Good afternoon and welcome to our weekly patient safety update. With significant announcements from the government and the CQC on maternity safety this is our main focus but we also look at how to deal with the backlog in mental health and GP practices; long Covid; a new report on over prescribing; world patient safety day and of course the pandemic which is still stubbornly around. As ever you can sign up to receive this update here.

GOVERNMENT RESPONSE TO MATERNITY SAFETY RECOMMENDATIONS Governments can ignore or shrug off most media criticism…but it’s not quite so easy with Select Committee reports as they have to respond in writing within 60 days which has now happened with our maternity safety report. Overall I was mildly encouraged by both the tone and content of the responses. Out of 15 recommendations they only completely rejected one (on implementing the Rapid Redress and Resolution Scheme), partly accepted eight, and completely accepted five. They are still considering the big one though – the additional £250m to £300m funding required to provide the maternity staff the NHS needs. Even if you are not as immersed in maternity safety issues as I am, the case for this is surely a no brainer given the NHS incurs a shocking £5.7 bn (yes you read that right) of liability every year relating to clinical negligence. I suspect the government is waiting until the Ockenden/Kirkup reviews before committing on this by when the clamour to deliver it will have become a deafening roar. Also encouraging was the commitment to a review of clinical negligence and to independent reviews of maternity safety incidents (although they are giving themselves to power to take this away from HSIB if they choose). You can read the full response here. 

£8.2BN AND COUNTING Much on the same theme Shaun Lintern has crunched the numbers to show how unsustainable the current system is finding that within all clinical negligence claims maternity alone has cost the NHS £8.2bn in the last 15 years enough to pay for 13 new hospitals - that is cash actually paid not simply liability incurred. Tort law reform is surely the only way to bring this down rather than administrative schemes so I am not too disappointed the Rapid Redress and Resolution scheme has gone as long as something better comes instead.

TO KEEP THE PRESSURE ON the Select Committee today launches a new inquiry today into NHS litigation reform. This will look at the ridiculous cost of the process, the damage it does to a learning culture and the unfairness to families of having to wait five years or more before a court settles the more complex claims. I feel a discussion with the new Justice Secretary Dominic Raab coming on.

CQC WEIGHS IN WITH CONCERNS In a very timely intervention the CQC has published “Safety, Equality and Engagement in Maternity Services” highlighting their continued concerns about the variation in quality of maternity care. Ted Baker calls out the quality of staff training, poor working relationships and a failure to listen to women as his key concerns. Some of you may have noticed Ted Baker announced he is retiring at the end of this year and this is the moment to reiterate how much we will miss him - he had big shoes to fill after Mike Richards but has done so brilliantly and been a fantastic advocate for changing to a more positive learning culture in healthcare.

OVERPRESCRIBED A fascinating report from the Chief Pharmaceutical Officer for England has found that 10% of items dispensed in primary care are overprescribed. This review found that 20% of hospital admissions in the over 65s and 6.5% of all admissions were caused by adverse effects of medicines many of which are preventable, echoing the report I commissioned from Manchester and Sheffield Universities in 2018. The government has accepted all the recommendations the main one of which is the creation of a National Clinical Director for Prescribing.

LONG COVID REALITY In the latest evidence session for our inquiry into the backlog the Select Committee heard yesterday about the truly devasting impact of long covid. Listen to this short clip but I’d also recommend listening to Lere’s full testimony which highlighted how awful it is when you are just not believed as a patient. Things do seem to be getting better and there was high praise for the UCLH long covid clinic, but even they have an average four month waiting list which is an agonisingly long time if you are suffering from symptoms like chronic fatigue.

10 MILLION ADDITIONAL MENTAL HEALTH PATIENTS The true scale of the impact on mental health services also came up. Not only are there currently 1.5m people waiting for support right now but 10 million additional patients are expected over the next 3-5 years. The government has still not clarified whether the ‘mental health investment standard’ (the commitment to parity of esteem made by me and Simon Stevens which says mental health spend will grow faster than overall NHS spend) applies to the extra resources that will be raised by the health and social care levy. Dr Adrian James of the Royal College of Psychiatrists says that if it did, an extra £1bn more would go on mental health services, enough to make a huge difference. But will it?

FACE TO FACE We also heard about the backlog in general practice and the hot topic of people finding it hard to access face to face appointments. Professor Martin Marshall of the RCGP was in hot seat and got some stick in the Mail today for his responses but for a GP perspective worth seeing this powerful video doing the rounds. There is a real risk that more stressed GPs will retire or go part time making the problem even worse with a smaller, even more stressed workforce having ever less capacity to offer appointments to the public. Difficult to see a short-term fix for this, but the long term solution is surely a credible plan to boost the GP workforce, not least by giving Health Education England the statutory duty to make independent forecasts as to how many GPs we should be training every year. I know I sound like a cracked record on this one but there really is a workforce emergency brewing and it is time the government recognised it.

HELLO! WE’RE STILL IN A PANDEMIC The latest ONS update published at the end of last week suggests that in the week commencing 11th September there was a slight increase in the number of people with Covid in the community. Just shy of 700,000 people or 1 in 80 had the virus then - so still quite high. But the COVID dashboard paints a slightly more positive picture with the 7-day average falling from 39,000 cases at the start of the month to 28,000 by 13th September. And as Alistair McLellan points out the number of patients in hospitals with Covid has fallen pretty steeply over the last week. With both the booster and child vaccination programmes now started the end of the tunnel feels in sight - but in fairness I was predicting that a year ago so don’t book your summer holidays just yet…

Jeremy Hunt