14 January 2020
  5. News Article
    The NHS is spending millions of pounds encouraging patients to give feedback but the information gained is not being used effectively to improve services, experts have warned. Widespread collection of patient comments is often “disjointed and standalone” from efforts to improve the quality of care, according to a study by the National Institute for Health Research (NIHR). Nine separate studies of how hospitals collect and use feedback were analysed. They showed that while thousands of patients give hospitals their comments, their reports are often reduced to simple numbers – and in many cases, the NHS lacks the ability to analyse and act on the results. The research found the NHS had a “managerial focus on bad experiences” meaning positive comments on what went well were “overlooked”. The NIHR report said: “A lot of resource and energy goes into collecting feedback data but less into analysing it in ways that can lead to change, or into sharing the feedback with staff who see patients on a day-to-day basis. NHS England's chief nurse, Ruth May, said: "Listening to patient experience is key to understanding our NHS and there is more that that we can hear to improve it. This research gives insight into how data can be analysed and used by frontline staff to make changes that patients tell us are needed." Read full story Source: 13 January 2020
  6. Content Article
    This short video, by Abertawe Bro Morgannwg University Health Board, demonstrates the Soothing Patient Anxiety (SPA), a unique approach to co-production in meeting the needs of complex patients requiring a surgical intervention.
  7. News Article
    Multiple failings have been found in the Parliamentary Health Service Ombudsman's (PHSO) investigation into the death of a young woman with anorexia. PHSO has admitted to multiple failings in how it handled a three-and-a-half year investigation into the systemic failings by NHS providers in Cambridgeshire and Norfolk which led to the death of Averil Hart in 2012. The findings come as a senior coroner in Cambridgeshire investigates whether there are links between the failures in Averil’s care and that of four other women with an eating disorder who were under the care of the same services. The PHSO’s failings have been revealed in an internal review, published today, which ruled the regulator’s investigation took too long and should’ve been completed in half the time. It also found “insufficient” resource was allocated to the Averil’s investigation, despite staff requesting it, which led to significant delays. Read full story Source: HSJ, 10 January 2020
  8. News Article
    A quarter of children referred for specialist mental health care because of self-harm, eating disorders and other conditions are being rejected for treatment, a new report has found. The study by the Education Policy Institute warns that young patients are waiting an average of two months for help, and frequently turned away. It follows research showing that one in three mental health trusts are only accepting cases classed as the most severe. GPs have warned that children were being forced to wait until their condition deteriorated - in some cases resulting in a suicide attempt - in order to get to see a specialist. Read full story Source: The Telegraph, 10 January 2020
  9. Content Article
    Key recommendations It is recommended that the Royal College of Ophthalmologists, working with relevant stakeholders, develop models and review workforce required for the optimal delivery of glaucoma care. The models should be tested and evaluated. It is recommended that NHS England/Improvement require commissioners to agree, under their service contracts, the action that providers will take to ensure compliance with the Portfolio of Indicators for Eye Health and Care follow-up performance standard. Where the standard has not been met, there should be a requirement for providers to demonstrate that they have reviewed individual pathways and taken action to mitigate risk, as well as to understand the causes of any unnecessary delays to inform improvement. It is recommended that NHS England/Improvement commission NHS Digital to publish reports of hospital eye services’ compliance with the follow-up appointments performance standard included in the Portfolio of Indicators for Eye Health and Care. It is recommended that NHS England/Improvement review the payment for the ongoing management of patients with glaucoma, regardless of setting. Pricing should reflect the complexity and costs of follow-up appointments and encourage new ways of working. It is recommended that NHS Digital include provision for identifying, prioritising and monitoring patients at risk of developing sight loss within the next version of the national Commissioning Data Set. Provision should include the ability to record a risk rating and the recommended follow-up date for each patient, meaning these are mandated data items for collection by hospital eye services. It is recommended that the Royal College of Ophthalmologists agree criteria for the risk stratification of patients with glaucoma so that practice can be standardised across NHS hospital eye services. It is recommended that the International Glaucoma Association facilitate the funding of research into the development and evaluation of an automated, predictive risk stratification tool. Further reading Surveillance of sight loss due to delay in ophthalmic treatment or review: frequency, cause and outcome (Jan 2017) National Patient Safety Agency: Preventing delay to follow up for patients with glaucoma (11 June 2009)
