Good afternoon and welcome to my latest patient safety weekly email. This week I look t some of the still unlearned lessons from the first three Covid waves, whether we are going to get social care reform and the radical changes for the treatment of people with autism and learning disabilities that may just be around the corner.

COVID PROGRESS CONTINUES According to the ONS there were 90,000 people in the community in England with the virus in the week ending 16th April which is just over one per thousand people, astonishingly low by recent standards. And it’s still going down - just over 18,000 tested positive that week according to NHS Test and Trace – a 9% decrease on the previous week. There are currently around 1600 people in hospital with the virus, less than 2% of NHS beds, and deaths are also down. We’ve also given 33m vaccine first doses and nearly 13m second doses. All great news but could the applecart now be upset by the….

DIRE SITUATION IN INDIA There are only two things to say about what is happening: firstly it is a massive risk to the global fightback against Covid because of the real risk of new, much more dangerous variants emerging. But secondly it is just a terrible, terrible human tragedy with heartbreaking images of pyres burning and hospitals overflowing. Modi is a canny and populist Prime Minister and to those, like me, who worried about his stoking of ethnic division there is now those utterly irresponsible election rallies to add to the charge sheet. India has now reported a world record-breaking 300,000 new cases in one day alone earlier this week and some 200,000 deaths. The UK government has sent ventilators and oxygen equipment. Welcome but I hope we do more soon - another reason we should not be cutting our aid budget incidentally (if you want to hear me have another go on that one listen to this Commons exchange).

15% OF COVID CASES STILL HOSPITAL ACQUIRED This is something I’ve been talking about for ages and remains the biggest unlearned lesson of the pandemic. The most recent CO-CIN paper showed 15% of patients developed symptoms 7 days after being admitted to hospital but overall we know there were probably 8,000 deaths caused by people picking up infections in a hospital they were visiting for other reasons. The NHS was slow to require social distancing in non-Covid parts of hospitals last year and slow to introduce weekly testing of staff - but the fact it is still an issue even after those things were sorted out suggests we need a new approach with an airborne virus pandemic including a review of ventilation systems in hospitals. More on this in a twitter thread I did this morning on this here.

MORE CLASSIC DOM anticipated when Dominic Cummings, the PM’s former Chief Adviser, gives evidence to my joint inquiry in the lessons to be learned from Coronavirus. The Sunday Telegraph misreported me as ‘pledging’ to publish any documents he provides but it is none the less normal practice for select committees to publish evidence they receive. Provided it is relevant to the pandemic and our inquiry I would expect both committees to do the same although ultimately it is their decision.

SHOW STOPPER We’ve heard some powerful evidence at the Select Committee but none more so than this must watch from the mother of an autistic child telling us how she was separated from her autistic daughter on one hospital visit and forced to watch as she was physically pulled away from her and restrained. The treatment of around 2000 people with autism and learning disabilities is becoming a human rights scandal - everyone agrees community care would be better but no one is prepared to fund it (even though the inpatient units cost £11k a week).  Equally compelling was Dr Sara Ryan who’s son Connor Sparowhawk died in an assessment and treatment unit in 2013. Expect a strong select committee report on this one.

TIME FOR AN ITALIAN JOB? The really radical reform would be to copy the Trieste model which effectively ended all long-term admissions to inpatient units. After a certain period sectioning orders have to be signed off every week (as opposed to every six months here). I asked Minister Helen Whately what needs to change to actually get that to happen. I also wanted to know why we don’t just get on and ban the use of restraint. The door does seem to be open - Claire Murdoch who runs mental health for NHS England said she is a ‘fan’ and ‘advocate’ of the Trieste model and Helen Whately said she was willing to consider it. After all the efforts Norman Lamb and I made without anything like the success we wanted surely it is time to recognise that structural and legal changes are called for rather than more of the same.

LAURA BOOTH REFORMS NEEDED The inquest into Laura Booth’s tragic and untimely death has concluded shockingly that malnutrition from neglect by the hospital she was in contributed to her death. The coroner has called for all coroners to receive routine training on the Mental Capacity Act. Training matters but so too, surely, does having the right culture, especially when it comes to people with learning disabilities.

MEDICAL EXAMINERS ARE HERE The National Medical Examiner has published his first progress report stating that 48 acute trusts had established a medical examiner office at the start of 2020 and 130 by the end. Only five are now left to recruit one which is excellent news (although the five really should be on the naughty step for not pulling their finger out for nearly two years). Minister for Patient Safety, Nadine Dorries, spoke about these vital roles at the Royal College of Pathologists Annual Medical Examiners Conference.

MISCARRIAGE RESEARCH Published this week by the Lancet shows that miscarriage rates are a depressing 40% higher in black women. The Department of Health is currently working at addressing the disparities in maternity outcomes but this is closely linked to some of the issues that have been surfacing in our maternity safety inquiry. As the Lancet says, “For too long miscarriage has been minimised and often dismissed. The lack of medical progress should be shocking. Instead, there is a pervasive acceptance…The era of telling women to “just try again” is over”.

WORLD SEPSIS CONGRESS At the end of last week I spoke as part of the World Sepsis Congress to mark World Sepsis Day. Despite significant progress 11 million people die around the world every year as a result of sepsis. In the UK we owe a lot to brilliant campaigners like Melissa Mead, Scott and Sue Morrish and Ron Daniels. You can hear my remarks here.

WRONG SITE SURGERY REPORT HSIB’s latest report, out at the end of last week, looked at the lack of a system to identify the effectiveness of measures intended to stop serious incidents like wrong site surgery. Worryingly HSIB seem to be picking up a theme on this as Dr Stephen Drage their National Director of Investigations states: “[across the NHS] there are not clearly defined, well managed and strong systemic barriers in place to reduce safety risks”. HSIB are also publishing a report on the management of chronic asthma in children and holding a seminar to discuss it on 12th May. Details here.

DEMANDS FOR SOCIAL CARE REFORM A broad coalition from across politics and the social care sector have published an open letter calling for social care reform to be in the Queen’s Speech. The Times also called for this in their leader on Monday. With only a couple of weeks to go let’s hope the government is listening - it will be a key sign of their seriousness if it is included - and a major blow if it is not.

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Jeremy Hunt