Good afternoon and welcome back to my weekly patient safety update. Thinking about the events of the summer I am somewhat reminded of Lenin’s dictum that there are decades when nothing happens and days when decades happen…but none the less I hope you had a good break, especially if you are frontline NHS and care staff. This week we take a look at where we really are with COVID including lessons from Israel; how to deal with the backlog and social care reform. As it has been a while a little reminder that if you are receiving this email from a friend you can sign up to get it directly here.

COVID LATEST We may have been away but the virus has stayed with us as the latest ONS stats show that 756,900 people (1 in 70) had COVID-19 in the week ending 20th August. The Times notes that the rolling average has declined for the last week but conversely we are all expecting it to go the opposite direction as schools go back, a big concern to scientists on SAGE. It feels like a plateau at about the level of mid-December last year with about half the number of daily new admissions to hospital because of the vaccine programme.

TIME TO WORRY? Yes if we look at the headline data coming out of Israel. 80% of adults (and 60% of the whole population) have had two vaccine doses, so significantly higher than us, yet they recorded their highest ever daily number of new cases yesterday. Cases there have been rising since July and so the Israeli government has responded with an aggressive vaccine booster programme which they hope will see a drop off in cases in the next few weeks. This is an interesting summary on what they are doing which involves once again mandating masks, vaccinating everyone over the age of 12, and offering a booster dose to those over 30 since last week. Some aren’t convinced even this is enough and think social distancing may be required as set out here. But this graph here shows that two weeks after their third dose campaign started the rate of growth in severely ill patients dropped significantly.

LESSONS FOR THE UK If we want to avoid another lockdown, we should surely do the same - not least now the WHO has changed its views on booster programmes (arguing countries should press ahead with them when previously they said developed nations should prioritise sending vaccine doses to other countries). Our own programme is due to start with the most vulnerable this month but following the latest Zoe study which showed vaccine effectiveness dropping after six months, why are we hanging around? There seems to be a concern about having enough doses to also roll out a booster programme although the government denies this. One for the Health Secretary to deal with in the inevitable Covid statement next week.

NHS BACKLOG AND SOCIAL CARE I’m expecting the government to announce their intention to introduce a health and care levy to fund the backlog in cases and social care reform imminently - possibly as soon as next week. The Mail has a run through of the latest discussions within government but it looks like a levy of 1p on employers and employee national insurance that is also paid by working pensioners would bring in about £10bn a year. Whether this is enough isn’t clear as the NHS is arguing it needs all of that just to clear the backlog but we should welcome the political courage of pushing through a tax rise, especially from a Conservative government.

SPEAKING OF WHICH My Health and Social Care Select Committee returns to action next week with the first session of our new inquiry into how to clear the backlog. We’ll be looking at the scale of the problem, how to clear it, and whether the NHS has the funds and the workforce required to do so. Most significantly we’ll also examine how we avoid sacrificing safety and quality of care in the pursuit of targets, in other words how to avoid sleepwalking into another Mid Staffs.

HSIB WHILE WE WERE AWAY No rest for HSIB as they published their annual report, a review into their maternity programme and a new national report into delays in diagnosing cauda equina syndrome during August. Some highlights include the fact that 22 national investigations have been completed, 39 patient safety recommendations have been raised, and more than a 1000 maternity investigations have been completed. I’m going to try and find out just how many of the recommendations HSIB has made as part of these investigations have actually been implemented and will report back on what I find out.

EVENT PREVIEW A couple of events to flag as next week Baby Lifeline are hosting their annual maternity safety conference and on 16th September HSIB is hosting a Healthcare Safety Investigations Conference.

Jeremy Hunt