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Good morning and welcome to my latest Patient Safety update. Covid vaccines and mass testing are finally offering some light at the end of the tunnel which will hopefully mean we can start to focus back on 'normal' patient safety issues such as maternity safety (including Shrewsbury and Telford), the Cumberlege review and apparent cover-ups at Great Ormond Street Hospital. I look at these and coronavirus issues and more below. Health Secretary at the Select Committee The top line from Matt Hancock's appearance on Tuesday is that he thinks we’ll be “getting back to normal” after Easter, although he warned some interventions would still be needed. The sparks flew a bit on the thornier question of whether he got the right scientific advice at the start of the pandemic including a minor diversion as to whether he “followed” or was “guided” by the science. What I wanted to understand was why SAGE only modelled South Korean test and trace at the end of April, two months after the first case had arrived in the UK. He rightly wants to be loyal to his team, but if we are to prevent the same mistakes happening again we need to understand why we failed to follow WHO advice for so long. An obvious remedy would be to publish SAGE advice as it is received so it can effectively be peer-reviewed in real time. Failing the test I also pushed him on the sub-par performance of NHS Test and Trace which was suppose to avert the need for another lockdown. I asked who was responsible for compliance with requests to isolate to which he said the whole of government - itself not entirely reassuring. On a more positive note the Secretary of State talked about using the lessons from testing and the fact we’ve now developed a world leading diagnostics infrastructure to revolutionise healthcare. How have we compared to other countries? Professor Devi Sridar also gave evidence to the Committee on what lessons we need to learn including this helpful summary of how she thought we did compared to other nations. In short, not that well mainly because we based our initial response on influenza unlike East Asian countries who followed a SARS/MERs playbook. I of course bear some responsibility for that, and it is clear now there was groupthink amongst the scientific and medical establishments of Western Europe and North America over many years that focused our pandemic preparations around flu. We look rather ruefully now at the Johns Hopkins GHSI index showing the UK was the second best prepared country in the world for a pandemic. Mass testing update The impact of the government commitment to mass testing and the resulting increased capacity in testing has been obvious over the last week with a raft of welcome new announcements. We’ve seen a testing strategy for international arrivals, a cohort testing pilot for university students and more local authorities being sent lateral flow tests. A particularly well-received announcement at the end of last week was that care workers looking after people in their own homes are now to be tested weekly. The government is also looking to roll this out to live-in carers and personal assistants in the coming weeks. Great Ormond Street Hospital Cover Up? A truly horrific story from the Independent at the end of last week regarding the tragic death of baby Jasmine Hughes. Two doctors have reviewed computer files from Great Ormond Street and Lister hospitals where Jasmine was treated at and uncovered evidence that her case notes were “mysteriously lost, or been deliberately culled and manipulated to expunge the truth”. One concluded that there therefore had been a “concerted effort” to conceal the truth about why Jasmine died. I have written my take on this here. What really saddens me is not that mistakes were made but the lack of transparency after things went wrong. Clearly much work to do tackling the blame culture in the NHS if even a world-class hospital is behaving like this. First Do No Harm All Party Parliamentary Group Last week Baroness Julia Cumberlege and I launched a new All Party Parliamentary Group to campaign for the implementation of her outstanding report of the Independent Medicines and Medical Devices Safety Review called “First Do No Harm”. We have a stellar line up of MPs and Peers signed up to the group which you can read about here. I wrote to the Secretary of State about the lack of a government response to this report back in October and he said the government would respond “in due course”. He did though set out what action is being taken on Sodium Volproate which formed one part of this review, which seems to be a further review by the Medicines and Healthcare Products Regulatory Agency. With 200 pregnancies exposed to this drug last year, I hope this is done with the urgency it needs. Health and social care funding needs The Health Foundation published a significant report highlighting how COVID-19 is likely to mean £40bn of extra healthcare costs this year and next. And that beyond next year to deliver the long term plan an increase of around £10bn per year by 2023/24 is required. They also argue that “improvements to adult social care will need an extra £6.1bn in 2021/22 on top of any specific COVID-19 costs, rising to £11bn per year by 2023/24”. Spending review Which brings me nicely to the Spending Review. Obviously the £6.3bn cash increase in NHS spending is good news and excellent too that lower paid care workers will also get a pay rise thanks to the increase in the living wage - but the cause of universal health coverage in the developing world will be devastated by a one third cut in the aid budget, something that sends exactly the wrong signals about our values as I asked the Chancellor. Also a massive disappointment - once again - for the social care sector which only gets a one year settlement with the big reform plan put off - yet again - for a year. Given it takes time for any plans to be put into action it is looking like the NHS will be half way through its 10 year plan before the social care sector gets anything at all, hardly treating the sectors equally. Burnout and workforce modelling NHS Chief People Officer Prerana Issar has written back to me about their NHS workforce modelling plans which look as if they will remain secret for some time yet. Ms Issar stated that they are updating them to take into account COVID-19 and “once we see the outcome of the Government’s Comprehensive Spending Review, including the HEE budget, further actions for 2021/22 and beyond will be set out in detail.” As that will be a year off it looks like we will not know be able to train any additional doctors needed until after the end of the NHS 10 year plan - hardly a smart way to run a health service. New model from Patient Safety Movement Foundation Earlier this week the Patient Safety Movement Foundation announced it was changing its model to help achieve its goal of zero preventable patient deaths by 2030. Over the last eight years they have asked healthcare providers to focus on the leading causes of preventable harm saving more than 350,000 lives along the way. But now they sensibly believe more of a cultural as well as a practical shift is required. CQC mental health survey This shows the real damage the pandemic has done to people’s experience of community mental health services. Users were surveyed between February and June of this year and the CQC found that many reported poor experiences of these services. Of particular concern is the fact that younger adults, aged 18-35, reported worse than average experiences than those aged 66 and older. Jeremy Hunt
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