Good morning and welcome to the latest edition of my patient safety email. This week I look at Manaus mania, the government’s NHS shake up, the Budget and some good news about transparency in the new health reforms planned by the government.

VACCINE LATEST The vaccine good news keeps on coming as we see some truly incredible numbers when it comes to their effectiveness. Either brand reduces the risk of hospital admission by 80% and emerging evidence shows it also reduces transmission too. This latter is very important as it shows - counterintuitively - that getting the vaccine out quickly will reduce new cases and therefore the risk of a new UK-variant that is immune to them. Which makes it even better news that we have now given a first dose to more than 20 million people including - as of Tuesday - yours truly in the very smooth and well-organised Royal Horticultural Hall. The government is now targeting 5 million doses a week which is a necessary uptick given the number of second doses starting to become needed.

TREND NUMBERS LOOK GOOD Bill Clinton always says look at trendlines not headlines but for the first time I can remember the trendlines are the headlines, with data continuing to head in the right direction with cases, hospital admissions and deaths all down significantly since the start of the year. Daily new cases have dropped from a seven-day average of 59,000 at the start of January to around 9,000 last week. Daily new admissions have declined from over 4,000 to around 1,200 over a similar timescale. And daily deaths from a peak of 1200 to around 300. This morning’s REACT study shows a slowing in the speed of decline but overall things look good.

BUT THE MUTANT FROM MANAUS has reached the UK as reports of six cases of the P1 variant arriving here slightly tempered all this good news. This strain is particularly worrying as this article in the Lancet explains. It was likely the cause of a recent surge in hospital admissions in Manaus despite potentially 75% of the population there having immunity from already having had the virus. We know it transmits more quickly but we don’t yet know if it reacts differently to vaccines. The fact that so much effort is going into tracing one person shows how much our test and tracing is improving - although I still don’t know why we aren’t plugging the hole of the 20% who ignore instructions to self-isolate.

JCVI UPDATES In their latest recommendations to government the JCVI has stated that age is still the biggest determinant of risk in terms of the virus. As such it has recommended that we continue to vaccinate based on age rather than prioritising certain groups like teachers or the police. I thought they might take a different view given that transmission risks are clearly higher for some key workers but they are clear that teachers are at no greater risk of getting the virus than anyone else of a similar age.

BUDGET REACTION It was a disappointing day for social care. Having pushed for action on this issue in an article with my colleague Damian Green, some really interesting polling from the Health for Care coalition showing how much support there is for additional funding for the sector, and a call from Care England for a ten year plan, the Chancellor said nothing on this. The sector has reacted as one would expect with Martin Green leading the charge expressing “disappointment” and calling for a 1948 moment, a ten year plan and £7bn in funding, the Alzheimer’s Society calling for reform plans to be “fast-tracked” and the LGA calling for reform proposals to be brought forward “urgently”. But the real high noon moment will be the spending review this year. You will get bored of me saying it’s now or never…

TALKING OF WHICH lack of social care reform was one of the biggest criticisms of the recent Health White Paper that the Select Committee heard evidence on earlier in the week. Hugh Alderwick from the Health Foundation was particularly stinging calling it an “ongoing political failure” and rightly pointing out that the worthy aims of the forthcoming health Bill won’t be achieved without sorting out social care. Richard Murray said a ten-year plan would be a welcome “gold standard” for the sector and Sarah Pickup from the LGA said the sector was “beyond distraught” that they didn’t yet have one.

WORKFORCE CONCERNS Other gaps in the White Paper included a lack of any meaningful change on workforce planning. Nigel Edwards at the Nuffield Trust tackled the long-held Treasury view that training more doctors and nurses committed them to ever increasing spending outside the usual spending review periods. Danny Mortimer from the NHS Confederation explained that having a shortage of trained medical staff actually cost more not less for the Treasury due to locum costs. There were also calls to ensure that the new ICSs had appropriate oversight from the CQC from Sir Robert Francis of Health Watch.

BUT GOOD NEWS ON TRANSPARENCY because after Sir Robert Francis said the CQC should be allowed to Ofsted-rate ICSs, Matt Hancock told me in parliament the CQC will have a “crucial” role in overseeing them. The details are still to be worked out but this is potentially excellent news if it bakes in safety and quality as one of the core metrics against which the performance of the new ICSs are measured.

TALKING OF THE CQC following last week’s announcement that care home residents will be allowed one visitor from 8th March the CQC has issued a statement reminding providers that they must follow guidance and that blanket bans on visits are “unacceptable”. The CQC is also working to ensure that each local authority area has a safe designated setting to discharge COVID-19 positive patients into. The challenges in this sector continue to be tricky but following CQC and government guidance is a must.

SODIUM VALPROATE The House of Lords heard from leading members of the First Do No Harm APPG this week with Vice-Chars Lord O’Shauggnessy and Lord Hunt (no relation and different party - but a nice guy like all Hunts) pressing the government for redress for those exposed to this drug, and Chair Baroness Cumberlege asking that the government ensure every pregnant woman on Sodium Valproate is warned of the dangers.

NEW HSIB NATIONAL INVESTIGATION HSIB has launched a new national investigation into maternity pre-arrival instructions by 999 call handlers. You can find out more information on this here.

Jeremy Hunt