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GP surgeries offered £1,000 to cancel second dose Covid jab appointments in roll-out chaos

GPs are being paid £1,000 to cancel second dose appointments for Covid jabs and given a script to follow to deal with angry patients amid growing chaos in the roll-out of the vaccine programme.

Practices have been offered the payments to cover the workload of postponing hundreds of patients who were set to have their second dose and booking new ones in their place.

NHS sources said the shift has contributed to delays in rolling out the programme. Some GPs have refused to postpone the appointments, with practice managers saying it was "too cruel" to dash the hopes of those who were booked for a second jab.

In December, everyone given a first vaccine by Pfizer was told to come back for their second dose three weeks later. But the strategy was changed 10 days ago in a bid to get a first dose to more of the population more quickly.

Patients are now being told they will have to wait 12 weeks for the second dose, with a reassurance from health officials that the longer gap could strengthen its effectiveness.

By the time the plan was changed, around one million people had already been booked in for their second dose. GPs are now under orders to postpone such appointments and instead give the slots to those awaiting a first dose. 

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Source: The Telegraph, 8 January 2021

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NHSE orders further dilution of staffing ratios to help double ICU capacity

NHS England has told hospitals in the Midlands to further dilute their staffing ratios so critical care capacity can be doubled, HSJ has learned.

In a letter sent on 9 January to the boards of all trusts in the region, national leaders said they needed to “dilute nursing ratios beyond the current ask of 1:2” to achieve the significant increase in capacity.

In November, all trusts in England were told they could dilute staffing ratios in critical care from the standard one nurse to one patient ratio, to one nurse to two patients. Informal reports from around the country suggest some trusts have already had to move beyond these ratios.

The letter said trusts had already been asked to surge capacity to 150% cent of the normal baseline on 6 January, and were expected to be at 175% today. But it said some units were still not achieving this and the region was “transferring patients to other regions.”

It added: “In addition to this, you need to have well developed plans in place that can be rapidly activated to surge to 200% of baseline, which may need to be enacted in the coming days.

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Source: HSJ, 11 January 2021

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New partnership to improve patient safety in South East London ICS

Guy’s and St Thomas’ NHS Foundation Trust will work with Omnicell to develop a European technology-enabled inventory optimisation and intelligence service which will be initially implemented across South East London Integrated Care System (ICS). This partnership will encompass all six acute hospital sites within the South East London ICS, including Guy’s & St Thomas’, Kings College Hospital NHS Foundation Trust and Lewisham & Greenwich NHS Trust.

The project will have the following goals:

  • Develop analytics and reporting tools with a goal of improving patient safety, achieving increased operational efficiency and cost efficiencies
  • Utilize the analytics and reporting tools with a goal of achieving agreed efficiencies and cost reductions
  • Demonstrate the impact of managing clinical supplies and medicine spend together at scale
  • Build a service model for the ICS which can be scaled up and adopted by other hospital groups in the UK

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Mortality rate for Black babies is cut dramatically when they’re delivered by Black doctors, researchers say

Rachel Hardeman has dedicated her career to fighting racism and the harm it has inflicted on the health of Black Americans. As a reproductive health equity researcher, she has been especially disturbed by the disproportionately high mortality rates for Black babies.

In an effort to find some of the reasons behind the high death rates, Hardeman, an associate professor at the University of Minnesota School of Public Health, and three other researchers combed through the records of 1.8 million Florida hospital births between 1992 and 2015 looking for clues.

They found a tantalising statistic. Although Black newborns are three times as likely to die as White newborns, when Black babies are delivered by Black doctors, their mortality rate is cut in half.

"Strikingly, these effects appear to manifest more strongly in more complicated cases," the researchers wrote, "and when hospitals deliver more Black newborns." They found no similar relationship between White doctors and White births. Nor did they find a difference in maternal death rates when the doctor's race was the same as the patient's.

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Research paper

Source: The Washington Post, 9 January 2021

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NHS COVID-19 jab letters 'confusing over-80s'

People waiting to receive the COVID-19 vaccine say they are confused by NHS letters inviting them to travel to centres miles away from their homes.

