Good morning and welcome to my patient safety weekly update in Patient Safety Awareness Week (yes I didn’t know either). This week I am looking at the latest news on COVID-19, this week’s Select Committee session with the Secretary of State, the final Each Baby Counts Report, a fascinating interview with the Head of the NMC and reports from the CQC and HSIB.

COVID-19 The trends in cases, hospitalisations and deaths all keep heading in the right direction which is great news. We’re now down to around 6000 new cases a day, around 500 new hospitalisations a day, and to double digit deaths per day. Lockdown sceptics in my party should note the arrival a worrying Philippine variant in the UK as evidence of the continuous risk of new mutations that are more resistant to the vaccine - and a reason to be cautious at this hopefully final stage. There have also been worries about vaccine supplies although the government has reassured us that we’re still on target to hit our targets. I am currently self-isolating after getting the dreaded virus myself although thankfully with mild symptoms. Lucia and I are counting our lucky stars the kids got iPads for Christmas as a triumphant return to school was not to be for the Hunt children last week.

A YEAR LIKE NO OTHER Earlier in the week the ONS published a report looking at the impact of COVID-19 in 2020 which is well worth a read for those who like jaw-dropping statistics. On the health front there were more infectious disease deaths than at any time in the last 100 years (although interestingly there were even more at the turn of the last century even without Spanish flu). On the economic front the drop in activity was worse for many industries than the 2008 economic crisis and debt as a percentage of the economy is now higher than it was when we were bailed out by the IMF in the 1970s. Happy New Austerity decade.

PATIENT SAFETY VICTORY However on the patient safety front this week has seen a major advance. Matt Hancock has written back to me confirming that the CQC will Ofsted-rate the new ICSs in his proposed reforms. Given that safety is one of the core CQC domains this means that it will become a core priority in the new integrated care systems and mean they support the welcome focus on safety now happening at Trust level. It is not clear yet whether local authorities will have their social care provision Ofsted-rated but that would also make sense. The importance of this change cannot be underestimated: it means that patient-facing metrics (not just safety, but quality and waiting times) will be at the heart of the new NHS organisations being set up which at a stroke reduces the perennial NHS risk of ever tighter upward accountability rather than the outward accountability to patients that matters most. Matt Hancock’s letter also explained a bit more about the regulation making powers the Bill will give the Secretary of State with regards to HSIB which will be used to add to the list of exemptions where the concept of safe space won’t apply rather than to change existing exemptions (so no retrospectively which really matters for whistleblowers) as Shaun Lintern has rightly fretted about.

SELECT COMMITTEE SESSION We discussed these changes and more in an occasionally bad-tempered evidence session with the Secretary of State this week. He added a bit more detail on the CQC’s role clearly stating that the four grade Ofsted style ratings system would be used. And in a quick fire round with me clarified some aspects of the directional powers the Bill will give the Secretary of State. He stuck to the usual government line on NHS pay that this was what was ‘affordable now’ although many on Twitter have doubted his claim that 1% is not a real terms cut given the CPI forecast for next year is 1.5% inflation. He gave some hope on broader budgetary issues saying that the government will pick up the tab for any additional COVID costs. But why is it taking so long? To have failed to agree Covid costs with the Treasury this close to the end of the financial year creates a distraction for hospital chief executives they could do without to say the least.

WORKFORCE PROBLEMS I was even less convinced that the government has any answers to our concerns about the lack of measures to address failures in long term workforce planning. On the need for independent projections of NHS workforce requirements the Secretary of State argued that these were judgements rather than objective facts - all the more reason, surely, for doing the work objectively and independently with regular scope for revisions and updates. He did say that transparency from HEE was needed so that a public debate can be had which is frankly more than we have at the moment so maybe there’s a glimmer of hope. But this is an area that the Committee feels strongly about as you can see from the spicy exchange between him and my Committee colleague Sarah Owen.

EACH BABY COUNTS REPORT The Royal College of Obstetricians and Gynaecologists has published the last Each Baby Counts Progress Report. This is the final one from the RCOG as HSIB will now be taking over responsibility for reporting and investigating stillbirths, neonatal deaths and brain injuries as a result of incidents occurring during term labour. The first step in improving anything is to measure it and this report has been invaluable over the years, so thank you RCOG. This year’s report too is well worth a read.

ANDREA SUTCLIFFE INTERVIEW Another must read this week is this interview with the head of the Nursing and Midwifery Council Andrea Sutcliffe. She talks about her plans to transform the regulator but says strikingly that many of the cases referred to the NMC have NOT been properly investigated by the relevant hospital or care home first. It is just too easy to blame an individual when something goes wrong, pass the problem on to the regulator and ignore the need for systemic change. As Andrea says, “If your automatic reaction is to say ‘something has happened and who is to blame’, and the first thing you do is refer them to their professional regulator without considering anything else, then you don’t get the learning, you don’t really know what happened.” Quite.

CQC DNACPR CONCERNS A report out this morning from the CQC called for improved oversight of the use of do not attempt cardiopulmonary resuscitations. The pandemic has really shone a light on their use - 508 uses of them made since March 2020 were not agreed in discussion with the person or their family. The report makes a series of recommendations to ensure this doesn’t happen in the future.

HSIB INTERIM BULLETIN ON MEDICATION ERRORS HSIB has published an interim update on its investigation into medication errors in children. The related interim report has some stark figures that are always worth remembering – 237 million medication errors occur in England each year.

WHO WORLD PATIENT SAFETY DAY PREP I joined a call of global patient safety experts and the WHO to discuss the potential theme for this year’s World Patient Safety Day. It is going to be maternity safety (although this has not yet been officially announced) which will resonate strongly with readers of this email.  

PATIENT SAFETY AWARENESS WEEK As I mentioned at the start this is really a US-based awareness raising week but hopefully we can do more in the UK from next year. For an interesting read on patient safety in the States I thought this was pretty useful.

RESEARCH CORNER The IPPR has a report out on the NHS Long Term Plan After COVID detailing a £12bn plan to ensure the health and care systems recover after the pandemic.

Jeremy Hunt