Good afternoon. Meaty questions we consider in this week’s patient safety update: what has the impact of the pandemic been on stillbirths in Britain? Is continuity of care the right model given the news coming out of the Worcester Royal? What will Sir Simon Stevens’ legacy be? Will we or won’t we see action on social care? And how do things look on the COVID front as we approach the next stage in the government’s roadmap?

BEVAN VS STEVENS The news we all thought was coming finally did last week with Sir Simon Stevens announcing that he’ll be leaving the NHS in July. Alistair McLellan has a very balanced write up of Sir Simon’s time which includes the claim that he is now the clear runner up to Aneurin Bevan in the list of the NHS’s most iconic figures. It is also worth reading Hugh Pym’s analysis. For my part I always admired his passion for the NHS, his first-rate political skills, and his ability to give such a large organisation strategic direction during some very choppy times. I was incredibly proud when together we secured the £20bn uplift in the NHS budget and a ten-year plan for the service in 2018 – I’m sure it wouldn’t have happened with him. My full thoughts on his time at the top of the NHS are here - we will miss him.

SOCIAL CARE: IN OR OUT? Like me Sir Simon was disappointed that we didn’t persuade the Treasury and No 10 that 2018 was also the time for a social care ten-year plan. We were told it would come next but events, for me - and indeed Theresa May’s government - got in the way to say the least. But there is a head of steam building up for the government to finally get this sorted – not least because ‘senior treasury officials’ have started briefing against the options. Following the Times leader article last week, Saturday saw the Telegraph make a powerful case for reform and writing in the same paper with Andrew Dilnot, I set out why we both think it is now or never. There are reports it will get a mention in the Queen’s Speech but probably not much more than a commitment to announce reforms later this year (which we already know). What is crazy is that most of the additional costs (which are substantial) will have to be found by the Treasury anyway as they relate to changes in demography and increases in the national living wage. So why not do so in a structured way that allows the sector to plan for the long term as worked so successfully for the NHS?

WHEN CONTINUITY OF CARER GOES WRONG Truly shocking reports from the Worcester Royal Hospital where staff fear that a badly implemented roll out of continuity of carer for pregnant mums has led to a two tier maternity system. Most people (including me) have assumed continuity of carer is a ‘good thing’ but it seems that in this case moving midwives from the main maternity wards to establish continuity of carer teams has meant some women deemed high-risk have been waiting days to deliver. The usual safety alarm bells are also reported including a culture where people are afraid to speak out and an over-focus on one metric (the roll out of continuity of carer) to the detriment of safety. But isn’t the biggest lesson from this that we need a minimum standard of maternity staffing in place across the country so that this doesn’t happen elsewhere? I’m in no doubt that the continuity of carer model can be a massive step forward if implemented well - but it needs the staff in place to do it.

PANDEMIC VS STILLBIRTHS A fascinating blog post from Dr Elizabeth Fisher of the Nuffield Trust sums up the evidence of the pandemic’s impact on stillbirths and other adverse outcomes. She reiterates that thankfully stillbirth numbers in England continued their downward trend last year and in each month of 2020 the number was below the five year average. Likewise the rates of preterm births and low birthweights also decreased in 2020. The pandemic did, however, have negatives effects on maternity services with obstetric outpatient attendances falling by 9%, maternity admissions by 8%, and midwives sickness absence rates being higher in April 2020 than the previous year. But thankfully maternity units as a whole seem to have been less severely impacted than other services.

FINDING ‘LOST’ PATIENTS HSIB’s latest report is on lost patients and the follow up appointment gap. This makes a couple of recommendations that would help ensure outpatient appointments are properly made after an inpatient stay.

COVID UPDATE Surely a sign of the progress we’re making that I’m ending rather than starting with this but as we’ve now reach the 50 millionth dose of vaccine that has been given, the news that only 4 people died from COVID yesterday, and the number of daily new cases has dropped below 2,000 is all good news. The only slight concern in the data is that the number of new daily admissions seems to have blipped upwards over the last few days from 125 on 24th April to 160 on 27th. It is also good to see extra funding announced to support vaccine development and testing at Porton Down and signs a booster jab may be given to the most vulnerable and possibly all over 50s in the Autumn to reduce the chances of a third wave this Winter. Pleased to be over 50 at last!

SIGN UP If you’ve been forwarded this email and want to sign up please do so here and you’ll get this update every Wednesday at about 5pm.

Jeremy Hunt