Good afternoon. There is something about Westminster that - love it or loathe it - is never dull…so what can we expect from the new Health Secretary? What does Sajid Javid’s appointment mean for COVID, care homes and patient safety? And after last night which date will liberate more people - the Euro 2020 Final on 11th July or Freedom Day a week later on 19th? If you aren’t a subscriber please do sign up here.

RETURN OF THE SAJ As I said on Marr, Sajid Javid is a good choice for Health Secretary – he’s a smart, decent and experienced figure and as the first ex-Chancellor to hold the post will know how to negotiate with the Treasury when it comes to the Covid backlog and social care. Reminds me of the advice I was given as a Cabinet minister ‘there are only two things people want of you: money and silence.’ Top of Saj’s in tray will obviously be dealing with the pandemic which may yet have twists and turns ahead. He will also need to decide whether to press on with the NHS and Care Bill including the new and controversial powers of direction they will give him (and are not really necessary anyway). My first question to him was a gentle prod to sort out social care and that he’s actually only got six months to do it in.  New health secretaries tend not to ‘get’ patient safety immediately but Saj will have heard me banging on about it around the cabinet table many times so I am optimistic on that front.

COVID SHIFT? He’s also shifted the tone on COVID quite noticeably with his comments about wanting to get back to normal as soon as possible, perhaps easier for him than Matt Hancock who accepted at the Select Committee mistakes were made in the first lockdown. What’s less reported is the way he still caveats this shift. He told the House of Commons on Monday that “With the numbers heading in the right direction, all while we protect more and more people each day, 19 July remains our target date.” After Chris Whitty’s cabinet briefing yesterday saying that he would support lifting restrictions, 19th July seems all but certain to be game on - but again note the caveats: Whitty’s reason was that he would rather a surge in the summer than in autumn/winter which is far from a full-throated ‘Cry Freedom’.

THINGS TO WATCH FOR Not so much the case numbers (although these are now really starting to shoot up from around 6,000 new cases a day on 12th June to over 20,000 now) but hospital admissions. Daily admissions seem to be stable around the 200 mark so the vaccines do appear to have broken the link between the virus and serious illness/death. Death rates according to new research this week from Cambridge University are now 1/1000 and for over 85’s have fallen from 15% to less than 2%.

INTERNATIONAL TRAVEL Despite growing confidence about 19th July foreign travel will remain difficult – not least because of the measures other countries may put in place (thank you Angela). But I think the real issue will be if Europe has its delta wave a month or two after us e.g. July/August. It seems unlikely that Chris Whitty would try to block travel if he has approved opening up here but will older and more at risk people really want to travel in those circumstances?

WINTER IS COMING The Royal College of Emergency Medicine has calculated that Trusts will need an additional 5-16,000 beds this coming winter. Lots of noise from A&Es about being busier than ever. My local hospital the Royal Surrey says it is handling 240 people a day vs 210 a day pre-pandemic but overall numbers seem to be returning to previous norms rather than a new high. Some noise about GPs - themselves very overstretched - doing more triage than before so people are finding it harder to get face to face appointments. This is a tricky one because video consultations are more convenient for many people (not just young professionals but also those with mobility issues) as well as quicker for GPs so we need to find a way to make the most of new tech without creating barriers to those who still want to sit in front of a doctor.

PPE RESEARCH A very interesting study this week that found that FFP3 respirators provided more effective protection against direct transmission of COVID-19 than other masks. The authors recognise that their study was only of a small number of cases at one Trust but I did argue last year we should look at requiring them for public transport as in Germany. That was pre vaccines so I wouldn’t make the same case now but clearly further research should be done into what the appropriate type of protection is for healthcare workers dealing with both COVID and other respiratory diseases.

COVID DEATHS AND THE MENTAL HEALTH ACT The CQC has published figures for the number of people detained under the Mental Health Act who have died from COVID over course of the pandemic. Between March 2020 and the start of June this year there have been 591 deaths of patients detained under the Act of which 174 (29%) were either suspected of or confirmed as having COVID. These COVID deaths have pushed the last year higher than the five year average as this chart shows.  

IMPACT ON DISABLED PEOPLE A stark survey from the BBC highlights how disabled people have been affected by the pandemic with many reporting worsening mental health, deteriorating conditions and cancelled appointments, something we have also picked up at the Select Committee.

OXYGEN HOSPITAL PIPELINE SAFETY This was the subject of the latest HSIB report which looked at issues with oxygen supply experienced by some hospitals during the COVID pandemic. Whilst no hospital ran short of oxygen some systems couldn’t deliver the right flow at certain critical times. A number of recommendations are made around the planning, investing and upgrading of medical gas pipeline systems.

COVID SUPPORT FOR CARE HOMES The government has provided another £250m for infection control and testing in care homes. This means the infection control fund will run through until September, something I know the sector has been asking for.

MORE MATERNITY DOWNGRADES Northwick Park Hospital is the fourth hospital in three weeks to have its maternity services downgraded. There were some serious problems found by the CQC inspectors including a terrible culture of fear and eight baby deaths over a five week period in July and August of last year. This continued run of bad news about poorly performing units shows that some of the bigger scandals like East Kent and Shrewsbury aren’t complete one offs. We need to see a cultural change across many hospitals across the country, something the select committee report on maternity safety will have a lot to say about when it is published next week. 

BABY LIFELINE CONFERENCE I’m speaking at this fantastic conference in September (but don’t let that put you off!). It was a great event last year and there’s an amazing line up again this year so go ahead and register your spot.

Jeremy Hunt