|
Good morning and welcome to my latest patient safety email. We’ve had a rare week of good news on COVID-19 with progress towards a vaccine, agreement (finally) to weekly testing for NHS staff and the tentative start of population level testing. I look at all of these below plus the highlights from a select committee session on the one area we really do need to see improvement in – Test and Trace. Away from COVID there’s more on maternity safety, and a couple of interesting pieces on the importance of culture. Pfizer to the rescue? You’ll have all seen by now the news from Pfizer and BioNTech where initial analysis suggests their vaccine can prevent more than 90% of people from getting COVID-19. This is obviously hugely exciting but the Prime Minister was right to warn that there are still some significant hurdles to get over before the vaccine can actually be used, not least the crucial approval needed on its safety. When I was health secretary I met the then CEO of Pfizer Ian Read in New York in a meeting that became legendary because he was so rude and didn't even offer me a cup of tea. I gave as good as I got (US drugs companies always complain about the low prices the NHS pays but we happen to be the biggest global customer so its called market power ok?) and since then the much more impressive Albert Bourla has taken over. How happy should we be? Professor Sir John Bell characteristically stuck his neck out in the way the PM wouldn't saying we could be back to normal by the Spring. In his new role as National Chief Optimist he doubled down on this on Tuesday telling me at the Select Committee there was a 70-80% chance of this being the case “provided they don’t screw up the distribution of the vaccine”. Regular NHS staff testing In a victory for the Select Committee and many patient safety
campaigners the Health Secretary finally announced that all patient facing NHS staff will be tested twice a week starting this week and being rolled out everywhere next week. This has been a big worry of mine for months, so I’m delighted we got there in the end even though it needed a stiff exchange of letters between me and Chris Whitty and Steve Powis to get it over the line. Just a reminder there around 2,000 of the 13,000 covid patients in hospitals right now are likely to have picked up the virus in their hospital. It is particularly good news for cancer patients who will be able to have much more confidence in the safety of hospital services. Mass testing progress The Health Secretary also announced that half a million rapid lateral flow tests are being sent out to local Directors of Public Health to kick start our moves towards mass testing. They will help pick up more of the asymptomatic cases that we are currently missing from NHS Test and Trace and build on the Liverpool pilot. Given that around half of all transmission is asymptomatic this must be the best insurance policy if we have any glitches with the vaccine roll-out. Why didn't the test and trace programme stop another lockdown? The whole point of the test and trace strategy was to avoid a lockdown right? We asked Dido Harding at the Select Committee why it had not on Tuesday morning. Professor Sir Chris Ham argued that localised contact tracing worked better than centralised systems. Dominic Harrison, Director of Public Health at Darwen Borough Council, argued that financial implications were a key factor in low compliance levels as people don’t like giving all their contacts to tracers in order to protect friends and family from financial loss. John Bell talked about the shift in philosophy we need from sticks to carrots by offering lateral flow tests every two days to close contacts, allowing them to avoid quarantine if they continue to test negative and offering 'freedom passes' to those who have antibodies. But the core issue is surely scale: of the 177,000 new people we should theoretically want to quarantine every day (3.4 contacts for each of the 52,000 new daily infections reported by the ONS) less than 5,000 actually do (e.g. a shockingly low 3%) as I asked Dido Harding. We have been focusing on the number of tests completed - which matters - but not nearly enough on the fact that only 20% of those asked to isolate actually do. Surely we should pay their wages as the bare minimum given what Dominic Harrison argued about loss of income being a key issue. Why does all this matter? Because population testing on its own won't work unless people actually isolate when they are told they are positive. I asked the Health Secretary to consider testing those in isolation later that day. Baby loss update Last Thursday parliament belatedly marked Baby Loss Awareness Week with a debate that started with one of the bravest speeches I’ve ever seen from Cherilyn Mackrory MP. Well worth watching her incredibly brave account of having to go into labour to have a baby she knew was not alive. There were also very moving contributions from Sarah Owen, Angela Richardson and Olivia Blake amongst others - truly parliament at its best. Patient Safety Virtual Congress A short plug for this conference which has been put together by Shaun Lintern. There has been an incredible line up of speakers and topics discussed over the last couple of days and I’m joining a panel later this afternoon with two of my favourite NHS Chief Execs Joe Rafferty of Mersey Care and David Dalton dearly beloved of the parish of Salford Royal. Research corner Worth reading a fascinating paper from the Patient Experience Library arguing that the NHS is institutionally and culturally bad at taking patient experience seriously. It contains some interesting insights comparing the language used around patients ‘stories’, complaints, and experience vs clinicians ‘records’, reporting, and data. Patient input is vital in the creation of safer healthcare systems so there’s much to think about in here. Just culture Equally worth checking out is this paper from Paul Stretton on how healthcare organisations have struggled to move from a culture of blame to a ‘just culture’. He suggests that an approach that focuses on learning rather than liability should be instilled to improve things. Something we heard a lot about in last week’s maternity safety session. New patient campaign group James Titcombe, one of our trustees, has launched the Harmed Patients Alliance with fellow patient safety campaigner Joanne Hughes. This is a great addition to the patient safety landscape and I wish them luck. Anything James does tends to have huge impact so this is definitely one to watch. Stat of the week For every direct Covid death to date we have had at least one indirect death caused by the interruption to normal NHS services. Jeremy Hunt
|
