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Good morning and welcome to the latest edition of my patient safety weekly email. This week we look at the promising progress in the vaccines race, a big new development in maternity safety that emerged at this week’s select committee and why we need this year to be a ‘1948 moment’ for social care. JAB-TASTIC It is not possible to over-spin the genuinely encouraging news from further trials with the Oxford/Astra-Zeneca vaccine yesterday. Not only does it look like spacing the doses out might make the vaccine more not less effective (zut alors) but we now have the first evidence that the virus reduces transmission. Whisper it quietly but this is the game changer we have been hoping for which should not only bring down the case rate (and associated hospital admissions and deaths) quicker but might also change who we vaccinate next - for example leading to teachers being prioritised alongside others who come into frequent, regular contact with other people through their work. We could even consider giving it to children on that basis although I am not aware of any trials done yet on children. All of which would make the next JCVI meeting a good one for flies on the wall. The vaccine roll out more generally marches on with more than ten million people having had their first dose so it looks like the 15th February deadline is in the bag. NOT OUT OF THE WOODS YET More concerning are the new mutations, in particular the E484K mutations found in 11 cases in Bristol, one dating back a worrying two months. A reminder that we are likely to be dealing with new versions of the virus for a while. Door to door testing in hotspot areas will be critical as will be the development of enhanced (e.g. South Korean) contact tracing. It also makes it even more important that we do something about the 20,000 people a day that Baroness Harding confirmed should be isolating who aren’t. She argued that financial incentives wouldn’t necessarily help and the government doesn’t seem at all interested in getting this number down. If we are going to deal with new variants then there is no point going door to door testing people if a significant proportion of them still feel they have no choice but to break isolation – we must do more to help them otherwise all the hard work will be for nothing. MATERNITY MARATHON The Select Committee evidence session on Tuesday covered just about all bases when it comes to making maternity services safer and was one of the most thorough and detailed sessions I have seen with some refreshingly frank answers from Patient Safety Minister Nadine Dorries. This included, but was certainly not limited to, whether we’ve got better at spotting problematic Trusts, litigation reform, ways to end the blame culture, ‘normal births’ ideology, staffing levels, breech birth scans, the lack of progress towards reducing harm experienced by BAME mothers, and how we are doing with the ambition to halve the number of still births, neonatal deaths and brain injuries. For patient safety buffs I’d recommend watching the whole thing back but some highlights from me…. LITIGATION REFORM UNDER CONSIDERATION In the biggest news of the session Nadine Dorries said that serious work is underway across government looking at whether we should reform litigation to stop it getting in the way of a proper learning culture. Although she wasn’t yet convinced the Swedish litigation system was directly linked to their better safety outcomes (which I must say I am) this sounded very encouraging. I particularly liked her refreshingly frank answer to my question of whether it was morally acceptable for the child of a banker to get more compensation than a child of a cleaner. I am sure we will also look at whether compensation should be linked to the cost of private rather than NHS provision which is brave but necessary territory. The biggest change would be to give compensation when a mistake has been made without requiring clinical negligence to be proved. At a stroke this would remove the adversarial and defensive relationship between families and doctors which makes it so difficult for lessons to be learned quickly after tragedies. A consultation is due later this year. SAFE STAFFING LEVELS It’s still not clear however whether the government has plans in place to address the 3,000 strong gap in midwife provision but it was interesting to hear that Health Education England are working on what numbers are needed across all roles for maternity services. We need an updated model for the number of doctors needed in maternity units similar to how Birthrate Plus works for midwives. The Minister promised to write when that work was completed and we will be making sure this does not get ‘long grassed.’ A BAN ON NORMAL? The Minister agreed with Laura Trott that the normal births ideology had been dangerous and argued that we should focus on safe births. She said she never uses the phrase and nor do her team which is great to hear. Even better was that she said she’d go away and think about whether it should be banned across the NHS. Still waiting to hear from the RCM and RCOG whether they are prepared to show leadership on this one, fingers crossed. INTO THE BREECH There was a great deal of support from the Minister and Dr Matthew Jolly for the idea of a late term scan dedicated to looking for potential breech births. This was something we’d previously taken evidence on from Professor Gordon Smith and is currently with the National Screening Committee for review. I would hope if they give it the all clear the government will find the resources to make this available to all women in England - it would not just save lives but significantly reduce the number of emergency C-sections. GROUP B STREP RESEARCH A really important piece of research from GBSS was published this week showing how few Trusts are following Public Health England and Royal College guidance on testing for this really common cause of serious infection. Nadine Dorries is clearly very personally committed on this issue and has written to all Trusts asking them to follow the guidance. She reiterated at the Committee session she expects them to follow this guidance with immediate effect. ON TARGET? Finally we had a very handy summary of where we are on progress towards the aim of halving the rates of still births, neonatal deaths, brain injuries and maternal deaths from Dr Jolly. We seem to be doing well on still births which are down 25% since 2010. Neonatal deaths after 24 weeks are down 23%. Brain injuries went up between 2012-2014 but are now down about 10% since then. Maternal deaths are down 9% since 2010 which was the one he was most worried about. Overall the figures felt encouraging. A 1948 MOMENT? Fixing the social care system is not just about being the civilised country we all want to be but also making the NHS safer. Better care in the community would see fewer older people turning up at A&E and less of an annual winter crisis. So great news there seems to be momentum growing behind my calls for us to have a 1948 style moment of reform for the sector including an editorial in the Times this week. I asked Matt Hancock on Tuesday whether it was time to harness the spirit of reform shown by the Attlee government after the Second World War and publish a ten-year plan for social care with a long-term funding boost. He reiterated our manifesto commitment to resolving the problems with the sector in a fairly bland reply. But he did say it was a manifesto commitment which the Prime Minister continued to support. I know from personal experience though that warm words from the Secretary of State doesn’t necessarily mean it will happen so we all need to keep the pressure up on this one to get it over the line. PAY FAIR FOR CARE DAY I took part in Pay Fair for Care Day organised by the Future Social Care Coalition yesterday. This was primarily focused on the need for care workers to be paid fairly – something the £7bn per year increase in funding the Select Committee has called for would go towards. But there was a general sense that we should also think bigger and turn the COVID-19 crisis into an opportunity that resolves long-term workforce issues once and for all. Jeremy Hunt
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