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Midwives and paramedics can deliver flu and covid vaccines after new laws come into force

A wider range of healthcare workers—including midwives, paramedics, physiotherapists, and pharmacists—are now allowed to give flu and potentially COVID-19 vaccines after the introduction of new laws by the UK government.

The changes to the Human Medicines Regulations 2012, first proposed in August1 and consulted upon last month, came into effect on 16 October.

The Department of Health and Social Care said that the expanded workforce will have to undergo additional training to ensure patient safety. It added that government planning will “ensure this does not affect other services in hospitals and in GP and community services, by drawing on a pool of experienced NHS professionals through the NHS Bring Back Scheme.”

Commenting on the changes, England’s deputy chief medical officer Jonathan Van-Tam said, “The measures outlined today aim to improve access and strengthen existing safeguards protecting patients.”

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Source: BMJ, 16 October 2020

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Deaths at home: More than 26,000 extra this year, ONS finds

More men than normal are dying at home from heart disease in England and Wales and more women are dying from dementia and Alzheimer's disease, figures show.

More than 26,000 extra deaths occurred in private homes this year, an analysis by the Office for National Statistics found.

In contrast, deaths in hospitals from these causes have been lower than usual.

The Covid epidemic may have led to fewer people being treated in hospital or it may be that people in older age groups, who make up the majority of these deaths, may be choosing to stay at home – but the underlying reasons for the figures are still not clear.

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Source: BBC News, 19 October 2020

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Ontario woman finds needle in her spine 16 years after giving birth

When the pain in her shoulders and weakness in her right leg started two years ago, Giovanna Ippolito thought it was just part of getting older — that's until the 46-year-old's doctor ordered an X-ray that showed a five-centimetre long, broken needle embedded in her spine.

It was a medical error that took more than a decade to discover — after medical staff at the time failed to report it. 

Exactly when the needle was left in Ippolito's spine is unclear, but she says she's only had something injected into her back twice — during the birth of her son in 2002 and her daughter in 2004. 

Ippolito says she believes the needle broke off when medical staff at Mackenzie Richmond Hill Hospital in nearby Richmond Hill (called York Central Hospital at the time) administered a spinal block or an epidural during one of the births.

She's now locked in a battle with the hospital for answers and accountability. But experts say, with a system that's stacked against Canadians harmed by medical errors, it's likely no one will have to take responsibility.

More than 132,000 patients experienced some kind of medical harm — something both preventable and serious enough to require treatment or a longer hospital stay — in 2018-19, according to the Canadian Institute for Health Information, an independent, not-for-profit organization that collects information on the country's health systems.

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Source: CBC, 5 October 2020

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Coronavirus: 'Long Covid could be four different syndromes'

"Long Covid" – the long-lasting impact of coronavirus infection – may be affecting people in four different ways, according to a review, and this could explain why some of those with continuing symptoms are not being believed or treated.

There could be a huge psychological impact on people living with long-term COVID-19, the National Institute for Health Research report says.

They need more support – and healthcare staff require better information.

Most people are told they will recover from mild coronavirus infections within two weeks and from more serious disease within three. But the report says thousands could be living with "ongoing Covid".

Based on interviews with 14 members of a long-Covid support group on Facebook and the most recent published research, the review found recurring symptoms affecting everything from breathing, the brain, the heart and cardiovascular system to the kidneys, the gut, the liver and the skin.

These symptoms may be due to four different syndromes:

  • permanent organ damage to the lungs and heart
  • post-intensive-care syndrome
  • post-viral fatigue syndrome
  • continuing COVID-19 symptoms

Some of those affected have had a long stay in hospital with severe Covid-19 - but others, who have had a mild infection, have never even been tested or diagnosed.

The review says coming up with a "working diagnosis for ongoing COVID-19" would help people access support.

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Source: BBC News, 15 October 2020

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Parents win six-year battle for truth after NHS ‘cover-up’ of son’s death

The parents of a three-year-old boy whose death was part of an alleged NHS cover-up have won a six year battle for the truth about how he died.

Shropshire coroner John Ellery backed the parents of three-year-old Jonnie Meek in a second inquest into his death on Thursday and rejected evidence from nurses about what happened at Stafford Hospital in August 2014.

