Jump to content

Search the hub

Showing results for tags 'Underlying health conditions'.

More search options

  • Search By Tags

    Start to type the tag you want to use, then select from the list.

  • Search By Author

Content Type


  • All
    • Commissioning, service provision and innovation in health and care
    • Coronavirus (COVID-19)
    • Culture
    • Improving patient safety
    • Investigations, risk management and legal issues
    • Leadership for patient safety
    • Organisations linked to patient safety (UK and beyond)
    • Patient engagement
    • Patient safety in health and care
    • Patient Safety Learning
    • Professionalising patient safety
    • Research, data and insight
    • Miscellaneous


  • Commissioning, service provision and innovation in health and care
    • Commissioning and funding patient safety
    • Digital health and care service provision
    • Health records and plans
    • Innovation programmes in health and care
    • Climate change/sustainability
  • Coronavirus (COVID-19)
    • Blogs
    • Data, research and statistics
    • Frontline insights during the pandemic
    • Good practice and useful resources
    • Guidance
    • Mental health
    • Exit strategies
    • Patient recovery
  • Culture
    • Bullying and fear
    • Good practice
    • Occupational health and safety
    • Safety culture programmes
    • Second victim
    • Speak Up Guardians
    • Staff safety
    • Whistle blowing
  • Improving patient safety
    • Clinical governance and audits
    • Design for safety
    • Disasters averted/near misses
    • Equipment and facilities
    • Error traps
    • Health inequalities
    • Human factors (improving human performance in care delivery)
    • Improving systems of care
    • Implementation of improvements
    • International development and humanitarian
    • Safety stories
    • Stories from the front line
    • Workforce and resources
  • Investigations, risk management and legal issues
    • Investigations and complaints
    • Risk management and legal issues
  • Leadership for patient safety
    • Business case for patient safety
    • Boards
    • Clinical leadership
    • Exec teams
    • Inquiries
    • International reports
    • National/Governmental
    • Patient Safety Commissioner
    • Quality and safety reports
    • Techniques
    • Other
  • Organisations linked to patient safety (UK and beyond)
    • Government and ALB direction and guidance
    • International patient safety
    • Regulators and their regulations
  • Patient engagement
    • Consent and privacy
    • Harmed care patient pathways/post-incident pathways
    • How to engage for patient safety
    • Keeping patients safe
    • Patient-centred care
    • Patient stories
  • Patient safety in health and care
    • Care settings
    • Conditions
    • Diagnosis
    • High risk areas
    • Learning disabilities
    • Medication
    • Mental health
    • Men's health
    • Patient management
    • Social care
    • Transitions of care
    • Women's health
  • Patient Safety Learning
    • Patient Safety Learning campaigns
    • Patient Safety Learning documents
    • Patient Safety Learning news archive
    • 2-minute Tuesdays
    • Patient Safety Learning Annual Conference 2019
    • Patient Safety Learning Annual Conference 2018
    • Patient Safety Learning Awards 2019
    • Patient Safety Learning Interviews
    • Patient Safety Learning webinars
  • Professionalising patient safety
    • Accreditation for patient safety
    • Competency framework
    • Medical students
    • Patient safety standards
    • Training
  • Research, data and insight
    • Data and insight
    • Research
  • Miscellaneous


  • News

Find results in...

Find results that contain...

Date Created

  • Start

Last updated

  • Start

Filter by number of...


  • Start



First name

Last name


Join a private group (if appropriate)

