Good afternoon and welcome to my latest patient safety update. This week I look at what the Indian variant means for our COVID strategy, the Select Committee’s dementia inquiry, social care reform, the Panorama investigation into unpublished safety reviews and the government’s NHS White Paper. As ever if you enjoy these emails please forward it to a friend. And if you’ve been forwarded it then sign up here.

INDIAN SUMMER The B.1617.2 variant first found in India is set to become the dominant strain of COVID-19 in the UK in the next few days. Modelling for SAGE has said it could be up to 50% more transmissible. And the Health Secretary confirmed the other day that there were 2,323 cases of it in the UK, 483 of which were in Bolton and Blackburn and Darwen. The government is using tactics similar to those deployed to get the South African strain under control with surge testing deployed and a big push on vaccinations. But they are not doing surge vaccinations which is puzzling a few of us given previous data about vaccinations preventing transmission.

DÉJÀ VU? Once again its summertime and people’s thoughts are turning to the lifting of restrictions, local lockdowns and travel bans being lifted. Sound familiar? Two things make it different from last year: the vaccine rollout and new variants. Which of these two dominate thinking will determine an awful lot of sangria sales.

VACCINE EFFECT Early evidence is that the vaccine still works against the B.1617.2 strain and 36m people have had a first dose, 20m two doses, and we’re on track to offer all adults a first dose by the end of July. The majority of those in hospital due to this strain were eligible for the vaccine but hadn’t had it. But what about the impact on transmissibility? We know it reduces it for other strains but nothing yet on this one although there is no particular reason to think it would be different.

BORDERS AND VARIANTS Not the name of second-rate law firm but the main issues at the heart of our continued response. I’ve been critical of our border controls in the past but Matt Hancock does have a reasonable point when he says India was put on the red list before the variant was of concern. And we did so before many other countries. The real question is whether you will ever be able to stop new variants coming in. Of course if one was vaccine immune you should try everything to keep it out - which suggests the key is to work out more quickly which variants are really dangerous before you have to make decisions on borders. 

RED/AMBER/GREEN One thing that does seem to have been missed in all of the debates on border controls is that the official advice has always been not to travel to amber listed countries. The Health Secretary confirmed this in an answer to me on Monday but it seems to have caused confusion even amongst Ministers. Maybe ditching amber and simply having Red and Green would’ve been better?

DEMENTIA BATTLES One thing that has come to the surface in the pandemic is the need to give better care to families living with dementia. This was the topic of discussion at this week’s Select Committee session. We heard from Jonathan, whose mother was one of 17,000 people over the last year who had to sell their home to pay for their care, well worth a listen. And in what I think was a first, John, who was diagnosed with dementia five years ago, gave a heart-breaking account of how this horrible disease affected him and how he’d changed at work from the person people went to, to the person they kept away from.

SOLUTIONS? The Alzheimer’s Society, Age UK and LGA then gave their views about solutions. Top of the agenda was - surprise surprise - social care reform and better support for the valiant social care workforce. Caroline Abrahams from Age UK said they need parity of treatment with NHS colleagues and Sarah Pickup from the LGA said she’d focus on giving people greater choice over their long-term care. We also discussed how to pay for these reforms which seems to be the blocker with the government at the moment.

SOCIAL CARE STATISTICS The government has published the first batch of monthly social care stats and for a small release there’s a lot of news in there. As of 26th April a rather shocking 20% of social care staff in older adult care homes still haven’t been vaccinated. The government has been consulting on making this mandatory so why the wait? 22% of care homes still had staff working in another health or social care setting - what happened to the ban on staff working in more than one setting?

NHS BILL REPORT Away from social care the Select Committee published its report on the government’s NHS White Paper. We think these reforms could improve care for patients provided ICSs are inspected on the quality and safety of the care they are responsible for. We also point out that social care reform and an overhaul of NHS workforce planning are the two glaring omissions. NHS Providers highlight similar issues helpfully in this document.

QUEEN’S SPEECH DEBATE This Bill was the main subject of the final day of debate on the Queen’s Speech. I used my contribution to highlight how safety and quality of care should be at the heart of what we ask from healthcare providers – something gleaned from meeting numerous patients and their families in my time as Health Secretary. In fairness Matt Hancock has listened to the Committee’s call for ICSs to be inspected by the CQC and that quality and safety will be a “core focus” when rating them. It would be the worst possible regulatory nightmare if ICS were being tugged in different directions to hospitals and surgeries as I told the HSJ.

INDEPENDENT REVIEW SECRECY Panorama tonight looks at how NHS Trusts are routinely failing to publish the independent reviews they have commissioned and that are carried out by Royal Colleges. Of the 260 such reviews that have been conducted only 16 have been published and only 26 shared with the CQC. More details are here and I think it is time we looked at introducing a legal duty to publish these reviews. Transparency is always the best outcome and in my experience the only way to earn the trust of patients affected when things go wrong.

HOW’S HSIB DOING? The first 22 HSIB safety investigations have been analysed (by HSIB themselves) and three broad themes identified within them. These are access to care and transitions of care, communication and decision making and checking. These investigations contained 85 safety recommendations and they are working on a National Learning Report to look in more detail at these. I’d be interested to know how many of these recommendations have been adopted.

MANDATORY READING this week is this amazing piece from Mersey Care CEO Joe Rafferty. I’ve long admired the work Joe and his team are doing and this article on ‘psychological safety’ is definitely worth a read.

Jeremy Hunt