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Good morning and welcome to my 18th patient safety weekly update. This time I look at this week’s tragic COVID milestone, examine the biggest hole in our current strategy, highlight the new info from the government on the Patient Safety Commissioner and pick out the most relevant sections of the Simon Stevens select committee appearance. REMEMBERING THE 100,000 It is sobering to say the least that the last year has seen more additional deaths than any year since 1940 and we have now officially reached 100,000 COVID-19 deaths. Even worse was the suggestion by SAGE’s generally loyal Professor Calum Semple that there are likely to be many more deaths still. There will be many lessons learned - and my Select Committee is currently doing a joint inquiry with Greg Clark’s Science one to sum up the main ones. Surely the biggest will be the simplest: the need for speed in decision-making when a virus is spreading exponentially. IS THE TIDE TURNING? It looks like lockdown is starting to work as hospital admissions are falling in every region, the seven day rolling average of cases is continuing to decline, and the latest ONS infection survey showed a drop in the number of people testing positive. The ONS estimate that there were still more than 1 million people with the virus during the week ending 16th January but case numbers are heading in the right direction. Most importantly more than 7 million people have had their first jab - one in eight of the population - and nearly half a million their second. SO WHY SHOULD WE STILL BE CAUTIOUS? Well for a start the latest REACT study suggests that infection levels are only coming down very slowly. And as Sir Simon told the Committee on Tuesday there are still 33,000 people in hospital with COVID - with his typical understatement he added that this was “stretching the system”. There is also the warning from one of the safest hospitals in the country that they may soon be unable to stop patients catching COVID. But the main cause for concern is that we expect the virus to mutate, whether imported or not, in a way that may ultimately be immune to the current vaccine. No one knows when this will happen - maybe not even this year - but we are far more likely to be able to deal with it effectively if we have broken the chain of transmission with the current variants. So at this stage it is more of a race than a war. And the one thing that would help us win the race is dealing with the biggest single hole in our approach, namely… 40% OF PEOPLE STILL NOT SELF-ISOLATING WHEN REQUESTED. Test and Trace, despite the grief it has received, has actually made great strides since the late summer and early autumn. For the latest week they have stats for more than 350,000 people were transferred to the system, 600,000 close contacts were identified of which 90% were contacted. BUT somewhere between 40-75% of those contacts are not fully isolating (Dido Harding says 40% but a Cabinet Office survey, a little older, says 75%). The Cabinet Office survey also suggests 15% are even going work. The biggest reason people are not complying is fear over loss of income - so should we not just make a blanket promise to refund any salary loss? It seems Boris does not agree from the question I asked him yesterday. HOW COULD SUCH A SCHEME WORK? By learning from other countries and once again looking to the democracies of East Asia. Talk of £500 for everyone testing positive was hastily dismissed by the Treasury but even that would not go far enough for some. We surely need a range of measures including covering salary loss, daily contact calls as happens in Poland and Taiwan and giving local councils the resources to monitor compliance. SCHOOLS MAY OPEN Slightly more positive news yesterday (for the Hunt household anyway) was the announcement that primary schools may reopen on March 8th. This homeschooling thing is getting a nightmare…and we also finally got Priti’s announcement on quarantine hotels which I fear may not go far enough. SIMON SAYS Quite a lot of interesting stuff at Tuesday’s select committee session with Sir Simon Stevens. Not only did he provide a succinct summation of the tough spot the NHS is currently in but he reminded us all that the reason we aim to protect the NHS is not to protect the institution itself but to protect its ability to treat the full range of its patients. He is particularly worried about the impact on cancer surgeries and the spike in people waiting over a year for their surgery. He also noted increasing urgent referrals for those with eating disorders. As usual he emphasised the best way to get the NHS back to normal and help cancer patients and others is “to get hospitalisation admissions for COVID down”. Something we can all help do by staying at home. BUT MORE SIGNIFICANT were his comments on long term reforms. Simon was very open to my suggestion that we need the ONS or other independent body to work with the NHS to publish annual workforce projections so we can finally crack this issue of making sure we train enough doctors and nurses. He was in full agreement that the social care system needs a ten year plan describing dealing with fair funding and reform of adult social care as a “fitting legacy” for the heroic work the sector has done during the pandemic. Sir Simon’s two main asks coming out of the pandemic are that health and social care are finally seen as two sides to the same coin and that investment in both is seen as part of the economic success this country needs. Hear hear. PATIENT SAFETY COMMISSIONER The government has published a handy fact sheet on their amendment to the Medicines and Medical Devices Bill which will create the Patient Safety Commissioner. This was a key recommendation of the Cumberlege Review and it is great that it will be established (and all credit to Julia Cumberlege). The fact sheet described the Commissioner as “a champion for patients” and its key role is “to promote the safety of patients and the importance of the views of patients in relation to medicines and medical devices.” Personally I think the best person to take on this brief as an additional part of his role is the excellent Rob Behrens, the Parliamentary Health Service Ombudsman. Perhaps with a name change to the Patient Safety Ombudsman. For parliamentary nerds the relevant clauses to the legislation can be seen here. And you can see the short(ish) debate in the House of Commons from last night where the relevant clauses were passed with support from all parties. Great news. CHANGES TO THE WAY CQC REGULATES The CQC has made some proposals to make the way it regulates more flexible and responsive. These include using more tools other than just on-site inspections, a move away from a fixed schedule of inspections, and a simplification of the way GP and Trusts are rated. Whilst this sounds reasonable on the face of it, I wouldn’t want Trusts to be able to go years and years without on-site inspections because even outstanding ones benefit from these. This consultation is open until 23rd of March. HSIB ON OXYGEN HSIB has published an interim bulletin about their investigation into oxygen issues during the pandemic. This comes just two weeks after the start of this piece of work and suggests that that these problems stem not from a lack of supply, as all trusts have plenty of oxygen reserves, but that “the issue lies with a combination of the pipework/system used to deliver the oxygen and where patients needing the most oxygen are cared for along the oxygen supply network.” AND FINALLY The Department of Health is recruiting people to join its Patient Reference Group to help implement the Cumberlege Review. Details are here. Jeremy Hunt
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