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Good morning and welcome to my latest patient safety email. In a week of the big blow up between my old sparring partner Andy Burnham and the PM I look at the real Covid patient safety issues, staff burn out in NHS and social care, culture change with National Speak Up Month, social care funding and those controversial SAGE models which came up in the second mega Coronavirus session with the Science and Tech Committee. Manchester brawl Andy Burnham was a formidable Shadow Health Secretary so I could have warned Boris he was going to get moments like this in any confrontation. The government actually had a reasonable case - offering Greater Manchester the same as Liverpool and Lancashire - but slightly wobbly foundations from which to make it given the immense frustration in GM about being in mini-lockdown since the late summer. The real catastrophe here is not £5m going one way or the other but the mixed public messaging in the middle of a pandemic which risks reducing compliance with social distancing measures. With deaths now reaching the November levels predicted by Chris Whitty no one is really arguing we don't need more restrictions in virus hotspots - but with respect to other areas the argument is raging in parliament and it feels to me like a firm majority of my colleagues are against another national lock down, even as a 'circuit breaker.' Not to be overshadowed but probably will be is the fact that the government now seems to be focusing on rapid, mass population testing as a medium-term goal. I welcomed this in the House of Commons earlier this week and of course we all want to hear more about the trials of LAMP and lateral flow tests. But surely now we can give a date when we are confident of starting weekly or monthly population testing? That would be the light at the end of the tunnel and stop people (especially in my party) flirting with the idea we should risk a herd-immunity strategy. Definitely also not to be overlooked and still might be is the issue of nosocomial infections in a second wave. We know from SAGE papers that up to 20% of coronavirus hospital patients and up to 11% of hospital deaths were people who picked up their infection in hospital. We know thanks to the HSJ that hospital acquired covid infections doubled in a fortnight. Today we have a patient safety paper from the OECD that says across the world in the first wave between 12.5 and 44% of infections were nosocomial, with one third of those infected being healthcare staff. If we are not to repeat this we need that weekly staff testing which I have been calling for like a cracked record. Prof Steve Powis has announced it will happen in hotspot areas but that is not good enough given the infection is now rising in nearly every part of the country. Lessons learned The second session of the joint Health and Social Care/Science and Tech Select Committees Coronavirus inquiry looked at the role of modelling and statistics. Two moments stood out: firstly Dr Max Roser from Oxford saying that the key metric to determine whether you are doing enough tests is not the absolute number but the number relative to the size of the outbreak, which can be seen by the proportion of positive tests. Across the UK this is just over 6% - and the WHO say you need to be below 5% ideally below 3% - and Germany is on 2%. Secondly I got a testy reaction from Prof John Edmunds when I asked why SAGE had not modelled Korean-style test and trace as an option for Ministers to consider in March. He is on SAGE and suggested they had done such modelling - but I can find no evidence of this except their paper saying test and trace should be stopped. He has promised to write to me to clear up the issue and it will be an important letter to say the least. Cancer concerns We now know the devastating impact of lockdown on non-covid services, with roughly 1 death for untreated illness for every covid death. I was on BBC Breakfast yesterday discussing the issues for cancer units. Encouragingly both the Christie and the Marsden appear to be doing weekly staff testing but there is still a job to do to persuade immuno-compromised patients it is safe to go in for treatment. But an even bigger issue is people not going to their GP if they see a warning sign, as demonstrated by the 75% fall in lung cancer referrals. Culture change is a familiar battle cry for patient safety campaigners who worry about a closed culture in healthcare which means mistakes get covered up. People are understandably more focused on the immediate issues around the pandemic but October is Speak Up Month which is a good opportunity to raise awareness of the work the 500 Freedom to Speak Up Guardians who work across the NHS. I set up the scheme following the follow up Francis Report into whistleblowers. I was persuaded to do so by Patient Safety Watch Advisory Board Member, Helene Donnelly, who bravely spoke out as a nurse at Mid Staffs and paid an enormous personal price for doing so. She argues that it is still too difficult for people to speak up and raise concerns, particularly if they are about the behaviour or conduct of colleagues/line managers. We’ll post a link to her blog for Speak Up Month when it becomes available. Staff burnout A key factor for patient safety is happy and unexhausted staff. Patient Safety Watch is currently looking into the impact of burnout on the number of adverse incidents and this week the Select Committee has started its inquiry on the subject. This week's session heard that burnout rates are the highest we’ve seen in 11 years and focused on workforce planning, which was curiously absent from the 'People Plan' published in July. As Health Secretary I came to understand the complex link between patient safety and staff numbers - and the risk of neglecting the latter given the long lead times to train additional doctors and nurses. But how can we know we are training enough docs and nurses if the government/NHS won't say how many they think they will need in 10 years’ time? Lots of weaselly words at the moment about possibly publishing such numbers post spending review but the normally impressive Prerana Issar, the new NHS Chief People Officer, was unable to confirm whether the numbers would be published at all. That will be incredibly depressing for frontline staff who recognise it takes time to train people up but just want to know good plans are in place. On this issue I'll be back - as someone more scary than me once said. Not to forget social care where the impressive Martin Green from Care England called for an integrated workforce plan that addressed the workers needed, the skills required and set out a vision for career progression in the sector as part of a 10 year plan for the social care sector.
You can watch the full session here. Stat of the week healthcare systems spend on average 8.7% of their income dealing with the consequences of preventable harm, around 1% of most country's GDP, according to a report out yesterday from the OECD on the economics of patient safety. Jeremy Hunt
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