- BBC News-Ethnic bias’ delayed care before Liverpool woman’s death
An article published on the website for BBC News, by the journalist Jonny Humphries, in the last week detailed the death of a pregnant black woman last year as a result of cultural and ethnic bias and reads:
“Cultural and ethnic bias” delayed diagnosing and treating a pregnant black woman before her death in hospital, an investigation found.
The probe was launched when the 31-year-old Liverpool Women’s Hospital patient died on 16 March 2023.
It also found “the impact of the junior doctors’ strike” and low staffing were among factors that delayed recognising how ill she was.
The hospital said it had made “immediate changes”.
Investigators from the national body the Maternity and Newborn Safety Investigations (MSNI) were called in after the woman died.
A report prepared for the hospital’s board said that the MSNI had concluded that “ethnicity and health inequalities impacted on the care provided to the patient, suggesting that an unconscious cultural bias delayed the timing of diagnosis and response to her clinical deterioration”.
“This was evident in discussions with staff involved in the direct care of the patient”.
The hospital’s response to the report also said: “The approach presented by some staff, and information gathered from staff interviews, gives the impression that cultural bias and stereotyping may sometimes go unchallenged and be perceived as culturally acceptable within the Trust.”
Liverpool Riverside Labour MP Kim Johnson said it was “deeply troubling” that “the colour of a mother’s skin still has a significant impact on her own and her baby’s health outcomes”.
‘Stereotyping’
The woman, who was 18 weeks’ pregnant, was taken to the hospital by ambulance on 13 March 2023.
She was suffering “acute” pain and was taken to the gynaecology ward.
A scan the following day found her baby had died, and after her condition became critical, she was taken to the Royal Liverpool Hospital and died two days later.
The medical cause of death was recorded as acute intestinal ischaemia, a medical emergency caused by the blood flow to the bowel being restricted.
The investigation into her death found hospital staff had not taken some observations because the patient was “being difficult”, according to comments in her medical notes.
The MSNI probe went on to raise concerns about “the impact of systemic cultural bias and stereotyping on the provision of safe and effective care” in both the woman’s case and that of another black woman whose death from sepsis in August 2023 is still under investigation.
“The approach presented by some staff, and information gathered from staff interviews, gives the impression that cultural bias and stereotyping may sometimes go unchallenged and be perceived as culturally acceptable within the Trust,” the MSNI told the hospital.
The hospital said it had since reviewed other previous incidents “which included elements of inequalities” and had introduced a “focused anti-racism strategy” and new ways of handling deteriorating patients.
Dianne Brown, chief nurse at Liverpool Women’s, said: “We want to extend our sincere condolences to the family involved in this tragic case.
“We are absolutely committed to learn, improve and embed change to ensure that no woman experiences any detriment in her care due to her ethnicity.”
A report last year by Mothers and Babies: Reducing Risk Through Audits and Confidential Enquiries UK (MBRRACE-UK) found that between 2019 and 2021, woman from black ethnic backgrounds were four times more likely to die during pregnancy or immediately afterwards than white women.
Mrs Johnson said “urgent action” needed to be taken.
She said: “I will be contacting the hospital to demand answers about what they are doing to ensure this never happens again.
“I had my own twins at the Liverpool Women’s Hospital, while I had a positive experience it is terrifying to think how easily that could have been different.”
This horrendous situation begs the question -When will the staff involved in the death of this patient be sacked by the Trust?
- The Guardian-Ethnic minorities in England have worse access to G
Experts blame outdated funding model as Guardian analysis shows huge disparity with areas that have the most white people
An article by The Guardian journalists Carmen Aguilar Garcia and Tobi Thomas with the above title was published on 15 February 2024 and reads:
Areas across England where the highest proportion of ethnic minorities live have the poorest access to GPs, with experts attributing this disparity to an outdated model being used to determine funding.
As of October 2023, there were 34 fully qualified full-time-equivalent GPs per 100,000 patients in the areas with the highest proportion of people from ethnic minority backgrounds, according to a Guardian analysis of NHS Digital and census data.