About me



Found 35 results
  1. Content Article
    Opportunities for addressing health inequalities in multiple conditions Improve our understanding of communities experiencing inequity and disadvantage Address distance and distrust between communities and health and care Build the right relationships to tackle the social determinants of health Support people to take greater control of their health Promote good health across local groups
  2. Content Article
    National investigation findings In March 2020, demand on the NHS 111 system increased. Demand exceeded the system’s capacity, and around half of calls were answered at that time. Evidence from families indicated that aspects of NHS 111 telephone triage, such as routing all Covid-19-related calls to the Covid-19 Response Service (CRS), did not function as intended. Strong national messaging advised people with suspected Covid-19 to stay at home. This may have impacted on patients’ willingness to seek medical advice from elsewhere, even if their condition deteriorated. The CRS algorithm did not allow for an assessment of caller’s comorbidities to establish whether a clinical assessment would be beneficial. Callers would only be transferred to a clinician/receive a clinical call back if they were “so ill that…[they’ve] stopped doing all of …[their] usual daily activities.” The healthcare system specified that patients with Covid-19 related symptoms and underlying conditions (including diabetes) who went through to core NHS 111 (instead of CRS) should be escalated to a clinician for assessment. However, some patients did not receive a clinical assessment. The intent was that Covid-19-related calls would be diverted to the CRS, which was operationally independent from NHS 111. Many Covid-19-related calls continued to go through the core NHS 111 service. Once callers had reached the core NHS 111 service, there was no way to route them to the CRS. Calls that went via the core NHS 111 service should have been audio-recorded, as per NHS 111 guidance. The CRS contract manager told the investigation that CRS calls were also required to be recorded, and all but one CRS provider were initially set up with a recording function. However, no recordings of CRS calls were made available to the investigation. NHS 111 call handlers do not usually have access to a patient’s medical history. This increases the importance of appropriate ‘safety netting’ – that is, telling a patient or their carer what they should do if their condition does not improve or they have further concerns about their health. Text messages that told a patient they had a positive polymerase chain reaction (PCR) test result included information about isolating and the legal requirements. It did not include sufficient safety-netting advice regarding symptoms to watch for and when and from where to seek medical advice. While this is not related to NHS 111 services, the investigation considers it important to highlight for the future. Ahead of the Covid-19 pandemic, there was limited understanding of the risks of such a novel virus to the healthcare system The decision to redirect the public to call NHS 111 rather than access healthcare advice in other ways (for example, through their GP) shifted the immediate burden of managing patients with Covid-19 in the community. This increased capacity, in the wider healthcare system, but risked disrupting continuity of care for patients with complex health needs. Learning and developments throughout the pandemic have led to improvements in how callers to NHS 111 are assessed and managed. These included recognising the importance of pulse oximetry (that is, measuring blood oxygen levels) to identify silent hypoxia (when a patient has low oxygen saturation levels without becoming breathless) in patients with Covid-19. Safety recommendations for NHS England HSIB recommends that NHS England ensures any Single Service contract or additional services contracts reflects the minimum requirements of the core NHS 111 service for audio-recording calls. HSIB recommends that NHS England reviews the risks associated with increased use of telephone triage in response to national healthcare emergencies. Consideration should be given to applying any recommendations of this review across telephone triage services within the wider healthcare setting. Safety observations HSIB makes the following safety observations: It may be beneficial to review triage software and safety-netting/worsening advice to ensure the language used by health advisors does not deter seriously unwell people from calling back or seeking medical advice if necessary. It may be beneficial, when dealing with a novel virus, for consideration to be given to the benefits of a face-to-face assessment for callers with comorbidities. It may be beneficial for strategic stakeholders in the healthcare system to understand and articulate adjustments in risk tolerance and thresholds in critical situations. Safety actions During the investigation, HSIB became aware of changes the UK Health Security Agency made to processes in a number of areas. These ‘safety actions’ are noted below. The UK Health Security Agency has taken steps to ensure governance arrangements are in place to assure themselves that contracted services are monitored and delivered as intended. The UK Health Security Agency has taken steps to assure itself of the safe and effective delivery of telephone triage for future healthcare emergencies. These have been tested through the delivery of services for Monkey Pox and Avian Flu. The UK Health Security Agency has taken steps to review contractual arrangements to ensure flexibility and the opportunity to implement the most appropriate contract for future public health issue.
  3. Content Article
    In this paper, ARMA makes the following recommendations: Develop multidisciplinary, networked, personalised approaches to pain as standard. Develop more community-based approaches to pain. Everyone with chronic pain should be offered a holistic assessment of their symptoms in primary care reviewing the impact on their physical and mental health, their activities of daily living and their wellbeing, including the ability to work/study, and explore any underlying causes of or contributors to their pain. A public health approach is needed based on community need to design and target effective public health interventions to support those who have chronic pain to improve their health and their quality of life. Take a strategic, integrated population health approach to commissioning pain services ensuring money transcends organisational boundaries, focussed on the provision of a range of chronic pain support options and intervention allowing for personalisation. There should be early access to treatment for painful conditions to minimise pain becoming chronic, including rapid diagnosis, which is important to people. Integrated physical and mental health support for people with MSK pain conditions should be available and every CCG should include MSK chronic pain in IAPT for Long Term Conditions with staff who have joint expertise in both physical and mental health and understanding of chronic pain. Understand health inequalities, discuss and implement levers for change. Systems and services should allow equity in access, experience of using NHS services and equity of outcomes for all groups. Systems and services should be inclusive and culturally sensitivity. Social prescribing to provide supported self-management at scale. Every person with chronic pain should have access to peer support and be signposted to the patient organisations relevant to them. Healthcare professionals education and training to include understanding and management of pain and emphasise the personalised biopsychosocial approach and communications skills training to support them to have good conversations. Public education – including employers, public attitudes to increase health literacy and understanding of pain.
  4. Content Article

