GOOD AFTERNOON and welcome back to my patient safety weekly update after a summer break which has hardly been uneventful for either the NHS or politics (although quieter for me than I was, er, hoping for). This week we take a look at what a new Prime Minister and Health Secretary will mean for health and care policy, NHS England’s new Patient Safety Incident Response Framework, the crisis in urgent and emergency care and next week’s Select Committee session following up on the Cumberlege review.

TIME FOR A COFFEY The big news this week is obviously the appointment of Therese Coffey as Secretary of State for Health and Social Care and Deputy Prime Minister. She was the first appointment Liz Truss made to her Cabinet and significantly for the Dept of Health is the Prime Minister’s closest ally having run the Parliamentary stage of her leadership campaign. I have known Therese over many years. She is sensible, pragmatic and approachable so I think will go down well in the NHS. She also has a dry sense of humour and is dab hand at karaoke - I seem to remember venting my frustrations at the height of the junior doctors’ strike by singing Suspicious Minds at one of them which was probably more enjoyable for me than for those listening. Therese has already listed her priorities as ABCD – “ambulances, backlogs, care, doctors and dentists”. Anyway welcome Therese and I hope you enjoy the copy of a rather interesting book called Zero I will be hand delivering to DHSC this afternoon.

TO CUT OR NOT TO CUT the NHS budget to fund social care will be her first big decision. Liz Truss has made clear that more money needs to go to local councils for social care so I expect Therese has been briefed to try and find it through ‘efficiency savings’ in the NHS budget. She will find this incredibly hard because although there is inevitably waste in a budget of just under £200bn, the massive pressure on the frontline will make it very difficult to push through efficiency changes - and looming disputes on pay will create pressure in the opposite direction. Efficiency programmes also take time - the £20 bn ‘Nicholson challenge' was successful - but took five years. But here’s a starter for 10: 13,500 beds costing £400/day are currently occupied by people who could and should be in the social care system where the cost would be just £50-100/day. Sorting that quickly, though, will need some additional money from the Treasury to local authorities. ‘Chancellor I have the DPM on the line…’

URGENT AND EMERGENCY CARE The now former Health Secretary, Steve Barclay updated the House of Commons on the government’s response to the crisis in urgent and emergency care earlier this week. The government has provided an extra £150m to Trusts to help, agreed a £30m contact with St John Ambulance to provide surge capacity, recruited more 999 call handlers, mandated HEE to recruit 3,000 paramedic graduates a year and is trying out new measures to reduce delayed discharges. All sensible stuff and credit to Steve for getting it agreed before he left - but I don’t think anyone believes the problem will now be solved.

PSIRF OFF Sorry couldn’t resist. In an unheralded but important announcement NHS England published their Patient Safety Incident Response Framework last month. For those interested in patient safety it is well worth a read as it sets out how the NHS should respond to such incidents and tries to shift such responses towards understanding how something went wrong. I wrote two chapters in Zero about why the NHS tends not to be good at learning from mistakes: firstly because there is still too much blame culture and secondly because there are so many messages to hospitals from ‘on high’ that they really struggle to know what to prioritise. I hope this will address both of those issues so well done to Aidan Fowler and his team.

VALPROATE SESSION Next week the Select Committee is holding a one off evidence session on the implementation of Baroness Cumberlege’s First Do No Harm report. We’ll cover all aspects of this powerful but disturbing report including the continued use of sodium valproate in pregnancy and vaginal mesh as well as from campaigners who have experienced harm from hormone pregnancy tests. Julia herself will give evidence and we will also have one of the presumably new Health Ministers join us.

COVID LATEST. In our last email before the summer break we reported that 1 in 17 people had the virus. That figure is now 1 in 60 – so the picture has improvement remarkably over August.  The dashboard data for the last 7 days is looking good too as cases have decreased by 20%, hospitalisations are down by 14% and deaths also down by 38%. Frontline NHS and care workers, immunosuppressed people, and people aged over 75 will be able to book a COVID booster from next week. The roll out started in care homes this week and should ensure a key boost in protection for the most vulnerable ahead of the winter.

THE INEVITABLE PLUG All NHS Trust Chief Executives and Medical Directors should have now received a copy of my book Zero over the summer in which I offered to visit any trust to do a seminar on patient safety. Please do get in contact if you would like me to visit. And if you have friends or colleagues who care about reducing avoidable harm and death why not get them to sign up to this email here? See you next week…

Jeremy Hunt