Jonnie, who was born with rare congenital disability De Grouchy syndrome, died two hours after being admitted to hospital to trial a new feed which was being fed directly into his stomach. His parents, John Meek and April Keeling, from Cannock in Staffordshire, have always maintained their son died after a reaction to the milk feed caused him to vomit and suffocate.

But they have been forced to battle what they believe was an attempt to hide what happened after they discovered attempts to alter their son’s medical history with claims he had experienced several cardiac arrests requiring resuscitation which never happened.

In 2015, healthcare assistant Lauren Tew, who was with Jonnie and his mother when he died, told the HSJ that a statement in her name submitted to a child death overview panel stating Jonnie had died from a sudden cardiac arrest was false and she had never made such a statement.

Another statement said Jonnie had been admitted to hospital for three weeks months before his death which also never happened.

After his parents exposed the false statements an independent inquiry was launched, with three independent experts agreeing with Jonnie’s parents, and in April last year the High Court quashed the original inquest verdict that Jonnie died of natural causes and pneumonia.

Speaking to The Independent Jonnie’s father said: “This does bring us some peace after six years. For the coroner to say he believes April over the nurses after all this time is a big weight lifted off her.

“The hospital definitely decided to try and cover up what happened to Jonnie. We have always said we knew what happened and this has been a massive waste of resources. I am still very concerned about how these things can happen in the first place.”

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Source: The Independent, 15 October 2020

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England's 'fragile' care sector needs immediate reform, says regulator

The government must immediately deliver a new deal for social care with major investment and better terms for workers, the Care Quality Commission (CQC) has said, as it warned that the sector is “fragile” heading into a second wave of coronavirus infections.

In a challenge to ministers, the regulator’s chief executive, Ian Trenholm, said overdue reform of the care sector “needs to happen now – not at some point in the future”.

Boris Johnson said in his first speech as prime minister, in July 2019: “We will fix the crisis in social care once and for all.” But no reform has yet been proposed, and more than 15,000 people have died from COVID-19 in England’s care homes.

Trenholm said Covid risked turning inequalities in England’s health services from “faultlines into chasms” as the CQC published its annual State of Care report on hospitals, GPs and care services.

The report reveals serious problems with mental health, maternity services and emergency care before the pandemic, and says these areas must not be allowed to fall further behind.

The regulator argued that the health system’s response to the pandemic needs to change. After focusing on protecting NHS services from being overwhelmed, health leaders must now adapt to prevent people who need help for non-Covid reasons from being left behind, it said.

These include people whose operations were cancelled and people from black and minority ethnic backgrounds, people with disabilities, and people living in deprived areas who have suffered more severely from the impact of Covid.

“Covid is magnifying inequalities across the health and care system – a seismic upheaval which has disproportionately affected some more than others,” said Trenholm.

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Source: The Guardian, 16 October 2020

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Leaking vials supplied for NHS test and trace, say whistleblowers

Leaking vials and suspected contamination were identified in a batch of more than 500,000 test tubes produced for the NHS Covid test and trace operation over the summer, whistleblowers have said.

The test tubes were provided by a small UK-based company, Life Science Group (LSG), which produces materials for the diagnostics industry.

According to the whistleblowers, there have been repeated problems with test tubes filled by LSG leaking. Stocks of some 600,000 test tubes were inspected in August as a result, and records seen by the Guardian describe the discovery of what looked like hair and blood contamination.

It is understood firms in the supply chain concluded that the contamination was not hair or blood, following inspections. However, records seen by the Guardian suggested at least one bag of LSG test tubes thought to be contaminated “cannot now be found”.

The whistleblowers said that rather than rejecting the entire potentially compromised batch, as would be normal safety protocol with NHS supplies, only part of the batch with visible problems was removed from use. They said they had blown the whistle because they were concerned for public safety.

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Source: The Guardian, 16 October 2020

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Infection control experts issue open letter on care home visiting

A group of experts in nursing and infection prevention and control (IPC) is today warning against the use of IPC measures as a “rationale” for stopping safe and compassionate visits in care homes during the Covid-19 pandemic.

In a new open letter published in Nursing Times, the specialists say that preventing people from visiting loved ones in social care settings in the name of IPC is a “misinterpretation and at times even abuse” of IPC principles.

