Good morning and welcome to the latest edition of my weekly patient safety email. This week I look at Chris Whitty’s stark warnings about lifting lockdown too quickly, the Select Committee session on the NHS White Paper, more thoughts on last week’s Budget, what the tragic case of baby Theo Ellis can teach us, and the latest from HSIB.

WHITTY’S WARNING Appearing in front of the Science and Technology Committee the Chief Medical Officer was very clear about the dangers of lifting restrictions too quickly. He pointed out that things can turn bad very quickly saying bluntly, “If you open up too fast, a lot more people die.” I don’t believe the scientific advice was right at the start of the pandemic but since then Whitty and Vallance have been spot on every time - so I hope the PM listens. It seems that he is given that the budget confirmed the various support measures will exist through to the autumn - we can take this sensibly and cautiously.

POSITIVE TRENDS CONTINUE with the ONS showing continued declining numbers of deaths from COVID (unlike many parts of Europe). The number of deaths registered in the latest week was still 1,143 higher than the five-year average but the number of deaths involving COVID was 1,252 lower than the previous week. NHS Test and Trace statistics show a 19% decrease in positive tests over one week and that the number of cases being transferred to their tracing system has been decreasing for the last seven weeks.

VACCINE DELIVERY The lockdown restrictions are no doubt the main driver of this continued good news but with more than 22 million people having now received their first dose of vaccine this will also have started playing a part. The government is confident it will have given a first dose to all adults by the end of July but Westminster watchers think it will be well before then.

NHS BUDGET PROBLEMS In a tradition going back as far as I can remember problems emerged from the Budget a day or two after it had been delivered. First we had the government’s recommended change in NHS staff pay rises from the 2.1% in the Long Term Plan to just 1% which is surely a miscalculation and certainly did not have the support of Sir Simon Stevens at this week's select committee. Surely the smart thing to do is to agree in advance that the government will accept the recommendations of the NHS Pay Review Body, something a government would not normally do but, hey, this is a pandemic.

BUDGET BLACK HOLE As I mentioned in the House there is a massive hole in budget funding with respect to the NHS which the OBR highlighted. The OBR stated that the Budget made “no explicit provision for virus-related costs beyond 2021-22” including any annual vaccination programme, NHS Test and Trace, long COVID, or the backlog in procedures caused by the pandemic (beyond the £1bn announced in the Spending Review last year). There is also an immediate problem for the coming financial year as Sir Simon said. My colleague Paul Bristow pressed Sir Simon on whether this £1bn in particular was enough and although recognising this was a “very important start” (oh the diplomacy) he clearly didn’t think it would be. On the issues highlighted by the OBR Sir Simon said it was the “expectation” that the NHS would get additional funding to cover them, presumably in the spending review, but given the sums involved will surely have a big impact on national finances and OBR forecasts it is a significant omission.

WHITE PAPER SELECT COMMITTEE SESSION Possibly one for the NHS governance geeks amongst our readers but we had a fascinating session on the White Paper with Sir Simon and Amanda Pritchard of NHSE&I. Sir Simon gave a robust defense of the timings of these reforms arguing that they were the final stage of a process that had really started back in 2014. He pointed out that 85% of the proposals were what the NHS had asked for after laughing when I asked if he disagreed with any of the rest. He agreed that the CQC should play a role in assessing the new ICSs and clearly thought not including social care in the proposals was disappointing. His explanation of the potential benefits of a ten-year plan to the social care sector is well worth a listen. Finally, on the other big gap in the proposals - workforce planning – he reiterated his (and my) thought that we need some form of independent projections on exactly what is needed. Amanda Pritchard confirmed what we heard last week that under-training actually costs more than training the right number of staff. Next week we hear from Matt Hancock.

MATERNITY TRAGEDY Shaun Lintern has the details of the tragic story of baby Theo Ellis who died after mistakes during his birth at Frimley Park Hospital in April 2019. Away from the obviously heartbreaking story itself and serious mistakes that were made, it is at least progress that there has been a proper apology from the Trust and an acknowledgement they got things wrong. They have also said they’ve made changes to their procedures as a result of HSIB’s investigation into this case. As a side note the case for a scan for potential breach births is something the Select Committee is considering which may help reduce the number of incidents like this in the future. 

HSIB NATIONAL INVESTIGATIONS Last week HSIB published a national investigation warning of the dangers of “residual drugs” to patients and concluded that “current mitigations don’t eliminate the hazard or ‘design’ it out”. They have introduced one recommendation to address this and will be doing further work in the future to further help mitigate this particular risk. This week their report highlights time critical delays to heart attack treatments.

INTERNATIONAL WOMEN’S DAY To mark this day earlier this week the government published a call for evidence to help inform their Women’s Health Strategy. This included some interesting stats on why we need to focus on women’s health – female life expectancy has increased more slowly then men’s since the 1980s, it takes 7-8 years for a diagnosis of endometriosis, and women have more than double the rate of death in the 30 days following heart attack compared with men. So please do respond to this call in the next 12 weeks if you have something to say on it.

Jeremy Hunt