Good afternoon and welcome to my latest patient safety update. In this week’s edition why freedom day is no longer irreversible; the select committee’s radical call for a ban on long term admissions of autistic people and people with learning disabilities to in patient units; will we or won’t we on social care reform; the new Health Bill and whether we ought to protect the title of ‘nurse’. If you aren’t a subscriber, please do sign up here.

COVID CAUTION Harold Wilson didn’t say a week is a long time in a pandemic but how things change - as rather than talk of freedom next week the PM urged people to proceed with caution. Talk of irreversibility has sensibly been dropped because no one actual knows what will happen from here on. As I said on Monday and Sajid Javid confirmed, the government must be prepared to reverse ferret quickly if hospital admissions rise more quickly than currently planned for. Because the vaccines mean that only 1 in 40 (rather than 1 in 10) cases end up with a hospital admission it is ‘justifiable’ (Professor Neil Ferguson’s carefully chosen word) to proceed even though admissions have gone up nearly 50% in a week. This fascinating interview by Nick Robinson with Dr Asher Salmon from the Israeli Ministry of Health (1 hour 41 mins in) is well worth a listen for the counter view: Israel is now going back to making face masks compulsory and considering re-introducing their Covid passport system after things went pear shaped following their own freedom day - and he argues there are real risks from see-sawing too much from one extreme to the other.

BAN LONG TERM ADMISSIONS for autistic people and those with learning disabilities was the headline recommendation from the Select Committee’s report into their treatment which was published yesterday. There are at least 2,055 people currently held in secure institutions, with an average stay of a shocking six years even though they are supposed to be ‘temporary.’ Voluntary efforts to deal with this human rights abuse have failed (as Norman Lamb and I both know to our cost) because however hard we try to discharge people new admissions keep going up. Time to follow the successful model in Trieste which is both cheaper and more humane. The report also calls for immediate action to reduce the use of physical restraint, segregation and seclusion. As I said to Sky News yesterday I think the way we treat people with learning disabilities and autism is shameful for a civilised society. Of course the main reason for such long stays in inpatient care is because community provision is just not good enough at the moment. Which brings me nicely too….

THE HEALTH SECRETARY’S TOP 3 PRIORITIES REVEALED by the Health Secretary himself at his first oral question session. They are 1. Getting us out of the pandemic; 2: Dealing with the backlog and 3…putting social care on a sustainable footing. Fantastic to hear this at the despatch box. I know people will say this is still words not action from the government but my own experience is that you do choose your words carefully on your first oral questions outing as a new Secretary of State so I think we can be encouraged. Not only because it will help get those 2000 people out of long term care and back into the community where they belong but, as I said on Tuesday in the House, also because it will help the NHS cope with winter demands and give the most vulnerable in society the care they deserve. 

HEALTH AND CARE BILL DEBATED The Second Reading Debate started in the last hour or so in the House of Commons and I focused on the lack of provisions to address long term workforce planning in my speech. I’m a supporter of the Bill overall and I’ve no doubt it will pass this stage of its proceedings but I’ll be looking for changes to it on workforce planning. Simply reporting once every five years on who is responsible for workforce planning (as the Bill currently states) will do nothing to address the fact that staff shortages set to rise to nearly half a million over the next few years. I hope the government listens to those who wrote on this issue to the Times today.

BMA STAFF SHORTAGES REPORT Published ahead of the debate this BMA report looks at how the UK compares with other countries in terms of the ratio of doctors per 1,000 people. Only Poland has a lower ratio than the UK in the OECD. The report also says we’re short of 49,162 full-time equivalent doctors, and that that could rise to 83,779 by 2043. Another reason for a new independent role for Health Education England to make forecasts.

WHO CAN BE CALLED A NURSE? Well it turns out anyone can regardless of professional qualifications or training. This has big implications for patient safety but also for the value we hold the profession in. The government is looking into the protection of medical titles as part of a review of the regulation of healthcare professionals so I hope they give nurses the same protection as other professionals and ensure that only those registered with the NMC or other regulatory bodies can use the title. A petition on this is gathering pace which you can read here.

NOTTINGHAM REVIEW Thankfully it looks like the government has agreed to an independent review of maternity services at Nottingham University Hospitals Trust. Minister Nadine Dorries has said that the draft terms of reference are being put together at the moment so I hope it can get started soon.

CANCER INQUIRY STARTS Finally this week we had the first session of the Select Committee’s inquiry into cancer services. We heard from Dame Cally Palmer, the National Cancer Director for NHS England, that they aim to clear the backlog caused by the pandemic by March of next year. She told the committee that there are currently around 16,000 people who have waited longer than the target of 62 days for a diagnosis and that 12% of these will have cancer. On the longer term plans Professor Peter Johnson, NHS Clinical director for cancer, said he was ‘cautiously optimistic’ that the NHS would hit achieve its ambition that by 2028, three quarters of people with cancer would be diagnosed at an early stage. The Committee’s independent expert panel will be assessing just how on track we are as not everyone who gave evidence was quite so confident. The biggest bottleneck seems to be in primary care and its ability to access diagnostic tests with rapid results.

Jeremy Hunt