Good afternoon and welcome to this week’s patient safety update. Discussed this week: how worried should we be about unlockdown, progress or lack of in reducing baby loss and yet another social care delay. As ever, if you have been sent this email by a friend and want to sign up for yourself you can do so here.

RED LIGHT FLASHING As I told the Today programme on Saturday (1 hr 15 mins in here) the situation facing the NHS right now is very serious. Hospitalisations are doubling every two weeks, daily cases are as high as they were in mid-January, and Professor John Edmunds has warned we could see 100,000 cases a day in just a couple of weeks. The ever reliable Alistair McLellan has more on just how bad things are here. At the moment with just under 5,000 covid patients compared to the 36,000 in the previous peak there is capacity but as I told Newsnight, these things can change fast. No cause for panic - but nor for complacency. All depends on whether the current wave appears to be peaking in about four weeks time -  otherwise the government will have to consider taking more draconian action.

WAY THROUGH The government is very alive to this as seen by the toughening the rules on travel to France and requiring proof of vaccine status to enter nightclubs from September (but why on earth wait on that one?). The biggest issue is with the NHS COVID-19 App. With 1.7 million people (yes you heard that right) currently self-isolating, we are now in danger of losing public consent about its effectiveness. One in ten users have already deleted it and one in five are set to delete it. So as I told the House of Commons on Monday surely we should move right away to allowing fully vaccinated to stop isolating as soon as they have a negative PCR test. I am as hawkish on health issues as any but surely we have to be pragmatic when a system is about to collapse. We have now moved to this for NHS staff and some key workers which I think rather proves the point: if we are prepared to take the risk with people in contact with vulnerable hospital patients why not for everyone?

COVID PASSPORTS are something I struggle to get worked up about. I personally would feel more ‘free’ going into a restaurant if I knew everyone in there had been jabbed or tested so I don’t see them as a threat to freedom but the opposite - a way of preserving our freedoms as they make a future lockdown less likely. The government appears to be doing a soft launch of the concept by introducing them for nightclubs in September (but without the option of demonstrating a negative test result, which if rolled out more widely would need to be included.) But other nations are introducing them more boldly and if cases are still high in September that is surely where we are heading.

VACCINE DEMAND Is dropping off and a third of 18-24’s have not come forward for their first jab which is also probably behind the nightclub decision. More worrying than the 3 million unvaccinated under 30s are those over 40 where demand has also dropped and BAME communities who still lag behind. That said the overall numbers are still very high with two thirds of adults now double jabbed and 88% having had the first.

SOCIAL CARE ANNOUNCEMENT DELAYED…AARGH! Frustratingly It looks like an announcement on social care has been delayed but I think it was more likely to be because the three key players were self-isolating and therefore unable to make the announcement in parliament than any backtracking. That said a delay does allow a change of heart so we have to hope the PM, Chancellor and Health Secretary remain resolute. As for the fact that we are now debating how to pay for it rather than whether to pay for it is progress. The choice seems to be between a new health and social care premium which neatly avoids breaking manifesto commitments on income tax/NI or a national insurance rise which raises more money because it is also paid by business  but also hits younger people harder. I personally marginally prefer the former as the more honest way to create a structure for future likely increases in health and care spend but would support either solution.

PROGRESS ON STILLBIRTHS There was a powerful debate yesterday morning on our progress towards the national ambition on stillbirths, neonatal and maternal deaths led by Cherilyn Mackrory my brilliant Co-Chair of the all party MP group on Baby Loss. Cherilyn spoke with passion and did a fantastic job summarising where we stand as well as endorsing the recent Select Committee report on maternity safety’s recommendations to improve things. In response the Minister Nadine Dorries said we were making good progress with regards stillbirths and neonatal deaths but more work was needed on maternal deaths.

THE BABY LOSS APPG also met yesterday to hear in more detail from the Minister about her response to the select committee report. Without giving too much away she seemed to accept the thrust of the recommendations, pointing to increases in maternity staff numbers and training already announced. The big question is whether the government will back the need for 2000 additional midwives and 500 more consultant obstetricians. She was less keen than I was hoping on the Swedish model of clinical negligence reform but said there was a big piece of work underway looking at different options. She hopes to publish the government’s response on 6th September.

FETAL HEART MONITORING was the subject of HSIB’s latest report following the use of CTG machines emerging as a key theme in their maternity investigations. This report highlights how variation in procurement processes and lack of staff training as issues that needed addressing.

THE NATIONAL STRATEGY FOR AUTISTIC CHILDREN, YOUNG PEOPLE AND ADULTS has been published and reaffirms the government’s ambition to halve the number of autistic people and people with a learning disability in inpatient care by 2023/24. There is a lot of good stuff in this about improving community care provision but the ambition is still too low and as my select committee report said last week we need to go further and ban admissions for long-term care. The government has also published their response to the CQC’s Out of Sight Report which you can read here which the Minister Helen Whately says she accepts in full.

I am taking a break from this email for August but look forward to being back in September when the biggest patient safety issue outside the pandemic will be the backlog: with the pressure of the biggest ever waiting lists, how do we stop a return to the bad old days of Mid Staffs and Morecambe Bay? Lots to get stuck into…see you then.

Jeremy Hunt