This is 29% lower than the 48 general practitioners per 100,000 people serving neighbourhoods with the highest proportion of white British people.
Although ethnic minorities tend to be younger than the white British population, minority ethnic areas still have the lowest number of GPs per person even when factors such as age, sex and health necessities are considered.
After adjusting for those factors, high ethnic minority areas had 37 GPs per 100,000 patients, 15% lower than the 44 GPs per 100,000 in the lowest ethnic minority places of England.
Prof Miqdad Asaria at the London School of Economics department of health policy said it was “very concerning” that ethnic minorities “have systematically poorer access to primary care which is likely to be a key driver of current and future health inequalities”.
“Primary care plays a crucial role in preventing disease, diagnosing and treating illness, and facilitating access to specialist or hospital treatment for people who need it,” he added.
Deprivation and population density play a role in this inequality. People from most minority ethnic groups are more likely to live in deprived neighbourhoods and highly populated dense places than the white British population, with socioeconomic poverty being a key factor that influences health.
The analysis also shows that, after adjusting for factors such as sex, age and health needs, the number of general practitioners per patient is 13% lower in the most deprived parts of England than in the most affluent areas. It is also 16% lower in the most populated dense areas of the country than the least densely populated areas.
Experts have said that the stark disparity of numbers of GPs across different local authorities is because the Carr-Hill formula, which is used to determine how much money per patient is allocated to each GP practice, does not adequately account for how factors such as deprivation and ethnicity may affect the health outcomes of an area.
Jake Beech, a policy fellow at the Health Foundation, said the formula did not “properly compensate practices for the additional health need associated with deprivation, skewing funding towards more affluent areas.
“People living in [deprived] areas often have higher health needs, and our research shows that after accounting for these higher needs, GP practices in more deprived areas are under-doctored and underfunded compared to more affluent ones,” Beech said.
“The main driver of this is the formula used to allocate funding to GP surgeries. The formula has been in place for over 20 years, and despite numerous promises to change it this hasn’t yet happened. Policymakers need to distribute funding and staff in general practice more equitably, so that resources are better matched to need.”
Beccy Baird, a senior fellow in health policy at the King’s Fund thinktank, said it was “widely recognised” that the Carr-Hill formula “doesn’t adequately reflect the extra costs associated with deprivation”.
She added: “It is also harder for GP practices in deprived areas to meet the quality targets which they need to meet to receive additional funding (known as QOF), such as how well patients are controlling their diabetes, because their patients may need more support than those in wealthier areas. This means that practices in more deprived areas may not be able to afford as many staff as they need to meet the needs of their patients.”
The analysis also shows that inequality is at its highest level in London. The number of GPs per patient is a quarter lower in the areas of the capital with the greatest proportion of ethnic minorities compared with those where the lowest proportion of people from minority ethnic backgrounds live.
A Department of Health and Social Care spokesperson said: “We are committed to eliminating health disparities across the nation so everyone can live longer, healthier lives and we have always prioritised the NHS by backing it with the funding it needs.
“We are dedicated to improving access to GPs, and we are now delivering 50m more GP appointments per year compared to 2019.
“The most recent data shows GP funding increased in real terms by 19% between 2017-18 and 2021-22, and our primary care recovery plan is investing up to £645m to expand pharmaceutical services and take pressure off general practice.”
How can the blame for this be on the formula when there have been requests made for it to be changed because it is faulty. Surely the blame lies with those in power who refuse to update or replace the formula to get the funding right for all areas. What could be the possible reason for the reluctance of those in power to correct the formula?
- The Kings Fund Report-Making care closer to home a reality-Refocusing the system to primary and community care
In the last week The King’s Fund published a report with the above title. The overview to the report as detailed in its summary report reads as follows:
Overview
- The health and care system in England must shift its focus away from hospital care to primary and community services if it is to be effective and sustainable.
- Despite successive governments repeating a vision of health and care services focused on communities rather than hospitals, that vision is very far from being achieved.
- This research explored the underlying factors that have prevented change, and what might need to be done to achieve the vision; we analysed published evidence and national datasets and interviewed stakeholders across the health and care system.
