Good afternoon and welcome to my latest patient safety update. This week I look at the latest good news on COVID-19, the select committee session on the treatment of people with autism and/or learning disabilities, HSIB’s latest investigation and an update on social care reform.

COVID LATEST Cases have dropped by 60% since February according to the latest REACT Survey although they reported that “the speed of this decline started to plateau from mid-March”. The government’s dashboard backs this up as we’ve seen the new daily cases dip below the 2,000 mark for the first time since August and daily deaths have been low for a few days now. The ONS has also highlighted that we’ve had four weeks in a row of total deaths have been below the five year average. BUT (there always is one) things are much less rosy elsewhere which is likely to affect us in due course: Europe is in the midst of a nasty third wave, with herd-immunity Sweden now having the highest per capita number of cases of anywhere on the continent; and Brazil, with a quarter of all deaths globally, is now grappling with the horrible P1 variant that seems to re-infect people who have already had the virus. We have our mini-outbreak of the South African variant in South London which feels like it will be containable but is a salutary reminder of the risks of variants and mutations. I reflected on these issues with Evan Davies on Radio 4’s PM yesterday (37 mins 30 secs in).

VACCINE LATEST Good news that a few days ahead of schedule we’ve now offered a first dose to everyone in the top 9 priority groups. The focus for this month now turns to second doses and we’ve already hit around 8 million of these. The programme will definitely be helped by the fact that the first Moderna jab was given in England this week and in the long term these ‘mix and match’ trials may also make things easier. However worries about the AZ jab won’t have been helped by the news that the US has halted roll out of the single jab J & J vaccine over similar blood clot worries - both vaccines being based on similar technology.

SWISS CHEESE PROTECTION An interesting explanation of why we can’t rely entirely on vaccines in this ‘swiss cheese’ model of protection by the BBC. This argues that no one method of protection, whether that’s vaccines, social distancing, test and trace, masks etc is 100% effective but all used in combination can be. This is of course what is happening in Lambeth and Wandsworth which is what the armed forces would call a full spectrum response. Whisper it quietly but being able to surge capacity to 650,000 tests this quickly - all with genomic testing and backwards/forwards contact tracing - may indeed be getting closer to that roundly ridiculed moniker ‘world beating.’

EMERGENCY MEDICINE WARNING The Royal College of Emergency Medicine has issued a stark warning that emergency departments could face overcrowding within weeks as patients return to hospitals. One to watch - not least the crucial question of whether we are using the summer months to prepare for this winter’s pressure.

SHOULD WE BAN LONG STAY MENTAL HEALTH ADMISSIONS FOR PEOPLE WITH AUTISM?  That is the bold approach taken in Trieste, which seems to be gathering support here judging from yesterday’s Select Committee. The session was well worth watching back for its thought provoking and at times shocking evidence on just how inhumane our treatment is of people with autism and learning disabilities. Journalist and campaigner Ian Birrell set out some horrific tales of cruelty and harm in his arresting testimony. He argued that the root cause of these terrible cases is that “we have a society that doesn’t respect people with autism and people with learning disabilities” and still admits people for treatment when these are untreatable conditions. He explained how his “mind was blown” by his visit to Trieste in Italy where the system based on the rights of individuals and restraint hasn’t been used in decades. We heard more details regarding how this system works and its strengths and weaknesses from Dr Davidson and Dr Courtney from the Royal College of Psychiatrists who supported the model in principle but pointed out it hadn’t worked well across all parts of Italy.

RESTRAINT, SECLUSION, AND LACK OF CARE PLANS were just some of the findings Baroness Hollins had uncovered as part of her independent review into the care of 26 people in long term seclusion. More than half were found to be autistic, many had learning disabilities, few had treatment plans, and there were no obvious points that they would be discharged. This really echoed what Ian Birrell had been saying about how people with non-treatable conditions get stuck in a system which makes them worse. 

HOW TO GET REAL CHANGE? My former Ministerial colleague Sir Norman Lamb gave a very persuasive explanation for why changing our current model of care had thus far failed. He argued that money was supposed to be pooled by the NHS and local authorities and then follow the patient into the community but that this simply had not happened. He also made the very reasonable point that sorting out the social care system was an absolute precondition for successfully moving people with autism and learning disabilities into good quality community care. Like Ian Birrell he was “inspired” by Trieste describing how they had ‘deinstitutionalised’ care of mental health patients, those with autism and those with learning disabilities. 

THE SOLUTIONS? Having come to a general conclusion that the problem was that there were too many people being treated inside institutions and not in the community we finished the session with a quick fire round up of the one thing the witnesses would change if they could. These included sorting out the transition from child to adult services, charging community providers for every admission and taking a close look at what worked historically. Well worth a watch.

MATERNITY SAFETY INQUIRY Big news on Select Committee corridor has been my committee’s decision to Ofsted-rate government progress on key commitments. We have appointed an Independent Expert Panel to assess the government’s performance against its own objectives on maternity safety in this area and last week we published an exchange of letters between myself and the Secretary of State setting out the objectives they will look at. You can see my letter here and the response which provides a very handy overview of all the government’s maternity safety ambitions and objectives. The Panel will report before the summer break.

MATERNITY STAFFING LEVELS Some important details regarding the £100m funding announced a few weeks ago in this Shaun Lintern piece. Trusts are being told to use their share of this funding to increase maternity staffing levels, and in particular bring midwife levels up to Birthrate Plus mandated levels. Brilliant news - but sadly we can’t do the same for doctors yet as there is no equivalent tool, something the Select Committee is pushing for.

VISA EXTENSION Last week the government announced that around 14,000 healthcare workers have had their visas automatically extended by one year. This is great news although as NHS Providers pointed out and the NHS Confederation also highlighted what about the social care workers in the same situation? Actions not words please on social care…

SOCIAL CARE Speaking of social care I followed up on the Prime Minister’s pledge to introduce a ten-year plan for the sector by asking the Health Secretary for more details on what would be in this and whether people would have an opportunity to feed into it. He was rather mealy-mouthed with his reply but he did say that a series of roundtable meetings with key experts was under way.

NEW HSIB INVESTIGATION has been launched into the risk of an unintentional overdose of paracetamol into low body weight adults. This follows a number of incidents where low body weight people were prescribed a standard dose of this common drug and went on to experience liver damage.

NORTHERN IRELAND MEDICAL COVER UPS An interesting piece from the Belfast Telegraph highlighting that three quarters of respondents to a Northern Ireland Department of Health survey thought it should be a crime for healthcare staff to withhold information or otherwise cover things up when patients are harmed in care.

NHS CONFED APPOINTMENT Congratulations to Matthew Taylor who has been appointed CEO of the NHS Confederation. I look forward to working with him to address long term work force planning issues in particular - Matthew will be brilliant.

Jeremy Hunt