Good afternoon in what is turning into a huge week for patient safety today’s email includes the Select Committee report on maternity safety, confirmation of ‘Freedom day, the new Health and Care Bill presented to parliament and the NHS getting the George Cross. And there is a certain game going on tonight as well…Thoughts on (most of) these below and if you aren’t a subscriber, please do sign up here.

COVID GAMBLE All legal restrictions will be lifted on 19th July provided there is no rapid increase in hospital admissions between now and Monday. Genuinely difficult call: on the one hand covid deaths are now projected to be less than a bad flu year so there is a good argument that it is time to start treating it as a normal disease (and have a spike now rather than in the autumn/winter). On the other hand as Stephen Reicher says in this tweet 100k cases a day means potentially 6-8,000 more people ending up with severe long covid (the worst kind) every day, something that is also worrying Chris Whitty. The question no one can really answer is whether we will peak at 100k/day and how long we will be at that sort of level but people worried about the government’s tendency to take too many risks will note that Chris Whitty, Patrick Vallance and Neil Ferguson all appear to support the approach being taken.

TWO JABS AND YOU’RE FREE Fully vaccinated people won't have to isolate from 16th August if they are a close contact of someone with the virus. Saj gets his first friendly fire from the right wing press today for not doing it earlier given that up to 6 million people may end up being asked to isolate between now and then, as has the Duchess of Cambridge. In fairness it is still a big decision and one that has probably been forced on the government by increasing non-compliance including people deleting their apps. A more important issue is whether we will use the summer to fix the problems that remain with Test and Trace, particularly the people who have covid but still go to work, something I asked the Health Secretary about on Monday.

BLAME CULTURE AND STAFFING SHORTAGES are the two headline issues the Select Committee focuses on in its report on maternity safety. The report recognises some big progress (stillbirths down 25% and neonatal deaths down 30% over the last year) but says these are from a low base and points out 1000 more babies would live if we had Swedish safety levels.  The first independent report of the Committee’s expert panel has also been published and concluded that the Government’s overall progress to achieve key commitments in maternity services ‘requires improvement.’ Thank you to Professor Jane Dacre for doing a brilliant job on this with her team, something which added real weight and credibility to the select committee recommendations. The report’s main recommendations were an immediate increase of £200-350m per year for maternity services to fund 2000 more midwives and 500 more consultants; a proportion of budgets to be ring-fenced for training purposes; HSIB to share its learnings in a more systematic manner; and a reform of the litigation process so that families get compensation if an accident was avoidable rather than having to prove clinical negligence - the single biggest thing that sets doctors and families against each other in an adversarial rather than constructive relationship which makes it so much harder for lessons to be learned. 

PRE-EMPTIVE STRIKE The day before our report came out the government announced £2.45m to improve maternity safety. Most of this very welcome money will go on testing the best ways to spot early warning signs of babies in distress. £449,000 of it will go towards developing a new workforce planning tool which should address one of the Select Committee’s recommendations that suggested such a tool should be developed.

GOVT PRESSES GO ON HEALTH AND CARE BILL The Bill itself has now been published which I suspect was a final wish from Simon Stevens (who was inducted into the Lords yesterday). At the moment there’s nothing in there updating the CQC’s remit to ensure that they can inspect the new Integrated Care Systems for safety and quality of care which was a key recommendation of the Select Committee report on the Bill and something the government had indicated would happen. I understand there will be government amendments to that effect. More worryingly nothing on overhauling workforce planning or social care despite it being the Health and Care Bill, two gaping holes there will be a lot of noise about when it is debated next week.

CANCER BACKLOG I used the second of this week’s covid updates in Parliament to ask about plans the new Health Secretary has to address the cancer backlog. Not only does this need additional workforce to tackle it but also new capital investment across the country, including at my own Royal Surrey County Hospital which I visited last week.

GEORGE CROSS If you didn’t see it here’s the very touching hand-written note from the Queen to the NHS published yesterday. One of those occasions when the Monarch really did speak for the nation.

Jeremy Hunt