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Good morning and welcome to my weekly Patient Safety Update where this week we look at testing, non-Covid NHS services, MBRRACE maternity safety data, and the NHS Providers’ annual survey. Testing times The big Covid story of the week has been the data glitch that saw 16,000 positive patients not have their contacts followed up. These things do happen - and it is in the context of a massive increase in testing - but with yesterday’s news that Roche is having problems supplying reagents and other parts to labs and (the elephant in the room) the possibility that even 500,000 tests a day will not meet soaring demand, we surely need to review the structure of the testing programme which creates over-reliance on 3 mega lighthouse laboratories. I spoke about this on the World at One on Monday and asked Matt Hancock in Parliament later that day whether 'pillar one' - testing capacity in hospitals - should be supported to take on more of the burden. My worry is that with the current imbalance between supply and demand we will never get round to weekly testing of NHS staff which is essential given we now know up to 11% of Covid hospital deaths were patients who caught the infection in hospital. But more generally is it right, when 50% of all transmission is from people with no symptoms, to have a system so stretched that we only test those with symptoms? For test and trace to work we need to be reaching many more and ideally population-wide testing which Tony Blair has been rightly championing but seems a long way off. Vexing vaccines A lot of surprise to say the least on comments by Chair of the Vaccine Taskforce Kate Bingham that only half the population may get the vaccine. It is not clear whether this is because of the logistics of getting enough or the clinical risk of long term effects, which may be why it won't be made available to children. Government ministers are rightly saying they will take advice at the time - and we don't have a vaccine yet so there is no point speculating what that advice may be. But it does change the calculus for the rest of us: normally to stamp out a disease vaccines need to be given to a very high proportion of the population to create 'herd immunity' (heard that phrase?) - 95% in the case of measles jabs. If the proportion vaccinated is going to be much lower we may end up with COVID-19 circulating for much longer which means life post Easter 2021 may not be quite as 'normal' as we all want. Covid-only NHS? As you will remember last week’s Select Committee report on delivering core services during the pandemic said weekly testing of NHS staff is the only reliable way to stop the NHS becoming a Covid-only service (and isn't even happening in hotspot areas as Chris Whitty said he would support). This week the Royal College of Surgeons confirmed the seriousness of the issue when it warned of a tsunami of cancelled operations’ coming this winter. Only one in seven surgeons are able to treat the same number of people as before the pandemic with nearly half seeing a drop of up to 50% in their operating capacity. We really need those Covid-free zones (or as near as dammit) in hospitals. Long COVID survivors are rightly getting more vocal about the lack of support they are receiving. King’s College research suggests around 60,000 people have horrible symptoms even three months after getting the virus including chronic fatigue and breathlessness. We still don't know very much but it appears to affect women more than men and the middle aged rather than young or old. It is good that the government is funding research into this condition but the dedicated clinics to give rehabilitation and mental health support are not yet up and running as I asked the Health Secretary about on Tuesday. Finally (on coronavirus) issues I met Covid Bereaved Families for Justice this week. Some truly heart-rending stories which reminded me of the many bereaved families I met when I was Health Secretary. They are angry - understandably - but the main message was they want to know the mistakes that caused their losses will not be repeated e.g. lack of PPE, poor infection control in hospital waiting areas and unsafe care homes. It isn't just about test, test, test either - they had a lot to say about the need for support for people with PTSD. MBRRACE data opt out Last week was such a bumper maternity safety edition I forgot to include some good news about MBRRACE who collect the vitally-important data on maternal and perinatal deaths. A few weeks ago Clea Harmer at Sands wrote to me pointing out that this data collection role was at risk due to changes to NHS patient data opt out rules due to start last month. Essentially they need an exemption and Matt Hancock has written back to me to say the compliance date for these changes has been moved to next March. He also said he understands the reason for an exemption so will look at what can be done. NHS Providers Survey Some interesting - and concerning - results from the NHS Providers’ annual sector survey. The main conclusion is that trust leaders are very worried about the 'perfect storm' of “workforce shortages, staff burnout, second wave of coronavirus and a potentially difficult winter”. Of particular interest to Patient Safety Watch is the fact that 99% of trust leaders are worried about the level of burnout in their workforce. We’re currently finalising our first report on the impact on safety related to burnout during the current pandemic and the Select Committee may also be looking at the issue. Patient Safety Watch Advisory Board As Patient Safety Watch prepares to publish our first piece of research we are delighted to announce our stellar Advisory Board whose names will be familiar to many of you: Clare Gerarda - former Chair of the Royal College of General Practitioners Dame Sally Davies – former Chief Medical Officer for England and Chief Scientific Adviser at the Department of Health Professor Sir Bruce Keogh – former Medical Director of the NHS Sir Robert Francis QC – led the inquiry into Mid Staffs Ann Clywd – former Labour MP and brilliantly powerful patient safety campaigner Sir Norman Lamb – former Lib Dem MP and colleague of mine at the Dept of Health who is now Chair of SLAM Jeeves Wijesuriya – former Chair of the BMA junior doctors committee Helene Donelly – nurse and mid staffs whistle blower Dame Marianne Griffiths - Chief Executive of Western Sussex Hospitals
Stat of the week... continuing a theme from last week, medication errors may directly cause around 712 deaths per year and indirectly contribute to 1,708. As always please feel free to share this email with friends/colleagues who can sign up here and if you are a new subscriber you can catch up on old editions here. Jeremy Hunt
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