The letter is the brainchild of independent global health consultant and former Infection Prevention Society (IPS) president, Jules Storr. Among the signatories are five former IPC presidents, current president Pat Cattini as well as incoming president Jennie Wilson. Dr Ron Daniels, chief executive of the UK Sepsis Trust, is also on the list, Helen Hughes, chief executive of Patient Safety Learning, as well as leading IPC nurse specialists, nurse academics, a GP and carers.

Ms Storr, a nurse by background, and the hub topic lead, said she was motivated to take action after hearing “the most heart-breaking” stories from health professionals and relatives of residents about restricted visits in the UK in the wake of COVID-19.

Some had not seen relatives for weeks or months, whilst others were only allowed to see their loved one once a week for 20 minutes at a distance, she said.

One individual had told her how when their father had died only one family member was permitted in the home and they were not allowed to sit close enough to hold his hand.

Ms Storr said these practices were “absolutely outrageous and wrong from an infection prevention point of view”.

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Source: Nursing Times, 16 October 2020

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Lockdown patients ‘put off’ GP visits after warnings about restricted care

GPs’ warnings about restricted services may have put patients off seeking treatment, delaying diagnoses and worsening existing illnesses, the health and care watchdog has said.

The Care Quality Commission (CQC) said that millions of people had struggled to see their doctors during the pandemic, which had magnified inequalities and risked “turning fault lines into chasms”.

Between March and August 119.5 million GP appointments were made in England, down from 146.2 million last year, according to NHS Digital.

Ian Trenholm, the CQC’s chief executive, said: “The number of lost GP appointments translates into millions of people potentially . . . not getting conditions diagnosed early enough, not getting those referrals on for diagnoses like cancer and other conditions.”

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Source: The Times, 16 October 2020

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Leaked emails raise flag on ‘extremely concerning’ bed shortage

‘Systemic’ problems within mental health services in Birmingham have caused the number of people waiting for an inpatient bed to reach ‘extremely concerning’ levels, according to documents leaked to HSJ.

There are currently 41 people waiting to be admitted to a bed by Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) , according to internal documents, while 36 people have already had to be sent to private sector facilities up to 150 miles away.

The NHS in the area has indicated to HSJ  that it is due to need for “intensive levels of care” now growing because of the impact of the COVID-19 pandemic.

In an email thread, sent to 60 people in the trust including senior executives, one senior clinician wrote in response to the bed figures: “The number of patients with Mental Health Act assessments completed is extremely concerning. This needs to be escalated to commissioners. The problem is systemic.”

It comes after an HSJ investigation earlier this year into the deaths of 12 patients under BSMHFT’s services. It revealed senior medics had repeatedly warned the trust about severe bed shortages and a lack of capacity within home treatment services.

The trust said it was addressing the issues raised, but senior clinicians told HSJ this week the trust is still short of at least 80 adult mental health beds.

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Source: HSJ, 15 October 2020

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NHS staff in northern England 'exhausted' amid second wave fears

Doctors and nurses in areas of northern England with some of the highest Covid infection rates have described being “physically and emotionally” exhausted, as the NHS braces itself for the second wave of the pandemic.

Most of the north has been put into the tier 2 “high risk” category, with Merseyside in the highest – tier 3 – bracket. While politicians debate whether a nationwide circuit breaker would be a more effective instrument to curb spread of the virus, frontline staff – still scarred from the first wave – are under no illusions as to what lies in store.

Carmel O’Boyle, a nurse in Liverpool, who is also chair of the Royal College of Nursing’s Greater Liverpool and Knowsley branch, said members of the public had used A&E and primary care sparingly during the first national lockdown but mixed messages and a lack of trust in the government had led to people throwing caution to the wind and attendances were rising accordingly.

“The nurses across my branch are frightened and exhausted – physically and emotionally,” she said. “They’ve been dealing with this for months and now there are more people in hospitals than there were in March. Although we know a little bit more about how to treat people and the kind of path of the disease process, it’s still frightening. It’s just so demanding and so draining to be nursing people in this manner without any family involvement and with the complications that there are.”

A consultant in Manchester, who did not want to be named, said her hospital coped with the first wave but “the difference this time is that we’re trying to continue all of the elective activity and that’s going to be challenging.

“I do think that we will manage the Covid cases. I just now worry about whether we will be able to continue to keep the normal care for people who need their operations [and] need care for cancer."

