Good morning and welcome to my patient safety weekly update. This week I look at the new more cautious Boris with his plan to lift lockdown, workforce burnout following the select committee session with minister Helen Whately, whether social care reform will be put into the long grass (again) and some real progress Group B Strep.

116 DAYS AND COUNTING until we reach the day in June when there might not be any legal limits on social contact. You can read the full document here for details on what the government’s expects to do and roughly when it hopes to do it but overall I think Boris got the balance about right given the ‘known unknowns’ of potential new variants. Those wanting a speedier end to the lockdown need only think back 6 weeks when the Kent variant forced us into another lockdown to see the risks of dangerous mutations are real not imagined.

SAGE WARNINGS This paper (amongst a raft published) from SPI-M says that even relaxing restrictions in the way envisaged will result “in a resurgence in hospital occupancy that is larger than seen in January 2021”. This is because the maths of even an effective vaccination strategy are slowly sinking in: 80% of the population protected with 80% efficacy means fully one third of the population are vulnerable.  As the SAGE minutes that considered this paper said  “Vaccines do not provide perfect protection from infection or disease and will not reach 100% of the population. Even when a significant proportion of the population has been vaccinated lifting NPIs will increase infections and there is a likelihood of epidemic resurgence (third wave) if restrictions are relaxed such that R is allowed to increase to above 1.” So going step by step is vital.

NO TO ZERO COVID What was interesting for pandemic strategy buffs like me was the explicit move away from a zero covid strategy. It is clear that we would have been much better off following the ‘zero covid’ countries in the last year (Taiwan 9 deaths, New Zealand 27 deaths,  Australia 900 deaths in total vs 121,000 deaths in the UK - and all of those with either no lockdowns or much less severe ones than here). But it is equally clear that ‘zero covid’ is not a long term solution - even Australia and NZ are going to have to find a way to manage the risk of Covid if they want to open their borders as we will certainly have to do with one of the most open and internationalised economies in the world. Vaccines provide the optimal way to manage that risk and given it has been an area the UK is leading on, I expect other countries to follow our path.

TALKING OF VACCINES the early data on the effectiveness of the vaccines seems to indicate they will have a much bigger impact than some of the modelling has assumed. But before rushing to speed up the lifting of restrictions, that still does not remove the risk of one of the 4000 variants we already have mutating into something that is immune to all the vaccines  we have. Which is why I come back to thinking our strategy is broadly correct.

BUILDING BACK BETTER? I used my opportunity to question the Prime Minister on the day he launched this plan to urge him to use next week’s budget to start addressing some of the long-term challenges the NHS and social care sectors face. Specifically I asked him to announce a strategy that will see us train enough doctors and nurses and to introduce a ten year plan for social care. The PM reiterated that he’ll be bringing forward plans for social care reform but nothing on NHS workforce planning. I will keep hammering away…

SECOND TIME LUCKY? So I thought I’d try asking the Health Secretary the next day the same thing in a bit more detail, namely if he had plans to publish a workforce plan this year. After summarising recent progress on recruitment of both doctors and nurses he did say that he’d be publishing a route to getting more of both in the future, but that now was ‘not quite the right time.’ Hmmm.

WORKFORCE INQUIRY Which brings me nicely to the latest Select Committee evidence session which was in fact the last of our inquiry into burnout and workforce planning. Anita Charlesworth was typically insightful in her critique of long-term workforce planning in both the NHS and social care sectors. She didn’t think the White Paper did much to address these issues but thought an independent body might be more useful, even if it presented its own challenges. I had an interesting exchange with Rob Smith from Health Education England on their long-term projections and whether they should be published or not. And Oonagh Smyth was very clear on the long-term needs of the social care sector. I also picked up where I’d left off with Prerana Issar on whether we’re ever going to see the NHS workforce projections or if they will remain shrouded in secrecy for ever more. I think she is on the side of the angels on this but very constrained as to what she is allowed to say.

SOCIAL CARE: WHEN, WHAT, HOW? Or at least that was what I tried to get out of the Minister, Helen Whately. She repeated the PM’s pledge that measures will be brought forward this year but couldn’t say exactly when. She was also reluctant to go into details about the cost or how it could be paid for.

CARE HOME VISITORS Some good news in the short term for care home residents at least. From 8th March they will be permitted one regular, indoor, visitor. I know this will be a great relief to many families across the country and is a real success for the extraordinary campaigners who have pushed the government on this throughout the pandemic.

SUPPORT FOR NHS STAFF It is also good to see the NHS looking after its staff with the launch of 40 new mental health and wellbeing hubs but I hope they are talking to Dame Clare Gerada about what they offer given her insights in her brilliant book Beneath the White Coat.

MATERNAL DEATHS DURING COVID The latest HSIB report looks at learnings from its investigation into 19 maternal deaths during the first wave of COVID-19. Out of the 19, 6 women died from complications arising from the virus and all of these were from BAME backgrounds.

MINISTER WRITES ON GROUP B STREP Following up her letter to Trusts last week and really passionate evidence in front of the Select Committee on the same issue, Nadine Dorries has written about her mission to reduce the harm this infection can cause. It’s a great piece, well worth the read, and to all our subscribers in leadership positions in NHS trusts – please do read it and sign up your trust to the trial and better test.

MATERNITY STATS Some great news from the ONS as new figures show in 2019 there were the lowest number of infant deaths since records began in 1980. More significantly these figures show there has been a 25% reduction in stillbirths and 30% reduction in neonatal deaths between 2010 and 2019. Great progress towards our target of halving both of these and an amazing achievement by all involved.

Jeremy Hunt