The first 130,000 letters have been sent to people aged 80 or older who live about 30 to 45 minutes' drive away from one of seven new regional centres.

But patients, many of whom are shielding, questioned why they had to travel so far in a pandemic.

Local jabs are available to people if they wait, the NHS said.

The seven centres include Ashton Gate in Bristol, Epsom racecourse in Surrey, London's Nightingale hospital, Newcastle's Centre for Life, the Manchester Tennis and Football Centre, Robertson House in Stevenage and Birmingham's Millennium Point.

Mary McGarry from Leamington Spa in Warwickshire told BBC News that her letter points to an NHS online booking page which suggests she would have to take her husband, who has cancer and a lung disease, 20 miles to Birmingham.

"We're very reluctant to go into Birmingham city centre," she said.

"If we can't get somebody to take us, we'd have to go on the train but we're shielding because my husband's got poor health.... we want to know why we've got to travel that far?"

People will not miss out on their vaccination if they do not use the letters to make an appointment at one of the centres, the NHS said.

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Source: BBC News, 11 January 2021

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Hospital's oxygen supply in 'critical' situation

A hospital's oxygen supply has "reached a critical situation" due to rising numbers of COVID-19 infections.

A document shared with the BBC showed Southend Hospital has had to reduce the amount it uses to treat patients. It said the target range for oxygen levels that should be in patients' blood had been cut from 92% to a baseline of 88-92%.

Hospital managing director, Yvonne Blucher, said it was "working to manage" the situation.

"We are experiencing high demand for oxygen because of rising numbers of inpatients with Covid-19 and we are working to manage this," she said.

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Source: BBC News, 11 January 2021

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US: 10 top patient safety issues for 2021

The Becker's Clinical Leadership & Infection Control editorial team chose the top 10 patient safety issues for healthcare leaders to prioritise in 2021, presented below in no particular order, based on news, study findings and trends reported in the past year.

  1. COVID-19
  2. Healthcare staffing shortages
  3. Missed and delayed diagnoses
  4. Drug and medicine supply shortages
  5. Low vaccination coverage and disease resurgance
  6. Clinical burnout
  7. Health equity
  8. Healthcare-associated infections
  9. Surgical mistakes
  10. Standardising safety efforts.

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Source: Becker's Healthcare, 30 December 2020

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Coronavirus hospital patients still have symptoms six months later, study finds

Three quarters of patients surveyed at Jinyintan Hospital in Wuhan, China had at least one ongoing symptom

The majority of people admitted to hospital with coronavirus still had symptoms six months after getting ill, a new study has revealed.

Over three quarters of Covid patients surveyed at Jinyintan Hospital in Wuhan, China had at least one ongoing symptom – with the most commonly reported being fatigue or muscle weakness. A total of 1,733 patients, with a median age of 57, were examined for the study between 7 January and 29 May last year. At a follow-up, 76% of patients reported at least one ongoing symptom.

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Trust boss warns region faces ‘absolute crisis’ with trusts ‘hanging on by their fingernails’

Hospital chiefs in the South West have warned the region will not avoid the extreme pressures felt by other parts of the NHS amid rapidly rising numbers of COVID-19 inpatients.

The region was the least affected area of England during the pandemic’s first wave, but the medical director of two acute trusts yesterday predicted a “tidal wave” of COVID-19 coming to the West Country.

Adrian Harris, medical director at Royal Devon and Exeter Foundation Trust and Northern Devon Healthcare Trust (NDHT), said the region faced an “absolute crisis” and individual trusts would be “hanging on by their fingernails”.

His comments, made at NDHT’s board meeting, came on the same day HSJ revealed the South West region now has the fastest growth in COVID-19 inpatients. Although the region is England’s least densely populated, it also has the lowest hospital capacity per capita in the country.

Dr Harris said: “We hope and we pray that the lockdown has come in time for Devon. My personal view — and of my colleagues around the country — is that there’s a tidal wave of COVID-19 coming to the West Country."

“We are preparing to be hit as hard as the East of England. If we are hit as hard, we will be hanging on by our fingernails and we are planning accordingly.”