    Self-isolation may be a pipe dream

    We knew what would be coming at us several weeks ago. Our daughter is a bit of a doomsday prepper and she had been warning us for a while. We had slowly stocked up on a few essentials, nothing ridiculous. We'd also made sure that we had supplies of our medications, and switched away from Boots to a small local pharmacy who promised to do deliveries. We had corded phones, candles, lanterns and lots of batteries in case of power outages. We had some bottled water. We had stocked up the freezer. We hadn't thought the panic buying would start so quickly, or last so long. Toilet paper was a surprise. We hadn't bought any extra of that, so that was an issue, but our daughter managed to find some for us. We are used to working from home. We have done it off and on for over a decade, so this situation is not new for us. We are tech savvy and able to use digital tools to meet our work needs. However, as freelancers, we have been hit hard by work just being cancelled and having much less to do than normal. Less money coming in too, soon. The hardest thing of all has been that while we want to heed the Government's call to stay at home as reasonably high-risk individuals, we cannot book any food deliveries. Tesco, Ocado and Morrisons have no slots available at all. Thankfully we had two already booked with Tesco before the end of this month. After that, the food will start to run out here. With rationing etc already in place, our family who do visit the shops cannot buy extra for us. At some point, regardless of the risk, we may have to leave the house. Wish us luck!!
  5. Content Article
    Recommendations The government should: fully fund a national two-year rehabilitation strategy that ensures people with significantly deteriorated long-term conditions get the therapeutic support they need appoint a national clinical lead to implement this rehabilitation strategy ensure local partners–such as local authorities and Integrated Care Systems (ICS)–develop and deliver their own localised rehabilitation strategy, and that each ICS has a regional rehabilitation lead.
  6. Content Article
    The report highlights how the pandemic has affected people with muscle-wasting conditions, looking at the physical and psychological impact of shielding and disrupted access to healthcare services. Based on the findings of its report, Muscular Dystrophy UK is calling for both short and long-term recovery priorities: Increased investment in the national neuromuscular teams with more neuromuscular consultant, physiotherapy, nurse specialist and psychology time Appointing a full-time network manager with administration support for the Scottish Muscle Network Reduce waiting lists, address the growing backlog of new and follow-up appointments by implementing virtual outreach clinics in local areas Consider flexibilities into the yearly growth of block contracts to reflect the growing neuromuscular population and increase in complex care needs
  7. Content Article
    The update highlights that: there is no automatic recall for a 3-month booster built into the national digital system for patients who are severely immunosuppressed and would be receiving a fourth dose. at present, patients are unable to book a fourth dose via the national online booking systems, because the patient's data shows that a total of three doses have already been administered. The system classifies these patients as having 'received a booster'. severely immunosuppressed people will not be able to book their booster (fourth dose) three months after their last primary course dose using the NHS online booking system. these patients can present at 91 days post-third dose to GPs, pharmacies and services offering unbooked appointments (‘walk-in’ or ‘drop-in’ centres). Some evidence of need for the booster as a result of their high-risk status will be required. It suggests that secondary care doctors will need to: communicate with their own high-risk specialty patient groups to ensure boosters are being taken up. ensure severely immunosuppressed patients have some ‘evidence of need’ for the fourth dose (previous letters issued on the need for third primary dose could be used).
  8. News Article
