|
Good morning and welcome to my latest patient safety email. This week we look at the COVID-19 vaccine delivery plan, the latest scary numbers on the virus itself, as well as the select committee session on NHS and social care staff burnout, the government’s response to the Cumberlege review, maternity training and a new strategy for the CQC. But we start in our usual way with the pandemic… TIDE TURNING? The Zoe Covid Symptom Study run by Tim Spector is reporting a fall in cases in all regions apart from the North West - which he describes as possible light at the end of the tunnel. Against that the number of patients in hospital with COVID-19 is the highest it has ever been, the UK has just had its highest level of excess deaths since the Second World War and the number of people testing positive for the virus, being admitted to hospital with it, and dying with COVID-19 is still increasing. Here’s how Boris Johnson described the situation on the frontline to me at the Liaison Committee. Given the time lag between infections and NHS pressure, no wonder the govt is hesitating before introducing new restrictions. GLASS HALF EMPTY brigade was led this week by the ever-persuasive Chris Hopson who told the Select Committee that we may not now see peak demand for NHS services until February with the pressure on hospitals moving out from the SE to the Midlands, North and SW. GLASS HALF FULL as ever was Matt Hancock who, whatever mistakes have been made, surely deserves huge credit for setting up the vaccines task force last April and pre-ordering 367 million doses from seven suppliers. The vaccine delivery plan has now been published and with 40% of over 80s already jabbed is off to a pretty impressive start, not least compared to other countries. But even though the top 4 priority groups will get their first dose by 15th February, they will all then need second jabs so it is going to be a while before we get population level immunity. GP surgeries are currently being flooded with often angry and aggressive calls so we need to be better at setting expectations as I asked Matt Hancock on Tuesday. And better data would help - why don’t we know the number of vaccines delivered by local authority area or - crucially - the wastage rates? See if you are convinced by Boris’s answer to me on that point yesterday. WORKFORCE WORKFORCE WORKFORCE The standout moment from Tuesday’s Select Committee session for me was Chris Hopson arguing that the main long term reform we need to come out of the pandemic should be a commitment from government to a long-term, transparent workforce plan. I completely agree and think we need an independent body (either a new one or perhaps the ONS) to project how many staff the NHS will need over the next 10-20 years so we can hold the government to account for training the right numbers. Staffing issues are at the heart of so many patient safety problems but bitter experience of battles with the Treasury suggests that only a structural reform will solve things. STAMPING OUT BULLYING AND HARASSMENT is still a big issue if we are to address the other big workforce issue which is retention of staff. The Committee also heard this week from the brilliant and brave Helene Donnelly, a whistle-blower in the Mid Staffs case and now a Speak up Guardian, and Dr Henrietta Hughes, the National Guardian. Helene reminded us of the bullying and intimidation she went through for daring to speak out and sadly said she still sees some of that today. Dr Hughes spoke about how it is possible to change the culture of an organisation provided the leadership is signed up to creating a positive culture. Part of the problem - but not all of it - is surely that we put managers under so much pressure with targets, regulation and inspection that they spend too much time ‘managing up’ rather than looking after their own teams. FOR PEOPLE FROM BAME BACKGROUNDS IN PARTICULAR the situation was summed up soberingly by Chair of the NHS Confederation, Lord Victor Adebowale, as one when this 20% of the NHS workforce are bullied more, less likely to get promoted, less happy in the workplace and are more likely to leave. I actually think the NHS is one of the most inclusive workplace environments in the country, but given it employs 10% of the population nor is it immune to wider societal issues such as unconscious discrimination. WHILE WE’RE TALKING LONG TERM REFORM surely the other big one that must come in the wake of the pandemic is social care reform. Boris talked about solving the crisis when he arrived on the steps of Downing Street but since then public finances have been shot to pieces. I asked him whether his commitment still stood yesterday and got an encouraging reply. But nothing less than the 10 year plan the NHS has will be enough if we are really treating the two systems equally. CUMBERLEGE VICTORY In a major success for tenacious campaigner Julia Cumberlege the government has responded to the Independent Medicines and Medical Devices review by agreeing to take forward most of her recommendations including the creation of a Patient Safety Commissioner. I’m delighted about this having commissioned the original report although would prefer the role to sit in an existing patient safety body rather than further complicate the landscape by setting up a new quango. MATERNITY SAFETY TRAINING We are starting to see how the unexpected (but welcome) £9.4m for maternity safety in the spending review will be spent. A new £500,000 fund to train maternity unit leaders sounds encouraging. The wider issue is a lack of institutionalised training and re-training for frontline staff so the latest lessons are continually being transmitted across the system, something I am sure the forthcoming select committee report will have something to say on. NHS England is also setting up a national network of advocates for families and patients to avoid that terrible feeling of being ignored we heard about in Ockenden. More in this letter from the Chief Midwifery Officer and National Maternity Safety Champion - should we not combine/coordinate with what Healthwatch do again to avoid duplication? MENTAL HEALTH REFORM I was proud to appoint Sir Simon Wessely in a bit of a hurry (as we were in the middle of the ill-fated 2017 election campaign) to do his review of the Mental Capacity Act and yesterday the government brought forward its proposals in response. Much sensible and long overdue stuff here, but I hope we bite the bullet and follow Italy in closing down the ‘temporary’ assessment units that still house 2,060 people with autism and learning difficulties, often run by independent sector providers with high levels of restraint in a flagrant human rights breach. I asked Matt Hancock to be bold on this yesterday. UPDATED CQC STRATEGY The CQC has launched a consultation regarding its strategy which you can see here. It is good to see that “safety through learning” is one of the four key themes of this consultation and how they expect “learning and improvement to be the primary response to all safety concerns in all types of service.” The David Behan David Prior reforms live on. RESEARCH CORNER Not research exactly but an interesting article on maternity safety in the BMJ. Jeremy Hunt
|
