|
Good morning and welcome to my new Patient Safety Weekly Update, fittingly going out on the morning of World Patient Safety Day 2020. I know some people were perplexed by my decision to turn down a Cabinet position and stand as Health Select Committee Chair. Was it really to spend more time with family...? Well yes, but also to campaign on patient safety - something I felt was unfinished business from my time as Health Secretary, when I was moved beyond measure by families who had suffered avoidable harm and devoted their lives to fighting for lessons to be learnt. This first email is dedicated to them (and also to Jack Blanchard of Politico fame, whose Westminster-transforming newsletter format is my inspiration, although you’ll be relieved to hear I don’t plan to go daily just yet). No to nosocomial Patient safety has been at the forefront of everyone’s minds with the pandemic, not least because of disturbing evidence about the number of people who actually caught the virus in a healthcare setting. We know 15000 residents died in care homes, a shockingly high number, not least when places like Hong Kong managed to avoid a single infection, let alone death, in their care homes (see my Select Committee interview with Professor Terry Lum of HK University). But less well publicised are the number of Coronavirus patients who caught the virus in a hospital rather than care home setting. According to SAGE evidence between 10-22% of all hospitalised patients picked up the virus from hospitals accounting for 5-11% of deaths at the time. It is always dangerous to extrapolate but that could mean up to 3,000 covid deaths were as a result of nosocomial (hospital-acquired) infections. Cover up… So it is fitting that today’s theme for the WHO World Patient Safety Day is the protection of healthcare workers, including asking countries to make a specific pledge on PPE. I will be launching it in a press conference with Dr Tedros at 0830 UK time, alongside, given the theme, the DG of the ILO. In the UK over 600 healthcare workers have died from Covid and whilst it is difficult to get a global estimate it is thought to be around 7,000. The WHO is launching a charter which it is encouraging its 193 members to sign up to - as with everything they do it is voluntary, but it is good they are giving such a high profile to this issue. …and test test test Following Lord Deighton’s appointment I am reasonably confident PPE issues are being sorted in England (I remember how formidable he was when we worked together on London 2012). But the real step forward we need in England is weekly testing of hospital staff, about which I talked to Nick Robinson at 0810 on the Today Programme yesterday. I have also written about it here and here. When around 70% of carriers are asymptomatic it is essential to give hospital staff and patients the confidence they are as near to Covid-free as possible - otherwise we will continue to see cancer patients staying away for fear of catching the virus when they are immuno-compromised. Talking of which there are clearly massive strains in the testing system at the moment, as has come up at PMQs two weeks running - and I asked Matt Hancock about on Tuesday in Parliament. In fairness to the government testing has increased from around 100k/day in May to 224,000 yesterday and is heading for the new 500,000 daily target by the end of October (very much on track according to Dido Harding). The issue seems to be that this has been accompanied by an even bigger spike in demand as offices and restaurants get back to normal - if one person tests positive, everyone in the workplace understandably wants to get tested. But don’t forget because of the virus incubation period (up to 14 days) such tests may not identify if you have the virus. Population testing Population testing, as advocated by Tony Blair, William Hague and others seems to me the only sustainable solution given that demand is likely to keep soaring. People would not get into a panicked rush for a test if they knew they would get one soon anyway. Such a solution may not be too far off: quadrupling October’s 500k daily test target would mean the whole population could be tested monthly, something well within the bounds of Operation Moonshot. But we need a plan based on existing technologies if people are to have confidence the end is in sight. It’s not just Covid We mustn't forget the impact that COVID-19 is having on other aspects of NHS patient safety. It was World Sepsis Day earlier this week and the Sepsis Trust produced some worrying figures showing that two thirds of people wouldn’t go to hospital if they showed the main symptoms of sepsis for fear of contracting Coronavirus. I spoke to Dr Ron Daniels yesterday who heads up the Trust and is one of the most formidable campaigners I know. We talked about the importance of making sure 111 handlers are able to spot potential signs of sepsis if A & Es move to call before you walk, as widely expected ahead of Christmas. …and cancer For cancer too there are some big worries as a result of Covid. Cancer Research UK estimates the backlog for cancer screening is now at 3 million people. They also think that between April and August 350,000 fewer people were referred than normal in the UK and that there was a 39% drop in the number of key diagnostic tests between March and July this year. These are worrying numbers and something the Health and Social Care Select Committee has been looking into. A report on non-COVID aspects of NHS care is due out soon but you can look at the evidence that inquiry received here. Maternity matters Another patient safety issue rising up the health agenda is the safety of maternity services in England. The specific coronavirus issue is whether partners are allowed to be present at births, mentioned at PMQs today, and something we can surely sort. But the broader issue is the Ockenden Review into maternity issues at Shrewsbury and Telford, now looking into nearly 2000 cases which would make it potentially a bigger disaster than Mid Staffs. At the same time Bill Kirkup, who did such a thorough job with the Morecambe Bay inquiry, is looking into unexpected baby deaths at East Kent and other hospitals. As a result the Health and Social Care Select Committee has opened an inquiry into maternity safety and you can submit evidence until 30th October. I wrote recently about my experience of dealing with the tragedies that occurred at Morecambe Bay and although I believe we have made some progress it is clear there is much, much more to do. Patient Safety Watch is the new charity I established last year which we will get around to holding a launch event for when such events can be held. I met many amazing people in my time as Health Secretary but those that inspired me the most were family members who campaigned bravely and tirelessly to find out what happened to loved ones they lost in order to make sure other families didn’t go through similar tragedies. Patient Safety Watch has been set up with such families in mind as they often struggled to get data on the scale of the issues they faced. It will therefore have a very narrow remit to commission leading universities to conduct independent research to quantify patient safety issues and I will shortly be announcing the first set of research that has been commissioned. And finally….the Health Service Safety Investigations Body Bill must remain in the Queen’s Speech! It is absolutely vital that HSIB is given statutory footing and that it maintains its responsibility for maternity investigations if we are to continue progress to the blame free investigations that will really allow doctors and nurses to speak openly - and therefore avoid repeating - mistakes. I asked the Health Secretary about this at the start of the month and again last week. He said that it was the government’s “full intention to legislate for it at the earliest chance”. This sounds promising but until the Queen’s Speech happens we won’t know for sure. Happy World Patient Safety Day and please feel free to share this email with friends/colleagues who can sign up here. Jeremy Hunt
|
