Good afternoon and welcome to the latest edition of my patient safety update. An action packed Select Committee session with Amanda Pritchard yesterday is our main feature together with concerns about the booster and teenage vaccination programme and related calls to move to plan B. We also cover the government’s GP announcement; the Dispatches programme on maternity safety and the HSIB report on missed diagnosis of lung cancer. As ever you can sign up to receive this update via our website here.

CLEARING THE BACKLOG was the focus of this week’s select committee session and we started by hearing powerful testimony from a patient called Sarah Lambrechts about the toll on her life of constant delays to having surgery. Money yes, shorter waiting times yes but she also talked about getting the culture right and a sense that the NHS didn’t care about her as a person - well worth a watch. More positively the IFS told the Committee that over the next two years the funding is “about enough” (precious words for any Health Secretary to hear) although did warn of a £5bn shortfall in three years’ time. The Kings Fund and - importantly - Amanda Pritchard basically agreed, saying that the extra funding the NHS is due to receive over the next three years will be enough for an additional 9 million checks, treatments and tests. Sensibly no promises are being made about clearing the backlog because we don’t know how many ‘phantom patients’ will materialize over the next few years after the artificial suppression of waiting lists during lockdown. Siva Anandaciva from the King’s Fund tellingly warned that it would take longer than 3 years to clear the backlog and even doing that would not return us to the 92% elective care standard.   

WORKFORCE WOES It won’t surprise regular readers that I spent some time talking about the apparent lack of a workforce plan to deliver these lofty ambitions. There seemed to be a lot of different programmes within the NHS, all of which will no doubt help recruit and retain staff to some degree, but still no sign of an overall plan to recruit the additional 4,000 doctors and 18,000 nurses the Health Foundation says we need. Indeed both Amanda Pritchard and Prof Steve Powis warned that it would be a mistake to freeze or cut HEE funding when next week’s budget is announced - the first time I can remember one arm’s length body making a direct plea for funding for another.

FOCUS ON GPs I welcomed the winter access fund and administrative changes designed to ease some of the pressure on GPs announced last week. But as I say in this thread I don’t think this package will turn the tide on the workforce crisis general practice is facing. We need a comprehensive workforce package that includes independent, long term workforce projections but also tackles the reasons clinical staff are retiring early or moving part time. Until we have that, more and more staff will retire early, work less hours or generally give up making the situation even more horrendous. We badly need that amendment to allow HEE to make independent annual workforce projections but so far the Treasury continue to dig their heels in -despite support for it from the Select Committee, every Royal College and every health think tank. Go on do it, you know it makes sense…

999, PLEASE HOLD It isn’t just lorry drivers where staff shortages are causing massive issues - yesterday it emerged that there is a shortage of 999 call handlers. Amanda Pritchard told the Select Committee there had been a surge in demand and we therefore lacked some capacity in that particular system. I also asked the Secretary of State about this yesterday and he seemed to suggest there were plans to address this to be revealed in the near future. I’ve followed up with some written parliamentary questions to get more detail.

COVID WARNING FLASHING AMBER This email has been highlighting the steady increase in cases picked up by the ONS survey for the last few weeks and it is now clear that with more hospitalisations and deaths than France or Germany our high cases are not just because we are testing more teenagers. Just 15% of 12-15 year olds in England have had their first jab and less than half of eligible over 50s have had the booster. Amanda Pritchard was clear that we don’t have a capacity issue and that the NHS is inviting everyone who is eligible for both programmes in a timely manner. So we need to turbocharge our efforts at getting people to take up these boosters. The NHS says that people aren’t responding to these invitations to the same extent as they did for the first wave of vaccinations so it may help that the government is changing tack for 12-15 year olds announcing that they will also be able to book their vaccines in national hubs in the same way adults can.

WHAT DO THE NUMBERS ACTUALLY SAY? According to the ONS 890,000 or 1 in 60 people have the virus in the community in England. This is up from 1 in 70 the week before. All three indicators on the COVID dashboard are showing red as cases (16.1%), deaths (14.6%) and hospitalisations (10%) are all up. The most alarming stat here is that having hovered around the 7,000 mark for weeks, the number of people actually in hospital jumped significantly over the last couple of days to 7749. Some of this may be due to a new Delta offshoot variant and the NHS Confederation has already called for plan b to be implemented and things like face coverings to be brought back. Sajid Javid will be announcing more on this at a No 10 press conference later today but plan B feels distinctly closer whatever the denials are from No 10.

HSIB AND LUNG CANCER The latest report from HSIB focuses on the causes of missed diagnosis of lung cancer focusing on the use of X-rays and non-smokers in particular. It recommends commissioning research into the clinical and cost effectiveness of low dose CT scans instead of X-rays and reviewing and improving advice and guidance for health professionals.

IS THE NHS BROKEN? That is the question the recent Channel 4 Dispatches programme tried to answer in a superbly produced programme fronted by Matthew Syed. The Guardian highlighted the widespread use of old CT and MRI scanners but it is well worth watching the whole thing if you get a chance as it covers workforce shortages, our low cancer survival rates, the blame culture and clinical negligence.

Jeremy Hunt