Good afternoon and welcome to my latest patient safety update in which we look at the Chancellor’s spring statement, the ongoing Select Committee workforce campaign including making common cause with my newfound friends at the BMA, whether we should be worrying about Covid and HSIB’s report on transferring stroke patients.

SPRING STATEMENT No surprises - positive or negative - for the health and care sector in the Chancellor’s statement today. I suppose it was good that he didn’t yield to backbench pressure to scrap the health and care levy - as regular readers know I have long thought this is the most honest way to engage with voters about how much we are actually prepared to spend on the costs of an ageing population and new treatments. But it is still disappointing that there is no long term plan to deal with funding shortfalls in social care and difficult to see how we deal with the Covid backlog if hospitals are full of people they can’t discharge.

THE BMA AND ME Whoever would have thought it? Earlier this week it was a little surprising to find myself sharing a platform with the BMA after the agonies of the junior doctors strike in 2016. I’m sure they felt the same - but hopefully it shows just how serious the crisis is in general practice if two old adversaries are prepared to come together like this. As it happens we have both been saying the same thing on this for some time so it wasn’t perhaps a total surprise. The polling released as part of the Rebuild General Practice campaign is worrying in the extreme with 90% of GPs fearing that their patients aren’t always safe and 77% attributing GP shortages to the fact that patients were being put at risk. I hope our combined efforts will make the government finally take notice of the desperate need for more action to tackle the problems in general practice - without which we will never be able to make a reality of the much touted phrase ‘prevention is better than cure.’

RETENTION, RETENTION, RETENTION On a not unconnected note this week’s Select Committee evidence session focused on what we can do to keep more staff within the health and social care systems. We looked in particular at factors pushing people out of the workforce including pensions taxation, mental health issues and discrimination faced by women and black and minority ethnic staff.  Professor Dame Clare Gerada from Doctors in Crisis (and it has to be said dearly beloved of this parish for many years) painted a horrible picture of an overworked workforce suffering a mental health crisis leading to a worrying amount of bullying. In terms of the barriers women face we were told that they feared that sharing their experience of menopause as it would be career limiting.  We also heard disturbing evidence of everyday racism against social care staff and detailed statistics of how BAME staff were discriminated against. Experiencing racism increases the chances of NHS staff retiring by 48% so we must do much more to stamp this out. Finally, on pensions, we were told how there was an exodus of senior staff due to “unfair and punitive” taxes on pensions. Why does all this matter? Because it will take a decade to train the number of additional doctors we need (if we ever persuade the government to do so) but tacking retention issues is something that could make a difference tomorrow.

HEALTH AND CARE BILL This completes its passage through the House of Lords today and we expect to see it back in the Commons next week.  Depressingly the government looks set to block Baroness Cumberlege and Simon Stevens’ amendment to the Health and Care Bill requiring bi-annual independent workforce projections: when workforce is the biggest single challenge facing the NHS why is it so difficult to get ministers to engage with it? Expect lots of publicity around this in the run up to the Bill being back in the Commons, expected to be next Wednesday.

HSIB ON STROKE TRANSFERS HSIB’s latest report looked at the safety risks involved when stroke patients are transferred between trusts. As Neil Alexander, HSIB National Investigator, put it “being bounced between different trusts creates a significant risk to safety especially when dealing with life-threatening conditions.” HSIB also features in the Health and Care Bill where the Lords wisely removed the ability for Coroners to have access to Safe Space investigations (without a high court ruling). Let’s hope that remains because if everything you say to an investigation will be passed on to Coroners you may as well not have a safe space at all.

COVID LATEST The ONS continues to see a rise in case numbers with 1 in 20 in England having had the virus in the week ending 12th March, up significantly from 1 in 25 in the previous week. To put it another way there were nearly 600,000 more cases on 12th March than on 5th March. The Covid dashboard suggests this rise will continue as there has been a 20% increase in cases in the last 7 days. There was also a 20% increase in the number of patients admitted to hospital and the total in there with Covid now stands at more than 16,000 – a figure last seen in January. The additional number of cases is starting to have an impact on day to day life with the number of pupils being absent from school tripling in a fortnight. Why are we not more worried? Basically because so few people are getting seriously ill. Although hospital admissions are rising the number of patients on mechanical ventilators, a reasonable indicator of serious illness, remains low at 299 and isn’t really increasing. One to keep a close eye on.

THE ADMIN Patient safety is not the most rip-roaring of subjects but in this email we try! As ever you can sign up to receive this update via our website here and please tell any friends you think might enjoy it.

Jeremy Hunt