Good afternoon and welcome to this week’s patient safety update. Today we look at Covid news and also a growing campaign to improve health and care workforce planning; we also cover East Kent’s maternity issues, a couple of CQC inspections related to hospital acquired COVID, HSIB’s bulletin on surgical care in independent hospitals and the Select Committee session on young people’s mental health services.

COVID SUNSHINE The situation in the UK continues to improve with the ONS reporting a further decrease in community cases. They now estimate that just 112,600 people in England had COVID-19 in the week ending 10th April. NHS Test and Trace also reflects this decline with just 19,000 people testing positive between 1st and 7th April – a 34% decrease on the previous week. Hospitalisations and deaths also continue to decline with just over 2,000 people in hospital with covid, down 94% from the peak and the current average number of daily deaths is 25—down 98%. The uptick from schools going back hasn’t happened - but nor did we get one when the pubs opened last August. Worth noting the Boris quote from yesterday’s press conference "the majority of scientific opinion in this country is still firmly of the view that there will be another wave of Covid at some stage this year."  

CARRY ON JABBING The roll out continues to impress with 33m people having had a first dose and over 10m their second. Overall take up has been encouraging with 94% of all over 50s getting the vaccine. It’s still lower - although heading up - amongst some ethnic minority groups. To work alongside the vaccines the government has also announced a taskforce looking into antiviral tablets to tackle the virus which would be brilliant if it can be pulled off.

LEAKY BORDERS One of the ironies of the pandemic has been the left rushing to keep foreigners out when the right has been determined to allow them to come in. Few would disagree now that we were too slow to close borders last year which is why there is somewhat predictable criticism that the decision to add India to the red list came too late. We now have just over 100 cases of the Indian variant (although the actual number of cases may be significantly higher) but with the vaccine roll out we are surely right to be trying to get borders open where we can because like or not we will be living with Covid for a very long time.

CRACKDOWN ON HOSPITAL INFECTIONS Surely one of the biggest failures of the pandemic has been the high number of hospital deaths caused by people who picked up their infection in the same hospital. The CQC has now published a couple of reports on COVID-19 infection control at Mid and South Essex NHS Trust and the Wirral University Teaching Hospital NHS Foundation. They report generally good adherence to the guidelines which begs the question as to whether those guidelines were adequate for an air-born infection.

DANISH CORONAPASS While the debate is still going on in the UK about how and whether to use some form of COVID status certification the Danes are already using one to help them open up. Well worth a read of what it involves as it may be coming to a pub near you…  

WORKFORCE SHORTAGES - SOLUTION IN SIGHT? The three main health think tanks have written to me and the Secretary of State with a sensible proposal to address the long-term workforce problems the health and care system face. Their suggestion is for a new clause in the forthcoming NHS Bill to give Health Education England a statutory duty to publish “annual, independently verified projections of the future supply of the health care workforce in England and how those projections compare to projected demand for health care workforce in England for a 15-year period”. This has great merit because it would create an OBR-style discipline on the government to make sure it is training enough doctors and nurses (at the moment the system is shrouded in secrecy and DHSC won’t even release what their long term workforce projections are). Chris Hopson from NHS Providers also seems to agree. Listen to me asking Matt Hancock to give it serious consideration on Monday. He promised to do so but didn’t sound overly enthusiastic about it so this is one to keep pressing on.  

PATIENTS STOLE THE SHOW at the select committee session yesterday on the provision of children and young people’s mental health services. Just watch this testimony from Lucas and Hope about the challenges of getting early help. Lucas was given a two year wait for a CAMHS appointment after self-harming at the age of 14 and Hope was fobbed off about her urgent need for help with anorexia. 

AUSSIE RULES We also heard from Professor Pat McGorry who set up a brilliant inegrated service for teens in Melbourne. The best bit was that it covers the years 12-25 so there is no transition cliff edge at 18.  Cassandra Harrison from Youth Access Service spoke about similar systems here in the UK arguing that community based, holistic services, open to everyone work the best.

SCHOOLS RULE It was very encouraging that the government is ahead of target for the rollout of schools services as envisaged in my green paper of 2017. We heard from Dr Aleisha Clarke from the Early Intervention Foundation who summarised the evidence on how effective such interventions are. Tim Bowen the Head Teacher at Maple Primary School, one of the trailblazer areas for Mental Health Support Teams, explained how this system meant they always had someone they could refer children to for help. Professor Peter Fonagy who helped write paper proposing these teams said one study of 2300 cases in London had shown that 60% of children seen through this system recovered. He also pointed out that there are 180 such teams active now and by April 2023 there will be 400 covering 3m pupils and 35% of schools.

SORRY AT LAST You will no doubt have seen the news that lawyers for East Kent Hospital Trust finally admitted failing to provide safe care for baby Harry Richford bringing “some level of justice” for his family according to his mother Sarah. Given Harry died in 2017 that is nearly four years of agonising battling that could surely have been avoided. However Sarah Richford was positive about the improvements in maternity safety since then saying they proved that “with the right level of focus, leadership and attention, babies' lives can be saved.”

GLOBAL PUSH At a recent WHO meeting on maternity safety (their patient safety theme of the year) I was struck by a comment from Dr Zsuzsanna Jakab, WHO Deputy DG who said every day around 7,000 new babies and 800 mothers die around the world. So as we look at clinical practice and issues of poor culture in our maternity units let’s not forget the lack of basic healthcare facilities - and clean water - makes it an even bigger priority in many countries. 

HSIB NOT GIVING THE INDEPENDENT SECTOR A FREE PASS HSIB has published a bulletin about its investigation on safe surgical care in independent hospitals. They launched this back in February following a case where someone died from sepsis. Particularly important given the role the independent sector has played during the COVID-19 pandemic.

PODDING ON I had a fascinating discussion with Adam Brimelow and Chris Hopson for the latest NHS Providers Podcast which should be released tomorrow - we discussed the pandemic, social care, patient safety and workforce planning.  

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Jeremy Hunt