- We found that to achieve the vision, political and other national leaders will need to completely shift their focus away from hospitals towards primary and community health and care – and all policies and strategies must align to that focus.
- This report is not about closing hospitals or moving existing services from one location to another, although the latter option may sometimes be appropriate. Rather, it is about a wholesale shift in the focus towards primary and community health and care across the domains of leadership, culture and implementation. This will free up every sector to provide the care that it is best equipped to deliver.
Makes perfect sense!
- Martha’s rule” granting urgent second opinion to be adopted in hospitals
Martha’s rule allowing patients whose health is failing in hospital to seek an urgent second opinion is being introduced by NHS England from April 2024. Information about the rule from NHS England’s website reads as follows:
Martha’s Rule
The first phase of the introduction of Martha’s Rule will be implemented in the NHS from April 2024. Once fully implemented, patients, families, carers and staff will have round-the-clock access to a rapid review from a separate care team if they are worried about a person’s condition.
Martha Mills died in 2021 after developing sepsis in hospital, where she had been admitted with a pancreatic injury after falling off her bike. Martha’s family’s concerns about her deteriorating condition were not responded to promptly, and in 2023 a coroner ruled that Martha would probably have survived had she been moved to intensive care earlier.
In response to this and other cases related to the management of deterioration, the Secretary of State for Health and Social Care and NHS England committed to implement ‘Martha’s Rule’; to ensure the vitally important concerns of the patient and those who know the patient best are listened to and acted upon.
What does Martha’s Rule involve
The three proposed components of Martha’s Rule are:
- All staff in NHS trusts must have 24/7 access to a rapid review from a critical care outreach team, who they can contact should they have concerns about a patient.
- All patients, their families, carers, and advocates must also have access to the same 24/7 rapid review from a critical care outreach team, which they can contact via mechanisms advertised around the hospital, and more widely if they are worried about the patient’s condition. This is Martha’s Rule.
- The NHS must implement a structured approach to obtain information relating to a patient’s condition directly from patients and their families at least daily. In the first instance, this will cover all inpatients in acute and specialist trusts.
Implementation of Martha’s Rule
The implementation of Martha’s Rule in the NHS will take a phased approach, beginning with at least 100 adult and paediatric acute provider sites who already offer a 24/7 critical care outreach capability. We will soon ask for expressions of interest to be part of the first phase of the programme.
This first phase will take place during 2024/25 and will focus on supporting participating provider sites to devise and agree a standardised approach to all three elements of Martha’s Rule, ahead of scale up to the remaining sites in England in the following years.
Criteria for participation will be set out in an expression of interest document and will include the requirement that the provider sites taking part in the first phase have an existing 24/7 critical care outreach infrastructure. The document will also outline the support offer from NHS England; this will include additional funding for project resources, and access to specialist implementation support and expertise from the Health Innovation Network’s Patient Safety Collaboratives.
Further developments
The focused approach at the initial provider sites will inform the development of wider national policy proposals for Martha’s Rule that can be expanded in a phased way across the NHS from 2025/26. We will also identify ways to roll out an adapted Martha’s Rule model across other settings including community and mental health hospitals where the processes may not apply in the same way.
Other measures to improve the identification of deterioration
Martha’s Rule will build on the evaluation of NHS England’s Worry and Concern Improvement Collaborative which involves seven regional pilots and began in 2023. They have been testing and implementing methods for patients, families and carers to escalate their concerns about deterioration and to input their views about their illness into the health record.
The introduction of Martha’s Rule comes alongside other measures to improve the identification of deterioration, including the rollout last November of a new early warning system for staff treating children, built on similar systems already in place for adult, newborn, and maternity services.
To ensure that Martha’s Rule is effective as it can be, it will be implemented as part of an integrated programme to improve the management of deterioration using the ‘PIER’ framework, which helps systems to Prevent, Identify, Escalate and Respond to physical deterioration. This work will improve how the NHS supports staff to manage deterioration and encourage greater involvement from patients, families, and carers.
Circulate this information to our communities please-it is important we know!