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Source: HSJ, 8 January 2021

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Pfizer vaccine 'works' against key variant mutation, study suggests

The Pfizer/BioNTech vaccine can still target a key mutation that has emerged in two new variants of coronavirus, laboratory studies show. 

However, this is only one of many mutations that are found in the new forms of the virus. So while the study has been welcomed, it is not being seen as definitive scientific evidence about how the vaccine will perform.

New variants have been detected in the UK and South Africa. Both forms of the virus are spreading more quickly and this has raised questions over what level of protection vaccines can offer against them.

The widely held view is that vaccines will still work, but researchers are on the hunt for proof.

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Source: BBC News, 8 January 2021

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Leak reveals urgent care patients face 30-hour waits because of covid pressures

Patients calling NHS 111 in London could face a 30-hour wait before being admitted to a hospital bed, the capital’s ambulance service has warned.

Slides presented by London Ambulance Service Trust at a webinar with NHS London this week showed “category three” patients faced long delays at all stages of the process.

The length of each stage was said to be as follows: having calls answered at 111 centres (20 mins); the “revalidation” of the call before it is passed to 999 (two hours); 10 to 12 hour waits for an ambulance; and similar waits in emergency departments before being admitted to a bed.

Category three calls are considered urgent, but not immediately life-threatening. The calls could involve abdominal pain, uncomplicated diabetic issues and some falls. Category three patients are among those the NHS is encouraging to call first, rather than going straight to accident and emergency, as part of the flagship “111 first” drive designed to produce pressure on emergency care. 

Normally, the pathway from a 111 call being made to a patient being admitted to a bed would take nine hours with a faster response at all stages, the slides suggest. But the pressure across the NHS from covid cases is leading to much longer waits.  

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Source: HSJ, 8 January 2021

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Moderna becomes third Covid vaccine to be approved for use in UK

The Moderna COVID-19 vaccine has become the third to be approved by the UK.

The US pharmaceutical company’s jab was given the green light by Britain’s regulator and doses will be available in the spring.

The announcement comes as the rollout of the Pfizer and Oxford vaccines is scaled up to meet Boris Johnson’s target of immunising all care-home patients by the end of the month, with 1,000 vaccination centres expected to be operational by Sunday. 

The government has also purchased an additional 10 million doses of the Moderna vaccine on top of its previous order of 7 million, taking the total to 17 million.

Supplies will begin to be delivered to the UK once Moderna expands its production capability, the Department of Health and Social Care said.

The Medicines and Healthcare products Regulatory Agency (MHRA) accepted the recommendation of the Commission on Human Medicines and authorised the Moderna vaccine following months of rigorous clinical trials and extensive analysis of the vaccine’s safety, quality and effectiveness.

The jab is 94% effective in preventing disease, including in the elderly.

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Source: The Independent, 8 January 2021

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Hospital watchdog chief calls for honesty over Covid pandemic’s impact on patient care

The chief inspector of hospitals has called for honesty about the impact of the coronavirus pandemic on patients warning poor care could become normalised.

Professor Ted Baker told The Independent it was vital staff continued to report incidents and revealed the Care Quality Commission had seen a 60% rise in whistleblowing concerns during the last national lockdown in November.

He said staff must report incidents and be free to speak up about any concerns as well as being transparent with families where things have gone wrong.

He emphasised that where a patient was unable to get the care they clinically needed because of the demand on services, this would amount to a notifiable patient safety incident.

Professor Baker’s comments follow multiple anonymous leaks from NHS staff to The Independent in recent weeks, showing how bad the situation has become in some hospitals. Many staff have only spoken out on condition of anonymity.

Many hospitals have declared major incidents, cancelled operations and been forced to stretch staffing ratios to unsafe levels to cope with the increasing numbers of COVID-19 patients.

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Source: The Independent, 7 January 2021

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There are so many Covid patients, younger this time. But my hospital is full

"There can be no debate: this is now much, much worse than the first wave", says a NHS consultant.

"Truly, I never imagined it would be this bad.