    A frailty index is rationing treatment for older and disabled people who catch coronavirus, says Patience Owen. Patience has has a debilitating connective tissue disorder and, like thousands of others with rare conditions, is already in a minority within a minority, marginalised by our NHS, battling increasing disability day by day. Back in March, without consultation and days before the first lockdown, the Clinical Frailty Scale (CFS), a worldwide tool used to swiftly identify frailty in older patients to improve acute care, was adapted by the National Institute for Health and Care Excellence (NICE). It asked NHS staff in England to score the frailty of Covid patients. Rather than aiming to improve care, it seems the CFS – a fitness-to-frailty sheet using scores from one to nine – was used to work out which patients should be denied acute care. Nice’s new guidelines advised NHS trusts to “sensitively discuss a possible ‘do not attempt cardiopulmonary resuscitation’ decision with all adults with capacity and an assessment suggestive of increased frailty”. "Checking the scale, I found I would score five, the 'mildly frail' category, and therefore should I get Covid I could be steered towards end-of-life care. Bluntly, if I catch the virus, the NHS may help me to die, not live," says Patience. By early April, there was a proliferation of illegal “do not resuscitate” (DNR) notices in care homes for people with learning disabilities, and for older people in care homes and in hospitals. Many acutely ill patients stayed at home with Covid symptoms in the belief that they risked being denied care in hospital. Following warnings by the healthcare regulator, the Care Quality Commission, and other medical bodies, that the blanket application of the notices must stop, and legal challenges by charities, exclusions were made to the NICE guidelines. These included “younger people, people with stable long-term disabilities, learning disabilities or autism”. Yet the guidelines remain in place, in spite of the fact that they appear to contravene the Human Rights Act (including the right to life, article 2, and the right to non-discrimination, article 14). A spokeswoman for NICE says it is “very aware of the concerns of some patient groups about access to critical care, and we understand how difficult this feels. Our COVID-19 rapid guideline on critical care was developed to support critical care teams in their management of patients during a very difficult period of intense pressure." “'Difficult' is a hollow word for the feeling of being selected to die," says Patience. "It’s difficult not to conclude that those with long-term conditions and disabilities, like myself, have become viewed as a sacrificial herd." Read full story Source: The Guardian, 29 September 2020
  9. News Article
    A leaked government report suggests a "reasonable worst case scenario" of 85,000 deaths across the UK this winter due to COVID-19. The document also says while more restrictions could be re-introduced, schools would likely remain open. But it says the report "is a scenario, not a prediction" and the data are subject to "significant uncertainty". However some are critical of the modelling and say some of it is already out of date. The document, which has been seen by BBC Newsnight, was prepared for the government by the Sage scientific advisory group, which aims to help the NHS and local authorities plan services, such as mortuaries and burial services, for the winter months ahead. Read full story Source: BBC News, 29 August 2020
  10. News Article
    Demand for oxygen from COVID-19 patients recovering at home is set to place the NHS under strain, the health service has warned. NHS England has issued guidance to out-of-hospital health providers on the extra demands likely to be placed on them given the number of people recovering after a hospital stay with the coronavirus. It warns that the provision from its home oxygen services and community respiratory teams across the NHS is expected to be an issue as the scale of demand increases. Andrew Whittamore, a practising GP and clinical lead for the Asthma UK and British Lung Foundation partnership, said concerns about the potential for hospitals to be overwhelmed in the early part of the pandemic had led to community oxygen teams being primed to take on more patients – but he described that ramping up as “a short-term fix”. “We don’t know how long people are going to need oxygen or other services for,” he said. “There are definitely going to be extra patients added on to our community teams’ workloads.” The Taskforce for Lung Health – of which the British Lung Foundation is a member – has raised particular concerns about access to pulmonary rehabilitation. An education- and exercise-based treatment, which is proven to be more effective for lung patients than many drug-based treatments, and face-to-face classes have been suspended during the pandemic. It may be that such treatment would also be helpful for some patients recovering from COVID-19. Jackie Eagleton, policy officer at the British Lung Foundation, said there had been issues with access to pulmonary rehabilitation for a long time, but the need to offer this form of support to people with lung conditions “has never been more pressing than it is now”. Read full story Source: The Independent, 16 June 2020
