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First, Do No Harm — But in a Pandemic, How? (25 September 2020)
Patient Safety Learning posted an article in Blogs
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NHS: How to register with a GP practice
Patient Safety Learning posted an article in GP and primary care
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News ArticleHospitals have been ordered to allow partners and visitors onto maternity wards so pregnant women are not forced to give birth on their own. NHS England and NHS Improvement have written to all of the directors of nursing and heads of midwifery to ask them to urgently change the rules around visiting. The letter, which is dated 19 September and seen by The Independent, says NHS guidance was released on 8 September so partners and visitors can attend maternity units now “the peak of the first wave has passed”. “We thank you and are grateful the majority of services have quickly implemented this guidance and relaxed visiting restrictions,” it reads. “To those that are still working through the guidance, this must happen now so that partners are able to attend maternity units for appointments and births.” The letter adds: “Pregnancy can be a stressful time for women and their families, and all the more so during a pandemic, so it is vital that everything possible is done to support them through this time.” Make Birth Better, a campaign group which polled 458 pregnant women for a new study they shared exclusively, said mothers-to-be have been forced to give birth without partners and have had less access to pain relief in the wake of the public health crisis. Half of those polled were forced to alter their own childbirth plans as a result of the COVID-19 outbreak – while almost half of those who were dependant on support from a specialist mental health midwife said help had stopped. Read full story Source: The Independent, 23 September 2020
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News ArticleA hospital trust has been fined for failing to be open and transparent with the bereaved family of a 91-year-old woman in the first prosecution of its kind. Elsie Woodfield died at Derriford hospital in Plymouth after suffering a perforated oesophagus during an endoscopy. The Care Quality Commission (CQC) took University Hospitals Plymouth NHS trust to court under duty of candour regulations, accusing it of not being open with Woodfield’s family about her death and not apologising in a timely way. Judge Joanna Matson was told Woodfield’s daughter Anna Davidson eventually received a letter apologising over her mother’s death, which happened in December 2017, but she felt it lacked remorse. Davidson said she still had many unanswered questions and found it “impossible to grieve”. The judge said: “This offence is a very good example of why these regulatory offences are very important. Not only have [the family] had to come to terms with their tragic death, but their loss has been compounded by the trust’s lack of candour.” Speaking afterwards, Nigel Acheson, the CQC’s deputy chief inspector of hospitals, said: “All care providers have a duty to be open and transparent with patients and their loved ones, particularly when something goes wrong, and this case sends a clear message that we will not hesitate to take action when that does not happen." Lenny Byrne, the trust’s chief nurse, issued a “wholehearted apology” to Woodfield’s family. “We pleaded guilty to failure to comply with the duty of candour and fully accept the court’s decision. We have made significant changes in our processes.” Read full story Source: The Guardian, 23 September 2020
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Content ArticleThe results paint a bleak picture of the massive toll on all patients of the coronavirus pandemic and the emergency measures taken in response to it. Despite the large scale celebration of the NHS over the spring and early summer, the emergency measures came at a huge cost to patients. In particular, access to services became very difficult, and many patients were left feeling unsupported, anxious and lonely. The relationship between patients and the NHS has been significantly disrupted. It was by no means all bad: some patients reported good ongoing care, and were impressed by the way their local communities came together to support them. This report uses what patients said to look to the future, both near and long-term. It contains recommendations for the next phase of the emergency response, and also a call for the health and care system to be built back better after the pandemic: the current emergency footing cannot be the basis for the ongoing relationship between patients and the NHS.
