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Good morning and welcome to my last patient safety update of 2020. This week we look at the latest tiering announcements on COVID-19, concerns about Christmas, and a deep dive into maternity safety following the publication of the Ockenden Interim Report. Early moves into tier 3 Major news this week was obviously the government’s decision on Monday to put London, South Essex and South Hertfordshire into tier 3 earlier than the first planned review date. As I said acting early and decisively is the right thing if you look at evidence from around the world, but these are still very difficult decisions for thousands of businesses. Full marks to Matt Hancock for not hanging around on this decision, although I am still not clear whether people in London are allowed to go Christmas shopping, see what you think from his reply to my question. The guidance by the way is no less clear saying both that shops can remain open but there should be no non-essential travel. Most worrying from the latest data are indications that infections started growing towards the end of the lockdown possibly relating to the new strain of the virus. Probably time to review the rules for the different tiers because - as we know from Manchester - there is nothing more demoralising than being stuck in a high tier without it appearing to have any effect on transmission. Christmas caution What do Alistair McLellan, Fiona Godlee, me, Keir Starmer and Scrooge all have in common? Afraid we are the people with a downer on whether it is really wise to take our national foot off the pedal when it comes to Christmas mingling. The BMJ and HSJ made this powerful intervention but Downing Street has said that changes to the rules have been ruled out even if the guidance has changed. I hope they have looked at what is happening to the NHS bed capacity, on track now to hit the April Covid peak by New Year’s Eve, a time of year that always terrifies those responsible for helping the NHS get through winters. In the Downing Street press conference on Monday night the Health Secretary emphasized how people should take ‘personal responsibility’ to keep relatives safe - I hope that is enough. As even the Sun says, it is curious to say the least to increase restrictions in London only to have thousands of people leave the capital to go and see their families for Christmas a few days later. Shrewsbury and Telford The interim Ockenden report was published towards the end of last week pulling no punches. Donna Ockenden gave evidence to the Select Committee on Tuesday detailing the repeated failure to listen to families, the blame shifting and the tendency not to have any investigation until there was litigation. But the most shocking part of her findings was the culture around ‘normal births’ where women were put under extreme pressure to avoid C-sections even when it would clearly have been safer to do so. The trust kept the C-sections at around half the national average for long periods and she was at pains to say that the culture promoting ‘normal’ births included doctors as well as midwives. The government welcomed the recommendations but we need leadership from the professional bodies too and it was disappointing to see both the RCM and RCOG refusing to condemn outright the use of the phrase ‘normal birth’ when we should only ever be talking to mothers about safe births. Worth also reading PSW Trustee James Titcombe’s typically powerful piece in the Guardian, Isobel Hardman in the Spectator, Janice Tuner in the Times, and the Observer’s editorial. Not just Shrewsbury and Telford More fundamentally as I said in the debate in Parliament last week we must not think these issues are isolated to just one trust so it was encouraging that NHS England sent out national guidance to all trusts urging them to take note of specific recommendations made by the report. Donna said her lessons for the wider NHS were ‘preventative’. Trusts have until Monday to respond. This matters because the big lesson of Mid Staffs, Morecambe Bay and Southern Health is that there are always lessons to be learned across the system. More on higher risk births The select committee session started with a look at the maternity safety issues for women from BAME communities where we heard powerful evidence from the founders of the 5 x movement, so named because black mothers are five times more likely to die in childbirth. We also heard from Professor Marian Knight that this metric has been going in the wrong direction and a powerful account of the dangers of pressuring women to have a ‘normal birth.’ Royal Colleges safety submission This joint submission from the RCOG and RCM makes some interesting suggestions to improve maternity safety. These include setting up a national maternity improvement centre, more investment in workforce numbers, and joint team safety training. Workforce issues in particular look like the next vital hurdle given that 80% of midwives don’t feel there are enough staff to operate safely. Research corner This piece in the Journal of Hospital Infection shows some major failings in preventing nosocomial infections in hospitals in the North West. Happy Christmas from me and Adam Smith who helps me draft this email every week…and as our contribution to Christmas cheer we will be sending out a New Year’s Eve update which talks about the many achievements on patient safety made in the last year. But as we have been talking about maternity safety, let me leave with you one: stillbirths down by 25% and neonatal deaths by 23% since 2010 according to Dr Matthew Jolly, who co-leads the NHS plan to halve baby deaths by 2025. Sweden here we come! Jeremy Hunt
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