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GPs asked to keep doors open after ‘significant incidents’ warning

New guidance requires GPs to offer at least some face-to-face appointments, amid reports that some had completely eliminated them, sparking ‘significant incidents’.

NHS England’s instructions for the third phase of the NHS response to COVID-19 were issued on Friday, including the call that “all GP practices must offer face to face appointments at their surgeries” along with remote triage and remote consultations.

Most appointments in primary care have been carried out remotely since the NHS instituted new operating procedures in response to covid, with practices offering a mix of remote consultations over the telephone or video, with a diminished number face-to-face. 

However, there have been reports of some GP practices not offering any face-to-face appointments at all, and continuing this approach following the peak of cases in the spring.

A letter to GPs last month told them they must offer appointments in person “where clinically appropriate”, now reiterated in the phase three guidance.

The letter added: “It should be clear to patients that all practice premises are open to provide care, with adjustments to the mode of delivery. No practice should be communicating to patients that their premises are closed.”

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Source: HSJ, 4 August 2020

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Patient Safety Movement Foundation, the American Society of Anesthesiologists, The Leapfrog Group, and ISQua join forces for #UniteForSafeCare World Patient Safety Day campaign

Today, four leading global organisations dedicated to fighting preventable deaths due to medical errors announced their partnership to co-convene the #uniteforsafecare programme on World Patient Safety Day (September 17, 2020).

In June, the Patient Safety Movement Foundation announced the wide-ranging campaign to bring attention to system-wide improvements that will ensure better health worker and patient safety outcomes, called #uniteforsafecare. Now, the organisation will be joined by the American Society of Anesthesiologists (ASA), The Leapfrog Group, and International Society for Quality in Health Care (ISQua) in co-convening the slate of programming, which includes a virtual physical challenge to raise awareness of the issue; collaboration with the National Association for Healthcare Quality’s annual conference, NEXT; an in-person demonstration in Washington, D.C. and a free virtual event for the public and those who have experienced errors, harms, or death to themselves or loved ones.

“As the first medical specialty to advocate for patient safety, and as physicians on the front lines treating COVID-19 patients, we know firsthand how critical ensuring health worker safety is,” said ASA President Mary Dale Peterson.  “The issue is especially timely.  From having the appropriate PPE to strategies for stress management and wellness – ensuring health worker safety is patient safety and improves outcomes.  We are happy to participate in this effort to advance safety in health care.”

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The shocking details of 'neglect' and fears for patients' lives at north Wales mental health unit

The mother of a former patient at a north Wales mental health unit has said she "couldn't let" her daughter "go back there" as new details about people being "neglected" there have emerged.

ITV News has seen a leaked copy of the Robin Holden report from 2014.

It was commissioned by Betsi Cadwaladr Health Board after staff on the Hergest mental health unit, which is situated within Ysbyty Gwynedd in Bangor, blew the whistle over management and patient safety concerns.

It reveals details never before made public, about how staff struggled to care for patients.

The document, which the health board has fought for six years to keep out of public view, gives an account of the death of a patient while no doctor was available because of rota gaps, another of a patient who tried to take their own life, again when no doctor was available, and inadequate staffing affecting patient care.

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Source: ITN News, 31 August 2020

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Coronavirus '90-minute tests to be provided in care homes and hospitals'

Two new tests for COVID-19 that are said to deliver results within 90 minutes are to be introduced across NHS hospitals and care homes, to speed up diagnosis ahead of winter and differentiate coronavirus infection from flu, the government says.

But some experts were surprised by the government’s decision, saying the particular tests were not well-known. No data had been published concerning their evaluation. The government had made mistakes in buying tests that turned out to be sub-standard in the past, they said.

“Repeatedly through the pandemic the government has raced ahead purchasing tests on the basis of manufacturer’s claims, and have found later when independent studies are done that the tests do not have adequate performance for use in the NHS,” said Professor Jon Deeks from Birmingham University, part of a team who have been evaluating tests of this sort.

“We would hope that the government would wait for proper evaluations, and consider the scientific evidence for all available tests before signing further contracts. The mistakes made in test purchasing have wasted millions of pounds as well as put lives at risk.”

