Good afternoon and welcome to the 50th edition of our patient safety weekly update. We hope you’ve enjoyed them so far. Sajid Javid’s first appearance in front of the Select Committee is the main news this week but we also look at our dementia report from last week, HSIB’s latest report, and the latest on all things COVID. As ever you can sign up to receive this update via our website here and please tell any friends you think might enjoy it.

SAJ’S DEBUT Lots to digest from the Health Secretary’s first appearance in front of the Select Committee as we covered workforce pressures, social care, mental health and patient safety. It won’t surprise you to know that I focused my questions on workforce pressures as I am still not convinced there is any kind of workforce plan to go alongside the big ambitions to reduce the backlog. The government has, to be fair, put in the cash which in many ways is the hard bit - but without enough doctors and nurses to do the extra work how on earth will it get done? I asked how can we possibly know if we’re recruiting the right number if the government won’t publish its own internal projections as to how many we will need, why the HEE budget was still not resolved, and whether there would be a workforce plan alongside the elective recovery plan published by the end of November. My sense was a Health Secretary who wants to do the right thing but is still being blocked by the Treasury from the long-term overhaul of workforce planning that we need. I also think DHSC is advising the SoS to do what I discovered was essential, namely to publish a workforce plan alongside every new initiative. I also asked Boris about the same issue in PMQs because I remain convinced that staffing shortfalls are the biggest risk to patient safety at the moment. You can judge whether his answer takes us forward but at least I put it on his radar.

GP TARGET FAILING One thing we do know is that the Health Secretary doesn’t think we’re on track to hit the government’s ambition to recruit an additional 6,000 GPs by 2024. That target means 1200 more GPs every year between 2019 and 2024. We are currently around 400 down or 300 up depending on which numbers you use - so a long way off. International recruitment and boosting medical school numbers will help but I worry we going to repeat the mistakes of the past when we underestimated the impact of shifting working patterns and early retirement. The risk of course is we get a vicious circle of more people going part time because of the pressure, leading to more pressure for those left who in turn decide they can’t take it and so on.

NEW APPROACH? Sajid did to his credit say he would like to see a change of approach on workforce planning and that he was open to more accountability and more transparency. He is willing to engage on the suggestion that HEE independent projections are published once every two years and so I’ll certainly be tabling an amendment to the Health and Care Bill to that effect.

SAFETY VS TARGETS? I also asked him what he was doing to ensure that as we rush to clear the backlog created by the pandemic we don’t end up putting targets above patients’ safety. He sounded sincere about protecting the safety and quality of care and rightly pointed to the vital role the CQC will play. Whilst he agreed that safety ought to be a vital part of future inspections of ICSs he did not commit to Ofsted-style ratings. The system often dislikes the accountability they bring but that surely is precisely their point: they allow the public to see clearly whether an NHS organisation is doing a good job. They have broadly worked for hospitals (indeed 4 million more people are now using good or outstanding ones compared to when Mike Richards originally set up the system) so I hope we do bite the bullet and do it for ICSs too.

DEMENTIA REPORT At the end of last week the Select Committee published its report into dementia care and argued that those living with dementia can’t wait until 2023 for more funding and urged the government to provide that now. It also called for the government to accept the recommendation of our previous report and ensure that the sector gets a £7bn increase from 2023/24 – at the moment we are way off that. Whilst it is great to see this government recruitment campaign for the sector what they really need is more certainty on funding as Barbara Keeley reminded Sajid yesterday.

HSIB REPORT An area that is likely to play a crucial role in clearing the elective backlog is the use of the independent sector and so HSIB’s report into shared care of patients between NHS and private hospitals is very timely. Their national investigation found significant variation in the capability of independent hospitals that take on more complex surgery and some communication and information sharing issues which they made a number of recommendations to resolve. Interestingly the Department of Health and Social Care has still not answered my question on who is responsible for ensuring HSIB recommendations are implemented - I got a holding answer nearly two months ago! That to me suggests no one is currently responsible - surely a big issue that needs resolving as HSIB is put on a statutory footing by the new Health Bill.

COVID LATEST Soberingly despite headline falls in new cases, prevalence in the community continues to rise according to the ONS – in the week ending 22nd October 1.1m people had the virus which equates to around 1 in 50 vs 1 in 55 in the previous week. In the last 7 days the COVID dashboard sees a 10.4% decrease in cases so it is possible the penultimate week of October was the high point. The focus on booster jabs seems to be helping as more than 800,000 people have had one in the last three days. NHS England point out that more boosters have been given since the start of the programme than at a similar point for the first dose campaign. And the latest from the ONS shows that the age-adjusted risk of deaths involving coronavirus was 32 times greater in unvaccinated people than in fully vaccinated people. There are still 9,500 patients in hospital with the virus and daily new admissions have been at over 1,000 for each of the last five days. So as both the Health Secretary said yesterday, and Sir Jeremy Farrar noted in his statement resigning from SAGE, the pandemic is far from over.

Jeremy Hunt