Good afternoon and welcome to this week’s patient safety update. The Select Committee report into the government’s handling of the pandemic is the major focus this week but we also have a think tank preview of the budget and spending review coming up later this month. As ever here’s the link to sign up if you have not done so.

COVID REPORT A year in the making, the joint Science and Technology/Health and Social Care Select Committee report on the government’s handling of the pandemic was published yesterday. By far the most important report my committee has done, most of the coverage reflected the essential paradox that our national response ranged from terrible errors to extraordinary successes. As I explain in this thread the initial response was too slow and hampered by groupthink which failed to look carefully enough at approaches being taken in Taiwan and South Korea; that delay made a lockdown inevitable but also meant Test and Trace had to cope with an impossibly high number of daily infections when it was finally set up and social care was neglected as all attention focused on stopping a Lombardy-style meltdown in hospitals. At the same time - and what makes a clean judgement particularly difficult - the very same people were pre-buying 400 million doses of vaccine without knowing if it worked and giving us the best vaccine programme in the world and scientists in Oxford were discovering treatments that saved a million lives globally. The key lessons to learn are to avoid groupthink, make decisions more quickly, build in greater latent capacity in both health and care systems, and make use of science and innovation to reform how we handle pandemics in the future. 

REFLECTIONS ONE DAY ON Most coverage responses reflect this position. A few criticised me personally as Health Secretary for 6 years until 2018 and certainly the flu groupthink was there then (and I was a part of it) - how else could Operation Cygnus have concluded without mentioning testing once? But I do believe the contents of the report are scrupulously balanced: 22 MPs spanning the three big parties at Westminster went through it line by line and agreed it unanimously. 

WILL WE LEARN? The government must now publish a response to the report within 60 days. That was the real purpose of the report - to make recommendations that could be implemented right away and certainly before any future pandemic. Let’s see what the government says but top of my list would be the requirement for local authorities to have the capacity to stand up local test and trace functions within 7 days of a pandemic being declared. Fingers crossed.

GREEN BUDGET The Institute for Fiscal Studies has produced their traditional Budget/Spending Review preview document and the section on health and social care is well worth a read. They concluded that the Health and Care Levy should mean that for the next two years the NHS has “enough to meet the pressures” caused by the pandemic but that this funding “is less likely” to be sufficient over the medium term. They are concerned that £5bn of covid related pressures in 2024/25 are unfunded. Something I’ll be asking them more about when they appear in front of the Select Committee next week.  

FUNDING UNCERTAINTY This King’s Fund briefing focuses on the financial aspects of the workforce crisis stating that “allocating specific funding to a workforce strategy to invest in training, development and wellbeing should be a priority for the Comprehensive Spending Review.” With day to day health spending set to rise nearly 4% a year between 2018/19 and 2024/25 there is a real risk that hoped-for improvements for patients could be put at risk by the ongoing workforce crisis so this one well worth reading. And what will happen to the HEE budget? One of the most crucial bits of budget small print we will all be examining.

WORKFORCE WARNING The Health Foundation have produced a helpful note on health and care funding which puts some numbers on this. They say that to keep pace with demand and recover from the pandemic we’ll need a whopping 488,000 more healthcare staff (up 405) and 627,000 social care staff (up 55%) by 2030/31. Surely more grist to the mill for those of us arguing time for a full scale rethink of how we recruit, train and retain.

CURRENT CARE JOBS As well as major long term challenges Skills for Care have today highlighted the immediate problems facing the sector in the annual state of the workforce report. Worryingly it states that “as of August 2021, vacancy rates are now back above their pre-pandemic levels with an average of 105,000 vacancies”. So we need to look at short term fixes too. 

COVID STATS Finally this week, just as a reminder that we are still, very obviously, dealing with the virus the ONS found another rise in the number of cases in the community - there were 786,000 in England in the week ending 2nd October. This represented 1 in 70 people compared to 1 in 85 in the previous week and 1 in 90 the week before that. This steady increase over a number of weeks is starting to look worrying. The COVID dashboard shows a rise in cases, deaths and daily hospitalisations too. The number of patients actually in hospital with COVID has remained stubbornly around the 7,000 mark since 25th September - it isn’t rising thanks to the vaccine but nor is it declining. Particularly worrying is the fact that nearly one fifth of those in hospital with the virus are unvaccinated pregnant women. 

Jeremy Hunt