  10. News Article
    Legal action is being launched against the NHS over the prescribing of drugs to delay puberty. Papers have been lodged at the High Court by a mother and a nurse against the Tavistock and Portman NHS Trust, which runs the UK's only gender-identity development service (Gids). Lawyers will argue it is illegal to prescribe the drugs, as children cannot give informed consent to the treatment. The Tavistock said it had a "cautious and considered" approach to treatment. The nurse, Sue Evans, left the Gids more than a decade ago after becoming increasingly concerned teenagers who wanted to transition to a different gender were being given the puberty blockers without adequate assessments and psychological work. Ms Evans said: "I used to feel concerned it was being given to 16-year-olds. But now, the age limit has been lowered and children as young as perhaps 9 or 10 are being asked to give informed consent to a completely experimental treatment for which the long-term consequences are not known." Read full story Source: BBC News, 8 January 2020
  11. News Article
    Delays to follow-up appointments for glaucoma patients leaves them at risk of sight loss, the Healthcare Investigation Safety Branch (HSIB) warns in their new report. The report highlights the case of a 34-year old woman who lost her sight as a result of 13 months of delays to follow-up appointments. Lack of timely follow-up for glaucoma patients is a recognised national issue across the NHS. Research suggests that around 22 patients a month will suffer severe or permanent sight loss as a result of the delays. In HSIB’s reference case, the patient saw seven different ophthalmologists and the time between her initial referral to hospital eye services (HES) and laser eye surgery was 11 months. By this time her sight had deteriorated so badly, she was registered as severely sight impaired. The investigation identified that there is inadequate HES capacity to meet demand for glaucoma services, and that better, smarter ways of working should be implemented to maximise the current capacity. The report makes several safety recommendations focused on the management and prioritisation of appointments. Helen Lee, RNIB Policy and Campaigns Manager, said: “This report has brought vital attention to a serious and dangerous lack of specialist staff and space in NHS ophthalmology services across the country. We know that thousands of patients in England are experiencing delays in time-critical eye care appointments, which is leading to irreversible sight loss for some." “Without immediate action, the situation will only continue to deteriorate as the demand for appointments increases. RNIB urges full and immediate implementation of the recommendations set out in this report to improve the capacity, efficiency and effectiveness of ophthalmology services.” Read full story Source: HSIB, 9 January 2020
  12. News Article
    A backlog of thousands of deaths of people with learning disabilities awaiting official review has grown further, despite NHS England committing in spring last year to “address” the buildup. Information obtained by HSJ shows the number of incomplete reviews increased slightly between May and November last year – from 3,699 to 3,802. The “national learning disabilities mortality review” programme – known as LeDeR – was launched in 2016 and is meant to review all deaths of people aged four and over. Mencap head of policy and public affairs, Dan Scorer, said: “It is unacceptable that thousands of deaths have still not been reviewed despite NHS England announcing further funding to make sure all reviews were carried out quickly and thoroughly. These latest figures show that little progress has been made; the programme is still failing to address outstanding reviews as well as keep pace with incoming referrals." “Behind these figures are families whose loved ones’ deaths may have been potentially avoidable and they have a right to know that health and care services are learning and acting on LeDeR reviews’ recommendations.” Read full story (paywalled) Source: HSJ, 8 January 2020
  13. News Article
    The partner of a dying man was denied the chance to be at his bedside during his final moments after a hospital wrongly banned her from daily visits, an ombudsman report has found. Brian Boulton, 70, was admitted to Royal Gwent Hospital in Newport, South Wales, after suffering from a chest infection, which was later diagnosed as aspiration pneumonia caused by oesophageal cancer. Celia Jones, his “long term life partner” of twenty years, was accused by hospital staff of giving the retired tailor a larger dose of the prescribed furosemide medication than was allowed. Ms Jones, 65, was restricted to one-hour visits twice a week, meaning she was unable to be with him when he died a day after her last authorised visit on Wednesday 27 September 2017. The Public Services Ombudsman for Wales has upheld her complaints about her “appalling” treatment, ruling that the visiting restrictions were imposed “without warning” and resulted in a “significant injustice”. It found no record of Ms Jones, a retired nurse, admitting to a senior ward manager that she gave the large dose of medicine to her partner. Read full story Source: The Telegraph, 6 January 2020
  14. News Article