Once again Covid has spread out along the hospital, the disease greedily taking over ward after ward. Surgical, paediatric, obstetric, orthopaedic; this virus does not discriminate between specialities. Outbreaks bloom even in our “clean” areas and the disease is even more ferociously infectious. Although our local tests do not differentiate strains, I presume this is the new variant.

The patients are younger this time around too, and there are so many of them. They are sick. We are full."

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Source: The Guardian, 7 January 2020

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Hospital declared it may ‘refuse critical care’ as ‘overwhelmed’ by covid

A hospital in the South East today declared a level of critical care alert meaning that it may be forced into ‘refusal or withdrawal of critical care due to resource limitation’ because it has been ‘overwhelmed’ — but later claimed it was an ”administrative error”.

Data from an internal NHS dashboard for critical care, seen by HSJ, showed today Darent Valley Hospital, near Dartford in Kent, declared it was at “CRITCON level four”. 

CRITCON level four declarations are extremely rare. In guidance they are known as “Triage - emergency” and defined as: “Resources overwhelmed. Possibility of triage by resource (non-clinical refusal or withdrawal of critical care due to resource limitation).”

The definition continues: “This must only be implemented on national directive from [NHS England] and in accordance with national guidance.”

Dartford and Gravesham Trust, which runs the hospital, replied to HSJ more than five hours after it was contacted, and after publication of the story, to say: “This was a purely administrative error which was quickly rectified.” The level has not however been changed so far on the live dashboard, HSJ has confirmed.

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Source: HSJ, 7 January 2021

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Two more life-saving Covid drugs discovered

Two more life-saving drugs have been found that can cut deaths by a quarter in patients who are sickest with Covid.

The anti-inflammatory medications, given via a drip, save an extra life for every 12 treated, say researchers who have carried out a trial in NHS intensive care units.

Supplies are already available across the UK so they can be used immediately to save hundreds of lives, say experts. The UK government is working closely with the manufacturer, to ensure the drugs - tocilizumab and sarilumab - continue to be available to UK patients.

As well as saving more lives, the treatments speed up patients' recovery and reduce the length of time that critically-ill patients need to spend in intensive care by about a week.

Both appear to work equally well and add to the benefit already found with a cheap steroid drug called dexamethasone.

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Source: BBC News, 7 January 2021

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Treasury ‘the barrier’ as full hospitals desperate to discharge patients to social care

The government is being pressed to urgently pay care homes to take on thousands of patients from hospitals, many of which are on course to be overwhelmed by COVID-19 patients.

Hospitals, particularly in London and the surrounding areas, are seeing very high and rapidly growing numbers of covid-19 admissions, and are running out of options to free up beds. Multiple senior NHS leaders said they need to discharge more patients to care homes, but that this had become increasingly difficult.

Beds in many care homes are lying empty, but many care providers are refusing to accept residents where there is a risk of introducing covid-19 and fear of repeating the disaster of the spring in the sector.

Part of the problem is some care providers which would otherwise become covid-designated homes say they are not insured for the risk of doing so.

HSJ understands national officials in the NHS and government are now considering options to try to alleviate the problem, amid urgent requests from local NHS leaders, including paying for the additional insurance cost. However, sources said the Treasury had not yet been willing to foot the bill.

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Source: HSJ, 7 January 2021

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Covid: Where are the seven mass vaccination centres opening next week?

The government has confirmed plans to open seven new mass vaccination centres across England next week.

The seven centres opening are:

  • ExCel Centre (Nightingale), London
  • Etihad Tennis and Football Centre, Manchester
  • Centre for Life, Newcastle
  • Robertson House, Stevenage
  • Epsom Downs racecourse, Surrey
  • Ashton Gate Stadium, Bristol
  • Millennium Point, Birmingham

The exact opening dates for each site have yet to be established, however the prime minister’s official spokesperson said they would be opening “next week”. More details on how the vaccination sites will operate are expected to be revealed over the coming days. 

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Source: The Independent, 6 January 2021

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Scientists create guide to building truth ‘sandwich’ to combat Covid misinformation

In a bid to fight against misinformation about the coronavirus vaccines, a group of scientists from all over the world have created an online guide to building a ‘truth sandwich’.

