Good afternoon - we’re back with a bumper patient safety email today after a fortnight off for half term including some fantastic news to match the sunshine - the adoption by the WHO of the first ever global patient safety action plan; here in the UK Matt Hancock has even matched that by announcing safety will be one of the three domains the new ICSs will be assessed on. As always if you think these emails are worthwhile, please forward to a friend. And if you are that friend sign up here.

WHERE WERE YOU? Seven hours of Dominic Cummings made compulsive viewing in the Westminster village - but has it actually changed anything? His political attacks on Matt Hancock and Boris Johnson felt like score-settling and he failed to supply any written evidence to back them up despite saying he would. Nor did we learn anything about Boris we didn’t already know - most people would have been surprised if he had not been comparing himself to the Mayor keeping the beach open in Jaws. But behind the politics, there was some important stuff: what really happened on herd immunity, the early blindspots in scientific advice and the general failure to look at benchmarks like Korea and Taiwan. Perhaps the most telling thing of all was his explanation of why the vaccine task force worked: appointing a good person with the power to choose her team, something that is all too rare in Whitehall. Matt Hancock appears tomorrow for his right of reply and no doubt the chance to comment on all of this. With no disrespect to the Health Secretary we are all hoping it will not be for seven hours.

CRY FREEDOM or not on 21 June is the question facing the government and its scientific advisers. This appears genuinely evenly balanced. On the one hand the situation the North West is so serious as to require additional measures and hospitalisation rates are increasing quite quickly. On the other vaccines do break the link between cases and hospitalisations but only really after two doses. The Health Secretary gave us the best news of the week when he said that just 3 of 12,383 sequenced delta cases had ended up in hospital after being jabbed twice. I suspect we will end up with a few weeks delay and then a full opening up - with summer holidays abroad in the balance.

GLOBAL MOMENT In truly massive news for patient safety campaigners the WHO agreed a global action plan towards eliminating avoidable harm in health care. Congratulations to Dr Neelam Dhingra and all at the WHO for their work to get this plan passed. In many ways the real work starts now with implementation and I look forward to the DG’s first report on how that’s going in 2023 but for now, really well done.

IC-YES It looks like the new ICSs will be inspected by the CQC on safety as well as integration and leadership. I look forward to seeing this confirmed in the forthcoming Health and Social Care Bill. Keeping safety as a core component of inspections is vital and means that we will get a new and much needed focus on system wide sharing of learning. But if we needed a reminder the battle continues at a ward level it was the disappointing downgrade to ‘inadequate’ of the Royal Hallamshire Hospital maternity unit.

NHSTRESS Hat-tip to the Metro for that headline but it certainly sums up the findings of the Select Committee’s report on workforce burnout. The situation is obviously made worse by the pandemic, but it is something no government has been good at tackling. We recommend a complete overhaul of workforce planning, including giving Health Education England a statutory duty to publish the long term workforce requirements for both the NHS and social care sectors. More on this here and my question to Matt Hancock on this central recommendation here. The government’s response is that there are record numbers of doctors and nurses working in England, true of course and welcome, but if even after that we have so many shortages doesn’t that make the case for change even stronger?

ALSO UNDER PRESSURE Mental health services. That was the finding of an NHS Providers survey of mental health trusts – all reported that their services were under increasing pressure and 84% said waiting times had got worse. This was due to three main factors: young people’s needs are more complex, the pandemic, and lack of suitable social care provision. Saffron Cordery talked through the main findings at our Select Committee session on children and young people’s mental health services. Barnadka Dubicka of the Royal College Psychiatrists also emphasised how absolutely essential investment in social care is if we are to reduce the number of young people stuck unnecessarily in inpatient care.

8,700 AVOIDABLE DEATHS That’s the number of people who died as a result of catching COVID-19 whilst in hospital for something else according to figures obtained by the Guardian. 32,307 people caught the virus in this way although there are important caveats over correlation/causation (some of those who died with Covid may not have died because of Covid). This really does pose some challenging questions around whether the right infection control guidelines were in place both with respect to PPE and social distancing but also hospital ventilation systems. I worry that the latest chart from SAGE suggests that more than 10% of patients are still developing COVID symptoms 7 days after admission to hospital.

23,500 AVOIDABLE DEATHS That is what some estimates have suggested the cuts to the UK Aid Budget will cause for pregnant mothers alone. This year’s World Patient Safety Day theme is “safe maternal and newborn care” so if we ever do get a chance to vote against these cuts I will be doing so. This is not a popular position electorally because understandably after a pandemic most voters think that charity begins at home. But next year the OBR say our economy will be a pre-pandemic levels - so shouldn’t our aid spending be too?

ZERO DEATHS should be our aspiration, particularly for suicide, according to Steve Mallen, co-founder of the Zero Suicide Alliance, in his testimony to the same Committee session mentioned earlier. He argued persuasively that nearly all suicides are preventable and that we must treat them as such. He also told the tragic story of his son Edward reminding us that suicide can affect everyone. Professor Louis Appleby, the country’s foremost expert on suicide prevention, agreed that there are nearly always preventable factors in each suicide and that we should definitely stop thinking of some suicides as inevitable. He was careful to warn that we’d never actually get the number down to zero though.

AMBITIOUS AND BOLD? That was what Helen Whately, the Minister for Social Care, told the Select Committee to expect from the government’s social care proposals. She reassured us that they would be brought forward this year and that they would address the issue of people having to sell their homes in the face of catastrophic care costs. She was less clear that these proposals would actually be implemented ahead of the next general election and I am still getting very mixed vibes about whether the Treasury is really going to support this.

MOVING CARE HOME STAFF The government has decided not to go ahead with changing regulations to prevent care home staff moving between settings in pandemics. In announcing this they do though say that “restricting the movement of staff between care settings remains essential to prevent the spread of COVID-19 in care homes” so very odd and disappointing to say the least.

NEVER EVENTS HAPPENING AGAIN Another investigation from HSIB on never events highlighted the risk posed to patients from the lack of effective safety measures that are in place to prevent them from happening. As Dr Sean Weaver says, there have been a few reports highlighting this issue and yet I’m not aware of anything being done to address the fact that “the current barriers in place to prevent these incidents are not strong or systemic”.

NICE WORK  In more positive news new guidance has been introduced by NICE to induce women at 41 weeks in order to reduce the numbers of stillbirths. Evidence largely from a study in Sweden suggests there is a greater chance of babies being stillborn if this if left until 42 weeks. This update also called for more research to be done into what gestational age induction of labour is best for women at higher risk of adverse outcomes such as those in black, Asian and ethnic minority groups.

Jeremy Hunt