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Source: The Guardian, 15 October 2020

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'I fear being a forgotten casualty of pandemic'

At the age of 49, Sarah Fisher feels her life is on a knife-edge. She had a heart attack during lockdown and has subsequently been diagnosed with heart failure.

In July, she was told she needed to have an implantable cardioverter defibrillator (ICD) fitted, which can shock the heart back into rhythm when it detects a potential cardiac arrest. But 12 weeks on, she is still waiting. "I could have a cardiac arrest at any point," Sarah says.

"It is awful not knowing what is going to happen. "I am on the urgent list – but the infection rates are rising and the clinics are closing."

"I don't know when I will get it.

"There are so many people in my position – we don't have Covid but our lives are at risk too. We are the forgotten victims of this pandemic."

British Heart Foundation analysis of Office for National Statistics data for England and Wales found almost 800 extra deaths from heart disease among under-65s from March to July - 15% more than would be expected.

The rate of death was highest during the full lockdown - but, worryingly, the trend continued afterwards. The charity blames delays in people seeking care, as well as reduced access to routine tests and treatments.

And NHS England figures show a sharp rise in the numbers waiting over six weeks for a whole range of key tests, including echocardiograms for hearts.

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Source: BBC News, 15 October 2020

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Liverpool intensive care units '90% full' as city braces for second wave

Intensive care units in Liverpool’s hospitals are more than 90% full, according to a local health leader, as the city braces for a second wave of COVID-19 infections.

Councillor Paul Brant, cabinet member for adult health and social care at Liverpool City Council, warned that hospital services were once again being forced to care for patients critically ill with coronavirus.

"Our intensive, critical care beds are filling up very fast,” he told BBC Radio 4's Today programme.

"The most recent figures I've seen suggest they are over 90 per cent full and our acute hospital trusts have occupancy levels of Covid-positive patients of over 250. At the current rate of increase, we would expect Liverpool to surpass the peak of the first wave probably within the next seven to 10 days."

Addressing the intensive care situation, he added: "They are not all Covid patients, I should say, but they are running very full and they are running with an increasing number of people who are Covid-positive."

He added: "It has become clear that the intensity of the demand on hospital services here in Liverpool is crowding out anything other than dealing with Covid."

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Source: The Independent, 14 October 2020

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NHS trust apologises after staff accused of restraining elderly man 19 times

An NHS trust has offered an unreserved apology to an elderly patient and his family after they accused hospital staff of restraining him 19 times in order to forcibly administer treatment.

East Kent Hospitals University NHS Foundation Trust admitted that care for the man, who has dementia, “fell far short” of what patients should expect.

The 77-year-old had been admitted to the William Harvey Hospital last November for urinary retention problems, according to a recent BBC investigation.

In February, The Independent revealed that a police investigation had been launched into an alleged assault against an elderly man at the hospital after nurses and carers were filmed by hospital security staff holding the man’s arms, legs and face down while they inserted a catheter.

A whistleblower told The Independent that the incident was being covered up by the trust and staff were told: “Don’t discuss it, don’t refer to it at all.”

On Wednesday, the trust said its investigation had found a failure to alert senior medics to the difficulties being experienced in caring for the patient.

Changes to dementia care including ward reorganisation, training and recruitment are underway, said a spokesperson, who added: “We apologise unreservedly to the patient and his family for the failings in his care, this fell far short of what patients should expect.”

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Source: The Independent, 14 October 2020

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Midlands trust fights to ‘preserve' elective work amid covid bed closures

Covid’s second surge has begun disrupting elective care at hospitals outside the north west, HSJ has learned.

At Nottingham University Hospitals Trust, the number of patients with COVID-19 is “rising fast”, causing ward closures and elective care disruption, according to an internal memo seen by HSJ.

The memo, sent by the trust’s divisional director for surgery Simon Parsons, said covid admissions to the trust “are way past 100 and rising fast”.

“There are also outbreaks of covid on certain wards, which have resulted in closures of beds,” Mr Parsons said.

“I am afraid the elective programme is going to be disrupted and we are doing everything we can to preserve as much elective work as possible,” said the memo to staff at the major teaching hospital.

Mr Parsons called on clinicians to concentrate on “getting patients discharged in a timely way” and for them to escalate instances where patients were fit for discharge but not leaving the trust.

“We are not asking you to make unsafe discharges but to keep length of stay as short as possible,” Mr Parsons said.