    At least 61 women in the UK have been diagnosed with a potentially fatal cancer linked to breast implants, but the type they received continues to be used, with no plans by the regulator to follow France and Australia in banning them. Lawyers for more than 40 of the women, who are bringing legal action against the manufacturers as well as the clinics and doctors who carried out the surgery, say the textured implants linked to anaplastic large cell lymphoma (ALCL) should be withdrawn from the market. Smooth implants are available instead, which have no proven connection to the cancer of the white blood cells. The Medicines and Healthcare Products Regulatory Agency (MHRA) says the disease is very rare, but Sarah Moore, a solicitor at Leigh Day law firm, believes there are more cases than the regulator is aware of. “I think there has been misdiagnosis and under-diagnosis, and I think we have to bear in mind that in the last 18 months there have been 17 more reported cases of ALCL,” she said. The leading manufacturer of textured implants, Allergan, has withdrawn them from worldwide sale. In December 2018 its European kitemark for the implants expired – the French agency that had granted certification had asked for extra safety data that the company said it could not provide in time. They have not been on sale in Europe since then. The US authorities asked the company to recall its textured implants in July 2019 and Allergan took them off the market. France and Australia have since banned the sales of all textured implants, although neither has suggested that women should actively seek to have them removed. In the UK, other brands of textured implants are still in use. Neither NHS England, the NHS Business Services Authority nor the MHRA could say how many had been given to women in the NHS after a mastectomy for breast cancer. Read full story Source: The Guardian, 7 January 2020
  15. News Article
    Hundreds of sexual assaults are reported each year on mixed-sex mental health wards in England, HSJ can reveal, highlighting the urgent need for investment to improve facilities. New figures obtained by HSJ show there have been at least 1,019 reports of sexual assaults between men and woman on mixed wards since April 2017 to October 2019. This compares to just 286 reports of incidents on single-sex mental health wards over the same period. Of those reports made on mixed-sex wards, 491 were considered serious enough to refer to safeguarding, and 104 were reported to the police. The level of incidents still being reported suggests patients are not being protected from sexual assault on mixed wards, despite the issue being highlighted by several national reports in recent years. Read full story (paywalled) Source: HSJ, 7 January 2020
  16. News Article
    Mother Natalie Deviren was concerned when her two-year-old daughter Myla awoke in the night crying with a restlessness and sickness familiar to all parents. Natalie was slightly alarmed, however, because at times her child seemed breathless. She consulted an online NHS symptom checker. Myla had been vomiting. Her lips were not their normal colour. And her breathing was rapid. The symptom checker recommended a hospital visit, but suggested she check first with NHS 111, the helpline for urgent medical help. To her bitter regret, Natalie followed the advice. She spoke for 40 minutes to two advisers, but they and their software failed to recognise a life-threatening situation with “red flag” symptoms, including rapid breathing and possible bile in the vomit. Myla died from an intestinal blockage the next day and could have survived with treatment. The two calls to NHS 111 before the referral to the out-of-hours service were audited. Both failed the required standards, but Natalie was told that the first adviser and the out-of-hours nurse had since been promoted. She discovered at Myla’s inquest that “action plans” to prevent future deaths had not been fully implemented. The coroner recommended that NHS 111 have a paediatric clinician available at all times. In her witness statement at her daughter’s inquest in July, Natalie said: “You’re just left with soul-destroying sadness. It is existing with a never-ending ache in your heart. The pure joy she brought to our family is indescribable.” Read full story Source: The Times, 5 January 2020
  17. Content Article
    Advocacy is a free and confidential service. Advocates are independent to the NHS. The NHS Complaints Advocacy service is there to: Give you information about different NHS complaints processes. Help you understand the different options you have in raising your concerns. Offer you support to help you think about your complaint and what you want to get from making your complaint. Help you make your complaint if you want us to. If you would like an advocate to assist you now or would like to talk to someone about advocacy, please contact the Helpline on 0300 330 5454. You can complain about any aspect of NHS care and services but might include: poor treatment or care the attitude of staff poor communication waiting times lack of information failure of diagnose a condition. NHS Complaints Advocacy can only support you if your complaint is about NHS funded healthcare. There are some limits on what can be achieved using the NHS Complaints Procedure. Where the outcome you are looking for is more likely to be achieved through another route, we can explain this and give you information about who best to contact instead. We can support you to make this contact, where required.