The guide serves to arm people with practical tips, up-to-date information and evidence to talk reliably about the vaccines, and enable them to constructively challenge associated myths.

The scientists, led by the University of Bristol, are appealing to everyone to understand the facts set out in the 'COVID-19 Vaccine Communication Handbook', follow the guidance and spread the word.

Professor Stephan Lewandowsky, the lead author of the guide, said: “Vaccines are our ticket to freedom and communication about them should be our passport to getting everyone on board."

“The way all of us refer to and discuss the COVID-19 vaccines can literally help win the battle against this devastating virus by tackling misinformation and improving uptake, which is crucial."

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Source: The Independent, 7 January 2021

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Covid crisis forces suspension of maternity services

Some trusts in London and the South East are closing standalone birth centres and warning they cannot support home births because of high levels of demand for ambulance services from covid patients.

Women in East Sussex who planned to give birth at Eastbourne District General Hospital and Crowborough Birth Centre have been told they need to go to other units. Both Eastbourne and Crowborough have standalone midwife-led units and women who have a difficult labour would need to be transferred by ambulance to another hospital.

Both East Sussex Healthcare Trust and Maidstone and Tunbridge Wells Trust, which run the services, cited pressure on the ambulance services as the reason for the closures. The trusts, both of which are served by South East Coast Ambulance Service Foundation Trust, have also suspended support for home births.

Services are continuing at a similar birthing unit at Maidstone Hospital, with private ambulances transferring women to Tunbridge Wells Hospital if needed. However, Maidstone and Tunbridge Wells Trust has posted on Facebook to warn women the situation may change and it is monitoring ambulance response times to determine “the safety of our out of hospital birthing choices”.

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Source: HSJ, 6 January 2021

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ICU hospital staff: 'Scared, sad, petrified, worried'

For the first since April the UK has recorded more than 1,000 daily Covid-related deaths – one of the highest figures of the pandemic.

Right now, London is at the epicentre of this crisis. Hospitals now have more Covid patients being admitted every day than they did at the peak in April. Many doctors and nurses say they're reaching breaking point.

The BBC's medical editor Fergus Walsh filmed inside the intensive care unit at London's University College Hospital, which is one of the busiest in the capital.

View video

Source: BBC News, 6 January 2021

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London will be overwhelmed by covid in a fortnight says leaked NHS England briefing

London’s hospitals are less than two weeks from being overwhelmed by covid even under the ‘best’ case scenario, according to an official briefing given to the capital’s most senior doctors this afternoon.

NHS England London medical director Vin Diwakar set out the stark analysis to the medical directors of London’s hospital trusts on a Zoom call.

The NHS England presentation, seen by HSJ , showed that even if the number of covid patients grew at the lowest rate considered likely, and measures to manage demand and increase capacity, including open the capital’s Nightingale hospital, were successful, the NHS in London would be short of nearly 2,000 general and acute and intensive care beds by 19 January.

The briefing forecasts demand for both G&A and intensive care beds, for both covid and non-covid patients, against capacity. It accounts for the impact of planned measures to mitigate demand and increase capacity.

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Source: HSJ, 6 January 2021

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Spitfire pilots and the nature of courage

In a Letter to the Editor published in The Times yesterday, the All Party Parliamentary Group on First Do No Harm Co-Chair Baroness Julia Cumberlege argues in favour of the work of the Independent Medicines and Medical Devices Safety (IMMDS) Review and its report 'First Do No Harm'.

"Inquiries are only as good as the change for the better that results from their work."

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Source: The Times, 5 January 2021

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Umbilical cord stem cells implanted into Covid patients improve survival chances, study suggests

An experimental treatment involving stem cells from umbilical cords could significantly reduce deaths and quicken recovery time for patients suffering the most severe form of COVID-19, a study suggests.

US researchers reported a 91% survival rate in seriously ill patients given the stem cell infusion, compared to 42% in a second group who did not receive the treatment.

Researchers said the treatment also appeared to be safe, with no serious adverse reactions reported.

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Source: The Independent, 5 January 2021

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