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Source: HSJ, 14 October 2020

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Rising covid absences will have ‘significant impact’ on NHS recovery

Increasing staff absence due to COVID-19 will have a ‘significant impact’ on the ability of the NHS to deliver critical care services and routine operations, leading intensive care doctors have said.

The latest NHS England data has shown the number of COVID-19 related absences of staff, either through sickness or self-isolation, has risen from 11,952 on 1 September to 19,493 on 1 October. Staff absence has almost doubled in the North West in this time as well – from 2,664 to 5,142 during the same period.

It peaked at 17,628 in the region on 11 April and means the October total accounts for nearly a third of that amount already (29%). 

Alison Pittard, dean of the Faculty of Intensive Care Medicine, confirmed increasing numbers of NHS critical care staff were absent from work. “I suspect this is due to having to be at home with children asked to isolate and therefore the parent needing to isolate, as was the case in the first wave," she told HSJ.

 “This will have an impact on our ability to deliver critical care services. We know that staff numbers are inadequate at the best of times, with a significant vacancy rate especially for critical care nurses.”

Royal College of Anaesthetists council member Helgi Johannsson said the rising absence rate was “likely to have a significant impact”, particularly on routine operations.

Dr Johannsson, a consultant anaesthetist at Imperial College Healthcare Trust, said: “In my hospitals, I have been aware of several doctors and nurses having to isolate due to their children being asked to self-isolate. These healthcare staff were otherwise well and would have been at work."

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Source: HSJ, 14 October 2020

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Coronavirus: Patient has sudden permanent hearing loss

A 45-year-old British man has been left with permanent hearing loss after developing COVID-19.

UK doctors say it is the first such case they have seen linked to the pandemic coronavirus. Although rare, sudden hearing loss can follow other viral infections, such as flu.

The ear-nose-and-throat experts told BMJ Case Reports journal steroid drugs could help avoid this damage if given early enough.

The patient, who has asthma, had been admitted to a London hospital with COVID-19 symptoms and transferred to intensive care after struggling to breathe. Tests confirmed he had coronavirus and he was put on a ventilator machine. He also needed various drugs and a blood transfusion before beginning to recover and coming off the ventilator 30 days later.

A week after the breathing tube was removed and he left intensive care, he noticed tinnitus (a ringing or buzzing noise) followed by sudden hearing loss in his left ear. A hearing test suggested the loss was linked to damage to the hearing nerve, the middle ear, or both, rather than inflammation or a blockage to the ear canal.

Doctors could find no explanations for his hearing problem, other than his recent COVID-19 illness.

They gave him steroid tablets as well as injections into the ear, which helped a little, but he has some irreversible hearing loss.

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Source: BBC News, 14 October 2020

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‘Babies are still being damaged’ Tory peer warns ‘evasive’ ministers

The government has been told it is ‘not sustainable’ to continue to delay its response to a major review on patient safety as ‘babies are still being damaged’.

The Independent Medicines and Medical Devices Safety Review spoke to more than 700 people, mostly women who suffered avoidable harm from surgical mesh implants, pregnancy tests and an anti-epileptic drug, and criticised “a culture of dismissive and arrogant attitudes” including the “unacceptable labelling of many symptoms as “attributable to ‘women’s problems’”.

The review’s author Baroness Julia Cumberlege told HSJ that “time is marching on” for the Department of Health and Social Care to implement the recommendations of her July report, which include setting up a new independent patient safety commissioner.

The Conservative peer said pressure was building on government to adopt the findings of the review, since it had been endorsed by Royal Colleges and has already been adopted by the Scottish government. She said the government had given “evasive” answers in parliament on the issue.

In an exclusive interview with HSJ, Baroness Cumberlege said:

  • There is a crowded field of regulators but “there’s a void” for a service that listens and responds to patients’ safety concerns.
  • She feels “diminished” that women’s concerns are still being dismissed by clinicians, but said young doctors are a cause for hope.
  • She is “very optimistic” report will be implemented – but the NHS has to have the will to make changes.

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Source: HSJ, 13 October 2020

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NHS England at loggerheads with Test and Trace over staff testing

The introduction of weekly covid tests for NHS staff in ‘high risk areas’ will mean other groups missing out or waiting longer, well-placed sources have told HSJ.

There is also understood to be a standoff between NHS England and Test and Trace over the regular testing of asymptomatic staff, which was announced for the North of England on Monday.

