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Good morning, Happ(ier) New Year…and a big thank you to readers of this email who worked on the NHS frontline over the Christmas period (including Chris Whitty who was reported to have been working in an ICU without seeking any publicity for doing so, seriously impressive). Lockdown was not the start to the year we wanted but is definitely better than the alternative we would almost certainly have faced in terms of pressure on the NHS. As well as a looking at the Covid situation I also look forward to what the year ahead holds for patient safety issues, particularly maternity safety and social care. Lockdown: third time unlucky? As this email heads out we will have been in our third national lockdown for just over 24 hours. As I set out in my twitter thread on Monday I think the government was absolutely right to bring this in - but why couldn’t they have worked it out before sending most primary school children back to school for just one day on Monday? Certainly the instincts around decisions being made are a whole lot better than a year ago when we were making a virtue of not acting too soon and flirting with herd immunity but surely the situation in the NHS was clear enough at the end of last week to have avoided the stop-go - and risk of infections - on schooling? But at least the right decision has been taken and the mood in the NHS seems to be that there is a fighting chance of getting through the next three weeks before the impact of ‘Tier 5’ takes effect. NHS staff seem to be getting more priority in getting the vaccines - helped by the decision to space the doses - but again this was a decision that should have been taken earlier. Border control We’re also due to hear soon what measures the government will introduce to prevent infections being imported, but it’s fair to say we’re an international outlier in only just introducing mandatory PCR tests before entry. Countries which have low death rates such as Australia, New Zealand, Taiwan et al acted very quickly to tighten their borders, with mandatory quarantine in Government-rented hotels, rather than the system of essentially voluntary compliance which we opted for. This can’t come soon enough and will surely be one of the key areas of scrutiny in the future inquiry. Grim reality Tuesday’s ONS figures were grim and scary: an incredible 1 in 50 people, or 1.1 million of us, had the virus between 27th December and 2nd January. In London it was 1 in 30. They also say there were 11,500 deaths in the week ending 25th December, although they point out that these figures will have been impacted by the Christmas bank holidays. I asked the PM yesterday about whether we need to have more than just a vaccine plan including mass testing of at risk communities. I also asked him when we will know for sure that the vaccines work with the new strain. Let’s be fair to Blair he was right to spot the potential of spacing the vaccine doses. According to Ben Osborn, CEO of Pfizer UK, their data only goes up to 42 days delay between first and second doses, so we are definitely taking a risk extending it beyond that. But it is a calculated risk between the second dose being less effective when delivered later (for which there is no evidence) and stopping more people catching the virus by getting more first doses out (for which there is a lot of evidence). There is also the theoretical risk of mutations that become immune to the vaccine but in a situation like this there is no risk-free option. So I personally agree with the decision by the UK’s Chief Medical Officers to deliver first doses to more people before moving on to second doses. Nosocomial infections rise The latest SAGE papers show that the number of nosocomial infections rose from less than 2% in October to 10% in November, although there were HSJ estimates of it being 24% in December. The sooner we get frontline staff vaccinated the better. Maternity services curing the pandemic Whilst progress has been made in updating national guidance to allow partners to attend maternity services with expectant mums not all trusts are delivering on that recommendation. Someone having to experience baby loss on their own doesn’t bear thinking about so we need to get this sorted. The @butnotmaternity campaign has done an excellent job tracking who is allowing what which you can see here. HSIB report on nasogastric tubes One from before Christmas (remember that?) but a worrying report from HSIB highlighting how the misplacing of these tubes, something the NHS deems a never event, continues to happen. Given it can be fatal, pretty scary that it happened 14 times across the NHS between April and September of last year. The report makes five safety recommendations about how to resolve this but highlights a broader issue that never events are still not being designed out of the system. Something for the Select Committee to return to. Top 10 issues for patient safety I set out my patient safety New Year’s Resolutions on New Year’s Eve but I was interested to see this top ten issues for 2021 from Becker’s Hospital Review. They include things like COVID-19, staff shortages, healthcare-associated infections, and surgical mistakes. This is a fairly familiar list to many patient safety campaigners but reminds us of the breadth of issues we need to tackle. For me the big issue of the year - directly impacting on patient safety - is social care: will or will we not get a 10 year plan and the £7bn + uplift in funding it needs as part of the spending review this autumn? You can see last autumn’s select committee report here
for more details. Research corner
This paper looking at nurses and midwives in Australia provides further evidence that staff mental well-being is a key factor in determining patient safety. Depressing stat of the week On 29th December more than 80,000 people tested positive for COVID-19, the highest single day figure yet. Jeremy Hunt
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