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News ArticleA decision not to "urgently" refer an anorexic woman whose condition had significantly deteriorated contributed to her death, a coroner said. Amanda Bowles, 45, was found at her Cambridge home in September 2017. An eating disorder psychiatrist who assessed her on 24 August apologised to Ms Bowles' family for not organising an admission under the Mental Health Act. Assistant coroner Sean Horstead said the decision not to arrange an assessment "contributed to her death". Mr Horstead told an inquest at Huntingdon Racecourse that also on the balance of probabilities the "decision not to significantly increase the level of in-person monitoring" following 24 August "contributed to the death". In his narrative conclusion, Mr Horstead said it was "possible... that had a robust system for monitoring Ms Bowles in the months preceding her death been in place, then the deterioration in her physical and mental health may have been detected earlier" and led to an earlier referral to the Adult Eating Disorder Service. He said this absence "was the direct consequence of the lack of formally commissioned monitoring in either primary or secondary care for eating disorder patients". Read full story Source: BBC News, 17 September 2020
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My hospital experiences during COVID-19 by Chris Maddocks
Patient Safety Learning posted an article in Blogs
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News ArticleA damning report into Devon’s NHS 111 and out of hours GP service has revealed shocking stories of patients who have either had their health put at risk or tragically died due to the service being in need of urgent improvement. Devon Doctors Limited, which provides an Urgent Integrated Care Service (UICS) across Devon and Somerset, was inspected by independent health and social care regulator the Care Quality Commission (CQC) in July, after concerns were raised about the service. They included the care and treatment of patients, deaths and serious incidents, call waits, staff shortages, and low morale. Inspectors found 'deep rooted issues'. The CQC concluded it was not assured that patients were being treated promptly enough and, in some cases, they had not received safe care or treatment. It is calling for the service to make urgent improvements which will be closely monitored. Since August 2019, the report stated Devon Doctors had received 179 complaints. Nine had been identified by the service as incidents of high risk of harm and six had been identified by the service as incidents of moderate risk of harm. These had been recorded on the service’s significant event log. However, on review, the CQC identified an additional 30 events from the complaints log which could also have been classed as either moderate or high risk of harm. Read full story Source: Devon Live, 15 September 2020
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News ArticleGP practices are being told they must make sure patients can be seen face to face when they need such appointments. NHS England is writing to all practices to make sure they are communicating the fact doctors can be seen in person if necessary, as well as virtually. It's estimated half of the 102 million appointments from March to July were by video or phone call, NHS Digital said. However, the Royal College of GPs said any implication GPs had not been doing their job properly was "an insult". NHS England said research suggested nearly two thirds of the public were happy to have a phone or video call with their doctor - but that, ahead of winter, they wanted to make sure people knew they could see their GP if needed. Nikki Kanani, medical director of primary care for NHS England, said GPs had adapted quickly in recent months to offer remote consultations and "safe face-to-face care when needed". Prof Martin Marshall, chair of the Royal College of GPs, said general practice was "open and has been throughout the pandemic", with a predominantly remote service to help stop the spread of coronavirus. He said: "The college does not want to see general practice become a totally, or even mostly, remote service post-pandemic. However, we are still in the middle of a pandemic. We need to consider infection control and limit footfall in GP surgeries - all in line with NHS England's current guidance." He said most patients had understood the changes and that clinical commissioning groups had been asked to work with GP practices where face-to-face appointments were not possible - for example, if all GPs were at a high risk from coronavirus. "Any implication that they have not been doing their job properly is an insult to GPs and their teams who have worked throughout the pandemic, continued delivering the vast majority of patient care in the NHS and face an incredibly difficult winter ahead," he said. Read full story Source: BBC News, 14 September 2020 Research from the college indicated that routine GP appointments were back to near-normal levels for this time of year, after decreasing at the height of the pandemic. "Each and every day last week an estimated third of a million appointments were delivered face to face by general practices across the country," added Prof Marshall.
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David Oliver: Should doctors be on first name terms?
Patient Safety Learning posted an article in Culture
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News ArticleThe Royal College of GPs (RCGP) has stressed the importance of GPs having rapid access to testing results for patients, as newly-released research highlights the role general practice is playing during the coronavirus pandemic. Released by Queen Mary University of London, and published in the British Journal of General Practice, the research showed GPs and their teams were continuing to deliver frontline care to NHS patients with both Covid and non-Covid conditions. The active role of GPs in the COVID-19 response is nothing new or surprising, though notably the Queen Mary research focused in heavily on ‘suspected’ cases of Covid, due to limited community testing throughout the pandemic, giving a clearer picture of the primary patient group using general practice services. Responding to the research, Professor Martin Marshall, Chair of the RCGP, said: “This data shows the significant role GPs and our teams have played in tackling Covid-19 and delivering care to patients during the pandemic – and how the virus has impacted on all parts of the health and care services. “General practice has been open throughout the pandemic with GPs and our teams continuing to deliver the vast majority of NHS patient care to patients with both Covid and non-Covid conditions." Read full story Source: National Health Executive, 8 September 2020
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Content ArticleThere are three work programmes to explore workforce retention and configuration in healthcare. The first programme will combine and align multiple large datasets from 20 NHS trusts across secondary care and mental health and 10 ambulance trusts. This will enable the analysis of multiple variables and their effect on workforce retention, and how these variables, in combination with workforce retention, subsequently impact patient outcomes. The second work programme will involve designing and testing an infrastructure for the routine extraction, combination and analysis of these large datasets. This will enable the adoption of these techniques across the NHS. The nursing element (NuRS) will start first, with the ambulance staff (AmReS) element following approximately six months later. A third programme will examine the effect of the COVID-19 pandemic on patient safety in terms of reporting behaviours, for example; and will explore how nursing and ambulance workforce configuration in response to a pandemic affects patient safety and quality of care. This project is a unique opportunity to unlock the key underlying drivers of nurse and ambulance retention and determine their impact on care quality, helping to tackle the challenge of supply in the NHS and ensure that high quality, sustainable care is available to all.