NHS trust labs don’t have enough capacity to test all their staff; and there is not enough spare in “pillar two” commercial labs to carry out hundreds of thousands of additional tests. National bodies are said to be in disagreement over who should do it.

NHSE believes they should be provided by T&T, and T&T says NHS labs should expand their capacity to carry them out themselves, HSJ has been told.

A senior source involved in the testing programme said there would have to be “trade-offs” for T&T to meet the new NHS demand, with supply having to be cut for others who want tests — mostly the general population, or care home staff.

At present the NHS has agreed to carry out 100,000 daily tests by the end of the month, as part of the T&T’s overall 500,000 target. It has been encouraged to do more by T&T, but any expansions may face shortages of equipment and supplies such as reagents, as well as staff and space.

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Source: HSJ, 13 October 2020

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Covid reinfection: Man gets Covid twice and second hit 'more severe'

A man in the United States has caught Covid twice, with the second infection becoming far more dangerous than the first, doctors report.

The 25-year-old needed hospital treatment after his lungs could not get enough oxygen into his body.

Reinfections remain rare and he has now recovered. However, the study in the Lancet Infectious Diseases raises questions about how much immunity can be built up to the virus.

The man from Nevada had no known health problems or immune defects that would make him particularly vulnerable to Covid.

Scientists say the patient caught coronavirus twice, rather than the original infection becoming dormant and then bouncing back. A comparison of the genetic codes of the virus taken during each bout of symptoms showed they were too distinct to be caused by the same infection.

"Our findings signal that a previous infection may not necessarily protect against future infection," said Dr Mark Pandori, from the University of Nevada.

"The possibility of reinfections could have significant implications for our understanding of COVID-19 immunity."

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Source: BBC News, 13 October 2020

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Pregnant women must have flu jab this winter, warn health bodies

All pregnant women have been urged by doctors to get a free flu vaccination this winter to ensure they and their babies are protected.

People can get infected with flu and coronavirus at the same time - with Public Health England finding if you get both simultaneously you may get more seriously ill.

Researchers previously said those who have been infected with both viruses face a serious increase to their risk of death and warned the public “not to be complacent” in the wake of fears flu could circulate around the country alongside COVID-19.

The Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Midwives note while getting flu is not a big deal for most people, getting the virus while you are pregnant can be serious for a small proportion of women and their babies. Flu can occasionally lead to stillbirth, maternal death and raise the chances of having a miscarriage.

Dr Edward Morris, president of RCOG, said: “We are keen to reassure pregnant women that flu vaccination is safe for women to have at any stage in pregnancy - from the first few weeks right up to their due date, and while breastfeeding."

"Over the last 10 years, the flu vaccine has been routinely and safely offered to pregnant women in the UK. The vaccine can also pass some protection to babies, which lasts for the first months of their lives."

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Source: The Independent, 12 October 2020

 

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Maternity scandal hospital fined for not triaging A&E patients fast enough

An NHS hospital which has faced repeated criticism by regulators for poor standards of care has been fined £4,000 for failing to assess A&E patients quickly enough.

The Shrewsbury and Telford Hospitals Trust has been fined by the Care Quality Commission (CQC) after patients were not triaged within 15 mimutes of arrival in A&E – in breach of conditions set by the regulator last year and a national target.

The care of emergency patients at the hospital trust, which is also facing an inquiry into poor maternity care, has been a long running concern for the watchdog which has rated the trust inadequate and put it in special measures in 2018.

Earlier this year the CQC’s chief inspector of hospitals, Professor Ted Baker, wrote to NHS England warning of a “worsening picture" at the Midlands hospital and demanding action be taken.

The CQC said it had issued the fixed penalty notice to the trust because it failed to comply with national clinical guidance that all children and adults must be assessed within 15 minutes of arrival. It also failed to implement a system that ensured all children who left the emergency department without being seen were followed up.

After inspections in April 2019 and November 29 the CQC imposed seven conditions on the hospital over emergency care. The regulator said it was now clear the trust had not stuck to the conditions and had breached them both at Royal Shrewsbury Hospital and Princess Royal Hospital.

Professor Baker said: "The trust has not responded satisfactorily to previous enforcement action regarding how quickly patients are assessed upon entering the urgent and emergency department."

