Good morning and welcome to a budget special Patient Safety email. We also look at the recent Select Committee session on cancer treatments, the MBRRACE report on maternity safety from last week, some news on the Health and Social Care Bill and of course, the latest on Covid.

BUDGET AND SPENDING REVIEW Most of the health announcements were leaked before the Budget day itself but we did find out that the Department of Health and Social Care’s resource budget will rise by 4.1% and NHS England’s day to day budget is set to rise by 3.8% over the  next three years. Glass half full or empty? The empty glassers will say it is only fractionally above the 3.4% rise (annually for five years) I negotiated with Philip Hammond in 2018 which doesn’t feel big given a brand new vaccine programme, 5.7m on the waiting list and other post-Covid hangovers. Full glassers will point out that this time there is a much more generous (and much needed) capital settlement this time, going up 4.1% to £11.2bn by 2024-25 and giving room for much needed diagnostic centres and IT systems. But the big gap was on workforce with no mention of what is happening to the Health Education England budget. The extra money for the NHS will unravel quickly if we do not train the extra doctors and nurses needed but despite warm words about “funding to continue building a bigger and better trained NHS workforce” as the HSJ points out the government has failed to confirm education and training budgets yet. The Health Foundation argues that “new money for technology and buildings, although vital, is of limited value without additional staff”. I couldn’t agree more and something I wrote about in the FT at the start of the week. This is serious unfinished business.

SOCIAL CARE Also as far as I can tell there was no specific new funding, beyond the Health and Care Levy, for social care. The LGA has rightly criticised this and pointed out it will be extremely challenging to deliver the appropriate standard of care whilst waiting for the Levy to properly kick in. Reminder: the levy generates less than £2 bn a year for social care, most of which goes to fund the new £86k cap on care costs rather than local government budgets.

HEALTH AND CARE BILL AMENDMENTS It is very welcome news to see that the government has tabled new clause 59 to ensure that the CQC will have oversight of Integrated Care Services. This is something I’ve been urging them to do for a while now in order to make sure the quality and safety of care are front of mind rather than simply internal NHS England targets. The CQC say that they expect to assess ICSs on “leadership, integration of services and care pathways, as well as quality and safety” and there is an assumption this will mean the same Ofsted-style ratings they do for hospitals. I will be tabling an amendment to make sure quality and safety are central to their inspections. The government has indicated it may accept this, really positive news given the success the CQC/Ofsted system has had to date in focusing attention on quality and safety issues.

HSIB AMENDMENTS Less encouragingly amendments I wanted to the HSIB clauses in the new Bill were rejected by the government after being debated in committee this week. The amendments sought to make the ‘safe space’ which allows doctors and nurses to talk anonymously to the new investigator even safer but the government decided coroners should have access to all protected material. This is a genuinely difficult issue but I still think having an independent investigator will be a huge step forward from where we are today.

SELECT COMMITTEE ON CANCER Well worth watching this powerful interview with a cancer patient called Philippa about how the pandemic had interrupted her treatment for breast cancer. What made it even more poignant was that the person originally scheduled to give evidence about her delayed cancer care had sadly died the week before. The lesson? If we ever do need to go into another lockdown we need ‘clean’ or ‘green’ sites for cancer care so it can continue uninterrupted. We also heard an impassioned plea to ensure we increase our capacity for treatments and not just diagnostic capacity Professor Pat Price. Finally (and it wouldn’t be a select committee session without me asking about it) there was a stark warning on workforce pressure from Professor Mike Griffin of the Royal College of Surgeons in Edinburgh.

MBRRACE REPORT The latest Perinatal Mortality Surveillance Report gave us the very welcome news that baby deaths have continued to fall between 2013-2019. Extended perinatal deaths were down 18% since 2013, Stillbirths down 20% and Neonatal deaths were down 12%. This is the equivalent to 2,910 lives saved or 770 fewer deaths per annum. Well done to the staff that have made this happen under the brilliant leadership of Jacquie Dunkley-Bent and Matthew Jolly, but also to the campaigners like James Titcombe, SANDS and Baby Lifeline who have kept the pressure up. BUT we still need 2000 more midwives and 500 more consultants, Maria Caulfield if you read this please note!

COVID LATEST The ONS weekly COVID survey shows that for the week ending 16th October the number of cases increased again. Nearly 1 million people in England, or 1 in 55 of the population, had the virus in that week. This continued the trend of the last few weeks that has seen cases rise steadily. More recent data in the COVID Dashboard would suggest we may have turned a corner as daily new cases have dipped from 56,000 on 18th October to 44,000 on 21st October. We’ve also seen tens of thousands of 12-15 year olds book vaccinations and the news that over half of over 50s have had a booster (including yours truly). The debate is around masks and covid passports but it seems to me the real cause of the spike has been that we have taken much too long to vaccinate teenagers. Will we make the same mistake on primary school children? Interesting to note the United States has just approved vaccines for 5-11 year olds.

Jeremy Hunt