Good afternoon and welcome to my regular patient safety update. This week we look at the latest session of the Select Committee’s inquiry into cancer, issues in the social care sector and all things Covid including the brave (but right) decision to make vaccines mandatory for most NHS staff. As ever you can sign up to receive this update via our website here and please tell any friends you think might enjoy it.

CANCER SERVICES INQUIRY Heart breaking testimony from one of our witnesses yesterday as Kathy Hall told us of her experience of being diagnosed late with a rarer cancer. It wasn’t because of the usual issue resources/waiting time issues but the fact that as a young woman she was not considered likely to have kidney cancer - and it was only discovered when she insisted on having the lump removed. 55% of all cancer deaths are ‘rare’ cancers so whilst the new diagnostics hubs will help, better training and understanding is also crucial. We don’t perform well at all in terms of survival rates for such cancers compared to other European countries and if we want to catch up we will have to address such issues. We also heard about the root causes of geographical variation in survival rates across the country with Professor David Shackleton of Greater Manchester Cancer highlighting the role deprivation plays - post-Covid it feels like health inequalities are going to come centre stage.

TALKING OF DIAGNOSTICS Earlier diagnosis of cancer is the biggest single thing we could do - exam question: have we suffered on this because all the cancer targets relate to time to treatment/test result and not the bigger question of how many cancers are diagnosed at stages one and two. Targets can be so powerful but if you choose the wrong ones… In fairness the government and the NHS are alive to this and have announced plans for 100 new diagnostic centres and this week also announced £250m to upgrade existing diagnostic labs and processes which should help cut waiting times for these vital services.

SOCIAL CARE LATEST As we (hopefully) get closer to the publication of the government’s white paper on social care I’ve set out my current thinking about the long-term solution to funding in the Mail. As I say in the article three cheers for the new Health and Social Care Levy but with respect to social care (which gets less than £2 bn of the annual £12 bn) we still have a massive problem. Aside from the short term fix (more money for local authorities) what is the long term answer? I have a stab by arguing that just as we save for our pensions, there should be auto-enrolment into saving for care costs, probably as part of the same scheme.  

MANDATORY VACCINES This is a difficult decision but I think the government has made the right one when it comes to mandatory COVID vaccines for most NHS staff. In the week when it was revealed that nearly 12,000 people died from the virus they likely caught in hospital we really need to do all we can to keep staff and their patients safe. Sajid Javid was challenged this morning on the Today programme about the assertion that lives will be lost if staff leave - but surely the first duty of anyone in heath and care is to protect their patients from a disease which transmits asymptomatically? I would go further though - many of the arguments the Health Secretary used to explain it can also be used for taking similar action on the flu jab. You can see his answer to my question on this issue here. Trust leaders have welcomed the decision to delay the introduction of mandatory Covid vaccines until April once the winter difficulties are over which is not ideal but probably sensible.

COVID LATEST Things seem to be heading in the right direction overall on the COVID front – although we’re far from out of the woods yet. The ONS reports that the increase in case numbers slowed over a two week period although they still report 1 in 50 people in the community have the virus. The COVID dashboard continues to report further declines in cases, this time a 15% decrease over the last seven days. Deaths have slightly crept up and there are still roughly 9,000 patients in hospital with the virus. This number hasn’t really changed much over the last few weeks hovering around that mark since 25th October. With far more people now getting the booster vaccine though things should hopefully start to improve on the frontline. We desperately need this to happen quickly though as many hospitals feel incredibly under pressure.

LITIGATION REFORM The Select Committee inquiry into litigation reform starts next week and regular readers will know I’m convinced that wide scale reform is needed if we’re to ensure we have a learning not a blame culture. I took part in a webinar organised by Irwin Mitchell which the Law Gazette has a handy write up of on this topic which is in the ‘boring but important’ category for those of us determined to end the blame culture in medicine.

Jeremy Hunt