“We have issued a penalty notice due to the severity of the situation and to ensure the necessary, urgent improvements are made. It is essential that patients are seen in a timely way when they arrive at an emergency department; failure to do so could result in deteriorating health, harm, or even death, which is why national guidelines exist and must be followed."

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Source: The Independent, 12 October 2020

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Coronavirus: Refuse Covid patients if you can’t stop spread of virus, care homes told

Care homes should refuse to take coronavirus patients from hospitals if they cannot prevent the spread of the disease, the care watchdog has told The Independent.

Staff should admit these patients only if care homes are equipped with the right personal protective equipment (PPE) and infection prevention measures, the Care Quality Commission (CQC) said.

During the first wave of the pandemic, care homes saw widespread outbreaks of the virus with 16,000 deaths. Homes struggled to access protective clothing for staff and were forced to take 25,000 untested patients discharged from hospitals.

In an in-depth interview, Kate Terroni, the CQC’s chief inspector of social care, said care homes should not be put under pressure during a second wave to take infected patients they could not properly look after.

She said any home that refused to admit patients would have her support.

“Care home providers should only admit a resident when they are confident they can meet their care needs, so where they are confident they’ve got good infection prevention control, they’ve got the right PPE, they’ve got the right workforce."

“We will absolutely support a provider to say they cannot admit someone if those ingredients aren’t in place.”

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Source: The Independent, 12 October 2020, 

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Liverpool hospitals cut back on operations to cope with COVID-19 rise

Hospitals in Liverpool are scaling back non-urgent operations to help them cope with COVID-19 patients despite NHS bosses insisting that normal care continues during the second wave.

NHS trusts elsewhere in north-west England, as well as in the north-east and Midlands, are also preparing to cancel routine surgery such as joint replacements and hernia repairs amid a rapid rise in seriously ill coronavirus patients.

A potential second suspension of non-Covid care is looming despite warnings that this may lead to many thousands dying because their cancer, heart problem or other illness is not diagnosed or treated.

Steve Warburton, the chief executive of Liverpool University Hospitals NHS trust, acknowledged that doing less surgery would be “distressing” for patients affected but said the city’s three main acute hospitals had reached a “critical point”.

It is the first trust in England to make clear it cannot provide normal levels of non-Covid care during the second coronavirus surge, even though NHS England has told all hospitals to do so. The decision is likely to lead to other trusts doing the same.

Warburton said: “We will continue to prioritise surgery based in clinical need with a view to maintaining urgent and cancer surgery where possible.” He promised that the trust would continue to provide outpatient appointments “wherever possible” and keep giving patients diagnostic tests such as CT and MRI scans.

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Source: The Guardian, 12 October 2020

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Changes to medicines and medical devices evaluation proposed

As part of wide-reaching work being carried out to review the methods and processes the National Institute for Health and Care Excellence (NICE) uses to develop guidance, the organisation has launched a public consultation on proposals for changing how it selects the topics it will develop guidance on.

Covering guidance on medicines, medical devices and diagnostics, the proposals clarify the criteria which would see a device or diagnostic selected for NICE guidance development.

In particular, these include where costs and impacts are expected to be significantly cost-incurring or cost-saving – or there is uncertainty around the likely cost or the impact it would have on the healthcare system.

With regard to medicines, the new proposals would confirm the commitment made in the 2019 Voluntary Scheme for Branded Medicines Pricing and Access that pledged NICE would appraise all new active substances and significant licence extensions for existing medicines, except where there was a clear rationale not to do so.

Similarly, all new or significantly modified interventional procedures that would protect patient safety will be selected if they are available to the NHS or independent sector, or set to be used outside of formal research.

This proposed approach would move away from the 15 criteria currently used to select topics for evaluation by NICE’s Centre for Health Technology Evaluation and provide a clearer and simpler process.

Helen Knight, Programme Director for Technology Appraisals and Highly Specialised Technologies at NICE, said: “Topic selection plays an important role in the development of NICE guidance and is designed to ensure that the guidance we produce is on topics that support healthcare professionals and others to provide care of the best possible quality.

“These proposals will ensure we can continue to meet these ambitions at a time of unprecedented change in the healthcare system.”

The consultation on the proposals runs until 19 November. This will be followed by a separate public consultation on the case for change to its processes in February and March 2021.

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Source: NHE, 12 October 2020

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