Good afternoon. Freedom delayed. Irreversibility. Artificial intelligence. Mandatory vaccines. And my take on the whole Hancock vs Cummings affair. Just some of the issues covered by this week’s patient safety update. As ever please do let your friends and colleagues know about this email. And if you’ve been sent it by someone you can sign yourself up here.

FREEDOM DELAYED As was widely expected the Prime Minister announced a four week delay to ‘freedom day’ meaning we are now due to unlock on 19th July not 21st June. With cases growing 64% a week and hospitalisations increasing by 51% a week I don’t think the PM had any option and if it means all over 50s get double dosed it could have an important impact on hospitalisations and bed capacity. There was some good news, namely new PHE research showing the vaccines are highly effective at preventing hospitalisation - Pfizer 96% effective and AZ 92%. This is also apparent by the age profile of those ending up in hospital now compared to the start of the year - in January 66% of hospitalisations were over 65, now more than 70% are under 65. Sensible too on that basis to see second doses being brought forward.

IRREVERSIBLE CAUTION Although he caveated it slightly the Prime Minister said tellingly at his press conference: “I am confident we will not need any more than 4 weeks and we won’t need to go beyond July 19th.” But 12 days before that he said “there was nothing in the data” to suggest 21st June wouldn’t go ahead as planned. As I said in the House of Commons, one of the main reasons people are disappointed by this delay is the language of ‘irreversibility.’ What happens if we haven’t double vaccinated all vulnerable people or all those over 50 by 19th July or we decide we need to wait another 2-3 weeks to let the effect kick in? With Sir Patrick Vallance rightly warning that COVID will be with us forever who knows what other bumps along the road we’ll have and it is surely better to be up front on this rather than raise expectations.

REFLECTIONS ON HANCOCK VS CUMMINGS Now that the Secretary of State has given his evidence to the joint select committee lessons learned inquiry (and Dominic Cummings has published his latest offering) it is time to look through claim and counter-claim. It is clear now that Ministers were only presented with two extreme options at the start of the pandemic – suppression (lockdowns) and mitigation (protect the vulnerable but let the virus run its course) but not the middle way of sealing borders and Korean-style test and trace. This was a serious failure and even well after we were into the first lockdown we still seemed incapable of looking at international best practice despite the fact that Taiwan, Singapore and South Korea were all doing a remarkable job at keeping the virus under wraps without lockdowns. This then meant Test and Trace had to cope with 2000+ cases a day when it was set up, much higher than East Asian counterparts, arguably setting it up to fail. Set against these huge failures of the state are some of its biggest ever successes: not just sourcing 400m vaccines before they were approved but distributing them through the NHS pretty flawlessly. With that kind of variation in performance I suspect my CQC colleagues would argue this is not one for an aggregated Ofsted-style rating… 

LONG COVID PLAN Speaking at the NHS Confederation Annual Conference Sir Simon Stevens launched the NHS Long COVID Plan. This will see £100m invested in specialist services to provide support and care, particularly for children and young people. Around 1 million people are reported to suffer from this condition with one third of those saying it impacts their daily lives even a year on.

PLEASE PLEASE MR POSTMAN Aidan Fowler and Steve Powis have written to every woman and girl aged 12-55 currently taking sodium valproate warning them about the dangers of taking the drug whilst pregnant. This is a welcome first step but has taken too long to happen given it was first called for by the Report of the Independent Medicines and Medical Devices Safety Review last July. They have not, however, gone for other options discussed in the report such as making valproate only available through specialist prescribing or making it a controlled substance. Hundreds of babies are still being born every year with disabilities after being exposed to valproate and I am sure I am not alone in being worried the letter is too little too late.

AI EARLY WARNING OF SELF-HARM An amazing piece of research from Cambridge out earlier in the week suggests the signs of self-harm can be spotted up to a decade before the behaviour itself materialises. As one of the researchers, Dr Astle, stated, "we typically wait for problems to escalate and then intervene to see if we can do anything…We really need to shift to a preventative, proactive model." This sort of method would really allow us to do this and is one of the more remarkable applications of AI I have heard of. The paper itself is well worth a read here.

CARE HOME COMPULSION Reports out this morning that Ministers are considering making COVID-19 vaccinations mandatory for care home staff. Those in the sector working with adults will have 16 weeks to get vaccinated and consideration is being given to extending this to NHS staff. I would support both measures (and considered making flu vaccines mandatory for NHS staff when I was Health Secretary) but I recognise it may cause problems on staffing levels if people leave as a result. So these measures therefore need to go hand in hand with a ten year plan for the care sector and independent workforce projections for both them and the NHS, something I raised with Boris in my question in the House of Commons today.   

CQC MONITORING AND MATERNITY DOWNGRADE The Chief Inspectors at the CQC have published a statement regarding their approach to monitoring which sets out how monthly reviews will be used to determine whether further evidence is required to assess the status of a provider. They have also downgraded maternity services at Colchester Hospital and Ipswich Hospital from ‘Good’ to ‘requires improvement’. There were some really worrying things going on including use of paper systems to record key information. The Select Committee report on maternity services will be published early next month and will be sure to pick up on some of these themes.

Jeremy Hunt