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Good morning and welcome to my latest update on all things patient safety related. This week we take a look at nosocomial Covid infections, social care, burnout and maternity. What links them all? Sadly too much avoidable harm across all of them… Nosocomial Covid infections are back on the rise in NHS hospitals and it is incredibly depressing to see we are still not learning lessons from Wave 1. The HSJ picked up that 50 people each day are catching COVID-19 in North West hospitals. First time round ignorance was an excuse, but this time it is not. We know 50% of Covid transmission is asymptomatic, we know the three most vulnerable groups are care home residents, hospital patients and healthcare workers and we know the only way to stop it is through social distancing, PPE and weekly or twice weekly testing. So why isn't it happening? Clues in the HSIB report published this morning on nosocomial infections in hospitals which is politely damning, saying there is a “lack of clarity regarding national responsibilities, ownership, and process for the development of national infection prevention and control (IPC) guidance”, that the potential for staff transmission is “not always well understood” in the trusts they examined and recommends a transparent process “to co-ordinate the development, dissemination and implementation of national (IPC) guidance.” I would put it more bluntly: when are we going to get weekly or twice weekly testing of NHS frontline staff to protect both them and patients? It was a national scandal when we got this wrong before and that was put right in care homes but it would be beyond comprehension to get it wrong a second time in hospitals. There is also good stuff in the HSIB report on burnout saying staff fatigue and emotional distress may 'impact on the NHS’s ability to mitigate against nosocomial transmission of COVID-19' - more on burnout later. £7bn for social care please As last week’s email was winging its way to you the Select Committee was publishing our report into social care funding which won't have endeared me to the Treasury. The report calls for a £7bn annual increase in social care funding by 2024 as a starting point - but points out this really is the minimum required for the Dilnot reforms, demographic changes and increases in the National Living Wage. Even £7bn (a 40% increase in the annual budget by the last year of the parliament) won't by itself improve access or quality. It is one of my biggest regrets of my time in office that although I secured a long-term funding settlement and 10 year plan for the NHS I was unable to do so for social care. I hope this government has the courage to do so - despite the emptying of national coffers caused by the pandemic. I wrote for the Mail my argument as to why this is an 'Attlee' moment for a Conservative government to prove its progressive credentials and there is strong support across the spectrum as evidenced by backing from the Guardian, the Economist and even Nick Ferrari so fingers crossed. Not to forget the link between patient safety and staff burnout as our select committee inquiry continues on that front. The People Plan has, I think, fantastic stuff on mental health support for staff and the benefits of creating a positive working environment. But where are the long-term workforce projections so that NHS staff know we are actually training and recruiting enough staff to fill the gaps? Professor Michael West identified chronic excessive workload as a key driver of burnout - but DHSC and the Treasury are clearly vetoing the publication of these numbers until after the spending review. My concern is a) when they are published will they be the actual numbers the NHS thinks it needs or what DHSC has been bargained down to accepting in the spending review? b) do we have to wait another year until the multi-year spending review is completed this time next year - in other words another year when we are not even starting to train the staff we will need? I’ve written to the NHS Chief People Officer seeking clarity on this. It takes 7 years to train a doctor meaning that the 25% increase I announced in 2016 will not actually feed through to any new doctors until 2024. If we need more doctors (as I suspect we do) and do not announce the plans until the end of next year we would not actually see any new docs until 2029, the last year of the 10 year plan. Surely shome mistake? Maternity services during the pandemic I was interviewed for last week’s Ridge on Sunday programme as part of an excellent package they put together on the continued difficulties expectant mothers are facing using maternity services without partners being allowed. It isn't just about sharing those happy moments but also making sure a mum gets emotional support if she has to cope with the tragedies that also sadly happen. Most hospitals are trying to sort the issue but there is a genuine concern about reducing the risk of infection in wards, especially to higher risk BAME or obese mothers. Surely a simple solution would be to allow a partner, loved one, or friend to be tested and if negative to attend appointments with prospective mothers? As we increase testing capacity to closer to 1m/day by the end of the year, including with the new on the spot lateral flow testing kits, we really should be able to sort this. The Independent shines a spotlight again on Morecombe Bay Earlier this week the Independent reported the worrying story of Jenny Feasey who tragically lost her son Toby due to an avoidable mistake at Morecombe Bay in 2017. This story brings back horrific memories for a few of us involved in Patient Safety Watch as it is just five years since the independent inquiry into the same Trust found failings had led to the avoidable deaths of 11 babies and one mother. These included Joshua Titcombe, the son of one of our Trustees. In Toby’s case the Trust has admitted negligence but only after a three-year process. I'm backing the Independent’s campaign to improve maternity safety led by the redoubtable Shaun Lintern. Next stop litigation reform, which we will be looking at in next week's Select Committee on 3 November. Speak Up Month continues As promised last week you can now read Mid Staffs whistleblower Helene Donnelly’s powerful article on understanding and uniting on the National Guardian’s website along side my video on the issue.. Healthwatch Research on COVID-19 discharge Some interesting findings from this piece of research by Healthwatch on the discharge experiences of COVID-19 patients. Around a fifth felt their discharge was rushed and more than a third weren’t given a contact they could use for follow up advice. More worryingly 30% had delays to their COVID test results which meant they could have been discharged with the virus. How we provide decent, safe care for those recovering from the virus will be occupying a lot of thinking if yesterday’s predictions about Wave 2 being worse than Wave 1 turn out to be true. Stat of the week Around 5% of hospital deaths could have been prevented in England, the Netherlands and Canada according to research quoted by the OECD last week. As patient safety campaigners constantly say, this is not an NHS issue but about the way healthcare is delivered everywhere. Jeremy Hunt
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