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Patients don’t feel safe in A&E, research finds
Patient Safety Learning posted a news article in News
Visiting A&E or relatives is considered much riskier than attending hospital for other reasons, according to the first in-depth piece of research into the subject. The research, authored by the University of Leicester and NIHR Leicester Biomedical Research Centre Bioinformatics Hub, asked 400 participants how they felt about attending hospital across a range of scenarios during the pandemic. It also revealed that consistent staff use of PPE is seen as a top priority by patients, with staff testing receiving significant but much less support. Participants in the Leicester research were asked to rank how ”safe and confident” they felt coming into hospital for a number of reasons on a scale 1-100. The median score given to “visiting a friend or family member” was 49. The score for attending accident and emergency was 50. Attendance at A&E’s fell sharply during the pandemic peak. It is now rising, but has not reached pre-covid levels. The research suggests that fear could still be playing a significant part in the drop off. Attending hospital for elective care received a median score of 61. Participants were most confident in visiting hospital for essential surgery (median score 78), and clinical scans or x-ray (77). Read full story (paywalled) Source: HSJ, 3 September 2020 -
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Coronavirus: Charity seeks judicial review on care home visit guidance
Patient Safety Learning posted a news article in News
A dementia charity is seeking a judicial review of the government guidance on care home visits. John's Campaign says many care homes in England are still refusing regular face-to-face visits, often essential for people with severe dementia. Dr Angela McIntyre, a retired doctor backing the campaign, has not seen her 92-year-old mother since March. A Department of Health spokesman said: "We know limiting visits in care homes has been difficult for many families." He added: "Our first priority is to prevent infections in care homes, and this means that visiting policy should still be restricted with alternatives sought wherever possible. "Visiting policies should be tailored by the individual care home and take into account local risks in their area." But John's Campaign believes the guidance does not take into account how important visits from family members are for dementia patients and believes it could be in breach of the law. Read full story Source: BBC Health, 3 September 2020 -
News ArticleNurses and essential healthcare staff could be left redundant in the middle of the pandemic as local authorities look to make changes to healthcare contracts that would leave patients facing major disruption, NHS bosses have warned. NHS Providers, which represents all NHS trusts, and NHS Confederation, which represents health and care organisations, said that the decision to put contracts for public health services out to tender as workers battle coronavirus in the community is “completely inappropriate” and a “damaging distraction”, creating uncertainty for those who have spent the past six months on the COVID-19 frontline. Shadow health minister Jonathan Ashworth told The Independent: “This process is disruptive and wasteful at the best of times, but to be doing this mid-pandemic is risky, unnecessary and undermines the ability of frontline health workers to focus not only on preparations for a potential second wave, but a whole host of other health issues, such as Covid rehabilitation, community mental health services and children’s health, all of which are now urgent priorities.” Read full story Source: The Independent, 1 September 2020
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News Article
Not wearing a mask a ‘serious conduct issue’, CEO warns staff
Patient Safety Learning posted a news article in News
A London acute trust has told its staff they may not be paid for time at home self-isolating if it transpires they were not wearing a mask near someone with coronavirus. Staff at Chelsea and Westminster Hospital Foundation Trust were told that if they have to stay at home self-isolating because they were not wearing a mask, that time would have to be taken as annual or unpaid leave. Chief executive Lesley Watts told all staff in an email today, seen by HSJ, that a worker had tested positive for COVID-19, and that four staff members had spent more than 15 minutes with them “without appropriate [personal protective equipment]” and must all now isolate themselves at home for 14 days. The trust considers it “a serious conduct issue not to wear a mask where you are putting colleagues or our patients at risk – this will be dealt with under our formal processes going forward”, Ms Watts said in the email. “If you are sent home to isolate for two weeks because you have not worn a mask, I am now informing you that you will be required to take this as annual or unpaid leave. The four staff members “would not be having to go home to isolate if the use of face masks and social distancing had been in place appropriately”. A Chelsea and Wesminster Hospital spokesman told HSJ: “The guidance around PPE has changed a number of times over the course of the pandemic and we felt it was important to be clear on the trust’s position and to reiterate how seriously we take staff and patient safety." Read full story (paywalled) Source: HSJ, 28 August 2020 -
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As college students return, a crisis in campus care awaits
lzipperer posted an article in Coronavirus (COVID-19)
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Top 10 tips for communicating a diagnosis of mesothelioma
Patient Safety Learning posted an article in Cancers
