Good afternoon and welcome to our new Wednesday afternoon delivery of this patient safety email - let us know if you prefer it. This week we mark one year since the first lockdown by looking at where we really are on COVID, the Prime Minister’s new commitment on social care reform at the Liaison Committee this afternoon and patient safety issues around children and young people’s mental health.

LIAISON COMMITTEE I have just come out of the Liaison Committee where - finally - the Prime Minister has agreed that the social care sector needed “a long term plan, a ten year plan.” This is the first time the government has committed to giving social care a 10 year plan like the NHS and is very significant news: time after time plans for social care have been watered down or kicked into the long grass. By committing to a 10 year plan to sit alongside the successful NHS 10 year plan the government is making this much less likely. There was even a big hint social care will appear in the Queen's Speech which also makes it more likely to be a central part of the government's programme in the next year. Still lots more to achieve - including the £7bn uplift in its annual budget recommended by the Select Committee but this is a very positive start.

COVID LATEST Things in the UK are still moving in the right direction with hospitalisations and deaths heading right down. What could possibly go wrong? Two things for the Eeyorish: firstly, daily new cases are remaining stubbornly consistent around the 5,000 mark which creates potential for new variants. It is much less than the 12,000 new daily reported cases at the end of November when the Kent virus really started taking off but still well above the 1400 level where South Korean capped them. Secondly, fog across the Channel where the PM was surely right to warn that a 3rd wave would find its way here. But the number of those vaccinated has now reached 28 million so deaths and NHS impact should be much lower. However the biggest risk remains vaccine supply if the EU puts an export block in place - here's the Prime Minister carefully not ruling out retaliation when I asked him at the Liaison Committee.

SOCIAL CARE STAFF AND VACCINATION The Telegraph broke the story and the Secretary of State then confirmed that the government is considering making vaccinations for social care staff compulsory. I remember debating with Bruce Keogh whether flu jabs should be compulsory for NHS staff back in 2017 and have pretty hardline views on this: is there not a duty of care to patients and care home residents to protect them from asymptomatic transmission? Of course medical exemptions should apply, but the question will be why, if the government bites the bullet for social care staff, it is not doing so for NHS staff. Reminder: around 30% of all Covid deaths were people who likely picked up the virus in hospital with nosocomial infections accounting for up to 36,000 deaths.

YOUNG PEOPLE’S MENTAL HEALTH is the subject of a new select committee inquiry which we kicked off yesterday. What is happening to all those senior mental health leads in schools - the 2017 Green Paper promised they would be in a quarter of schools by 2023? DfE stopped the training programme last January but I am told it has now been restarted. We heard some excellent evidence from  experts on the impact of the pandemic with Emma Thomas of Young Minds saying that 30% of young people with existing mental health needs lost access to the support they need during lockdown. Sophie Corlett from Mind explained that young women and those from BAME communities were disproportionately affected and pointed to a survey that said one third of 18–24-year-olds used self-harm as a coping strategy for mental illness. But the big question is why, a decade after Winterbourne View, we still have so many long-term patients in secure in-patient units. Should be just ban new admissions as they have done in Italy? Professor Tim Kendal, NHS England clinical lead was surprisingly open to the idea. But given how long the issue is taking to sort out, a few sparks flew on the issue.

SUICIDE came up because it is curiously not treated as ‘preventable ‘by the NHS even though most families that have suffered from losing a loved one would strongly argue that it can be avoided with better mental health support. Should we not do Hogan and Black-style case note reviews to quantify just how many suicides could have been prevented? Again an encouragingly open approach from both Tim Kendall and Claire Murdoch. My thinking on this has been prompted by a number of inspirational meetings with Steve Mallen and Joe Rafferty who run the remarkable zero suicide alliance.

CAMHS BEDS RUNNING OUT? Prompted by this worrying article in the HSJ I pressed Claire Murdoch on whether the NHS had run out of CAMHS beds last week. Her answer could be summed up as ‘technically no but practically yes’ on the basis there are clearly massive strains from a doubling of referrals. 

WORKFORCE PLANNING LATEST Great to see the Academy of Medical Colleges calling for more to be done on workforce planning in this statement released earlier in the week. I agree with them that the upcoming Health and Care Bill represents an opportunity to really sort this issue out once and for all. I am particularly drawn to their suggestion of regular published assessments of workforce projections and requirements from a “designated body” - HEE perhaps?

NHS CONFED WARNINGS ON STAFF RECOVERY As important as long term planning is how to address some of the short term issues facing the NHS workforce. The NHS Confederation has a report out today warning that thousands will leave if they are not given the time and support to recover from the past year, something my local NHS trusts are very worried about. They also call for significant investment to help fill the vacancies in the system right now.

PATERSON INQUIRY UPDATE The government has provided an update on the implementation of the recommendations from the independent inquiry into the issues raised by Paterson. Progress seems to have been made on recommendations 2, 4, 5, 7 and 8 and Nadine Dorries stated that the government “will respond in full to the inquiry during 2021.”

Jeremy Hunt