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Good morning and welcome to my latest patient safety weekly update. This week the select committee returned to its inquiry into NHS and care staff burnout, there was good news on safe visiting to care homes and HSIB published a crucial report into one of the reoccurring themes from its maternity investigations. But with hospital admissions for COVID-19 still rising we start where you’d expect…. Heading to the end of the nightmare Good news on the Covid vaccine front continued, but equally as significant this week was the news that two new lighthouse labs will open in early 2021 increasing our testing capacity to over 1 million tests per day. We need this extra capacity to successfully deliver mass population testing which could become the vital 'plan B' that allows the government to announce a much hoped-for return to normal from Easter irrespective of where we are on vaccines. Dominic Cummings will apparently be continuing to work on mass testing (from home) and whatever you think of him deserves credit for pushing through the new 20-minute lateral flow tests. Population testing was criticised by public screening experts this week due to the high number of false positives and false negatives but those numbers are disputed by people like John Bell who thinks the issue could be solved by using lateral flow tests as a substitute for quarantine. Whoever is right, there is a compelling logic to offering second, confirmatory tests to key workers in order to stop large numbers having to self-isolate needlessly. Brilliant Bratislava Best evidence of how population testing can work is Slovakia where they tested 97% of people aged 10-65 in one weekend, uncovered 38,000 more cases, and have now seen a reduction of 85% in the number of daily cases. You could also point to similar programmes in China, not least in Qingdao (home of China's most famous beer) where they tested 9 million people in five days. Our own pilot in Liverpool isn't quite that scale but is not a bad start. Keeping gran safe Is it more cruel to stop people with dementia from seeing loved ones in the last days of their life or risk seeding the virus in care homes by allowing visits? The media has been full of this impossible dilemma - to which the only solution is allowing family members to count as key workers and get regular testing. Whilst it was good to see the government announce a pilot on this, eyebrows are being raised at whether it really will be rolled out in in time for Christmas (as the Health Secretary has promised) given there will be just two weeks to do this after the pilot has finished. Staff movement between care homes In another update on making care homes safer
the government has also published a consultation to prohibit care home staff working in more than one care setting in a 14 day period. This is something other countries like Canada, Israel and Singapore did during wave one. I support the policy intention but why on earth has it taken so long, not least when the PM told me it had already been introduced in May. Unbelievably we are still doing a 'consultation' on this which runs until the 23rd November - how many care home residents will have picked up the virus unnecessarily by then? Workforce burnout On Tuesday the Select Committee held its second session on workforce burnout and resilience. We heard from a Macmillan lead cancer nurse about her concerns regarding how quickly the system can get back up to pre-pandemic speeds, from Chaand Nagpaul of the BMA about how even before the pandemic 80% of doctors were at risk or high risk of burnout with 40% experiencing either anxiety of burnout itself. What was fascinating was how witness after witness made the link between staff burnout and patient safety - exhausted staff make mistakes. Chaand highlighted studies that showed a 45-63% increase in chance of a doctor making a mistake when they are stressed and that surgeons are three times more likely to make a mistake. As he said investing in staff wellbeing is an investment in patient care and safety. Another very powerful intervention was made by Dame Clare Gerada who has personal experience of the issues from work with Practitioner Health Service, an NHS-funded mental health service for doctors with 5,000 patients on their books. Clare gave this powerful description of what it is like as a doctor working in a pandemic. The great disappearing workforce projections The other common theme was that however much support you offer staff, the one thing that would really improve morale was to know we are training enough new doctors, nurses and AHPs to fill the gaps that are so widespread. But where is the workforce plan that was supposed to accompany the 10 year plan? Not in the People Plan, as I challenged Prerana Issar about at the Select Committee. The truth is the Treasury are refusing to let DHSC publish the projections submitted by NHS England until after the Spending Review (and maybe not even then if they don't agree to fund the necessary training places). If you want to see why I smell a rat on this, listen to this non-answer to my question to Matt Hancock on Tuesday. HSIB report A review of HSIB maternity investigations identified delays in interventions during labour once there were signs indicating that a baby may not be well as a key theme that needs to be addressed. This report highlights some of the reasons for this and includes some questions for maternity units to consider in order to reduce this type of delay. Top of the list were “inadequate staffing, poor infrastructure and high workload as contributory factors to the delays” but I was most struck by the suggestion that situation awareness isn’t necessarily something that can be improved through training but needs to come through organisational design. The need to have a dedicated staff resource, separate from that delivering hands on care, to anticipate the workflow of a labour ward is one interesting suggestion I hope units will consider. Inquests for stillborn babies A coroner has written to the Ministry of Justice urging them to consider allowing coroners to hear inquests into stillborn babies. This is something the Campaign for Safer Births has been calling for. Stat of the week Test and trace needs 70 close contacts to quarantine for every one infection prevented; lockdowns need 1000 people to stay at home for every infection prevented, according to Professor Sir John Bell at the Select Committee. Jeremy Hunt
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