  11. News Article
    The UK's organ transplant network could be forced to shut down as a result of the coronavirus outbreak, the body that runs the scheme is warning. One factor is the pressure on intensive care beds, according to NHS Blood and Transplant (NHSBT). But there is also the risk to transplant patients, who have their immune systems suppressed so their bodies don't reject new organs. This is a dilemma for those like Ana-Rose Thorpe, from Manchester, who is waiting for a liver transplant. Now aged 29, Ana-Rose has lived with hepatitis almost her entire life after contracting it as a baby. The disease has taken its toll and now her liver is failing and she is in desperate need of a transplant. "Having to go into hospital while there are coronavirus patients there is very worrying," she says. "Whilst my body could withstand the transplant, the longer I'm not being monitored, not being seen as often as I was, the longer I leave it, I could just get sicker and sicker. "I feel like it's patients that are already on the transplant list, patients waiting for other operations, we have just been swept aside." "It's my life - it is a matter of life and death," Ana-Rose says. Read full story Source: BBC News, 9 April 2020
  12. News Article
    Nick has terminal bowel cancer. He’s been told he won't receive chemotherapy for three months because it would put him more at risk of the coronavirus. He fears having the treatment taken away would shorten his life. Current NHS guidelines say cancer specialists should discuss with their patients whether it is riskier for them to undergo or to delay treatment at this time. Read full story Source: BBC News, 6 April 2020
  13. News Article
    Thousands of people have been missed off the government's high risk list for Covid-19 despite meeting the criteria. Among them have been transplant patients, people with asthma and some with rare lung diseases. Many are worried it will affect their ability to access food and medical supplies as they shield from the virus, unable to leave their homes for at least 12 weeks. "It's like she's been forgotten," said Bev Pearson, mother of 20-year-old heart transplant patient Lucy Pearson. Miss Pearson, from Whitsbury in Fordingbridge, Hampshire, had her transplant 14 years ago and still visits hospital for regular check-ups. She has been shielding in the home she shares with her mother, brother and sister - none of whom have been venturing out in an attempt to protect her. Despite registering her daughter on the government list herself, she said she had received no confirmation. When she asked her GP she was told it had "nothing to do with the surgery", she added. Read full story Source: BBC News, 7 April 2020
  14. News Article
    Healthcare professionals have been told to consider not treating patients with the COVID-19 coronavirus if they themselves would be put at risk, part of new ethical guidance that calls on doctors to prioritise some ailments over the pandemic. The new recommendations for healthcare professionals over 70 years, or with pre-existing conditions, to put themselves first when tackling the pandemic comes following the death of a doctor who returned to the frontlines as a volunteer following a call to arms from the government. The guidance from the Royal College of Physicians (RCP) makes up part of a sweeping list of ethical considerations faced by healthcare workers in the face of the global pandemic. Read full story Source: The Independent, 2 April 2020
  15. News Article
    GP practices should review 1.5 million patients identified by NHS England as the most vulnerable to the coronavirus. NHS England will send a standard letter to these patients asking them to stay at home at all times and avoid any face-to-face contact for at least 12 weeks. GPs will be able to access a report on which patients will be contacted with specific advice, with NHS England directing GPs to review the list and provide additional support to patients. The patients, who are at ‘the highest risk of severe illness that would require hospitalisation from coronavirus’, include those who have had an organ transplant; people with specific cancers; people with severe respiratory conditions; people with rare diseases; people on immunosuppression therapies; and pregnant women with significant heart disease. In a letter to GPs, NHS England said: "We ask that you review this report for accuracy and, where any of these patients have dementia, a learning disability or autism, that you provide appropriate additional support to them to ensure they continue receiving access to care." Read full story Source: Management in Practice, 24 March 2020