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Source: The Guardian, 3 August 2020

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Trust with record covid deaths sees high rate of hospital acquired infection

The proportion of patients confirmed as infected with COVID-19 after admission to East Kent hospitals is running at twice the national rate, according to figures seen by HSJ.

The discovery comes as the Care Quality Commission confirmed to HSJ that it has sought and received further information from East Kent Hospitals University Foundation Trust on the high covid death rate at the trust. It is now deciding whether to take further action over the issue.

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Source: HSJ, 31 July 2020

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NHS told to return to "near-normal" performance before winter

Trusts have been set a series of “very stretching” targets to recover non-covid services to nearly normal levels in the next few months, in new guidance from NHS England.

NHS England and Improvement set out the system’s priorities for the remainder of 2020-21 in a “phase three letter” sent to local leaders.

It said the NHS must “return to near-normal levels of non-covid health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter”, when further emergency and covid pressures are anticipated.

In recent weeks providers have found it very difficult to resume many services, with many running at well below normal capacity, due to infection prevention measures, staffing gaps, and other covid-related barriers.

The targets in the new guidance for phase three of the NHS’s covid response include:

  • In September trusts must deliver “at least 80 per cent of their last year’s activity for both overnight electives and for outpatient/daycase procedures, rising to 90% in October (while aiming for 70% in August)”;
  • “This means that systems need to very swiftly return to at least 90 per cent of their last year’s levels of MRI/CT and endoscopy procedures, with an ambition to reach 100 per cent by October.”
  • “Trusts must hit 100 per cent of their last year’s activity for first outpatient attendances and follow-ups (face to face or virtually) from September through the balance of the year (and aiming for 90 per cent in August).”

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Source: HSJ, 31 July 2020

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Sponge-on-a-string test set to revolutionise oesophageal cancer diagnosis, researchers say

A sponge-on-a-string pill test could transform the way oesophageal cancer is diagnosed, researchers say. The method can identify 10 times more people with Barrett’s oesophagus than the usual GP route, scientists say.

The test, which can be carried out by a nurse in the GP surgery, is also better at picking up abnormal cells and potentially early-stage cancer.

Barrett’s oesophagus is a condition that can lead to oesophageal cancer, cancer of the food pipe, in a small number of people. Normally it is diagnosed in hospital by endoscopy, which involves passing a camera down into the stomach, following a GP referral for long-standing heartburn symptoms.

The cytosponge test, developed by researchers at the University of Cambridge, is a small pill with a thread attached that the patient swallows. It expands into a small sponge when it reaches the stomach, and is then quickly pulled back up the throat by a nurse, collecting cells from the oesophagus for analysis.

The pill is a quick, simple and well tolerated test that can be performed in a GP surgery and helps tell doctors who needs an endoscopy. In turn, this could prevent many people from having potentially unnecessary endoscopies.

Scientists say that as well as better detection, the test means cancer patients can benefit from kinder treatment options if their cancer is caught early enough.

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Source: The Independent, 1 August 2020

 

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From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists

The list of lingering maladies from COVID-19 is longer and more varied than most doctors could have imagined. Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys and brain.

The likelihood of a patient developing persistent symptoms is hard to pin down because different studies track different outcomes and follow survivors for different lengths of time. One group in Italy found that 87% of a patient cohort hospitalized for acute COVID-19 was still struggling 2 months later. Data from the COVID Symptom Study, which uses an app into which millions of people in the United States, United Kingdom, and Sweden have tapped their symptoms, suggest 10% to 15% of people—including some “mild” cases—don’t quickly recover. But with the crisis just months old, no one knows how far into the future symptoms will endure, and whether COVID-19 will prompt the onset of chronic diseases.

One such patient is Athena Akrami. Her early symptoms were textbook for COVID-19: a fever and cough, followed by shortness of breath, chest pain, and extreme fatigue. For weeks, she struggled to heal at home. But rather than ebb with time, Akrami’s symptoms waxed and waned without ever going away. She’s had just 3 weeks since March when her body temperature was normal.

“Everybody talks about a binary situation, you either get it mild and recover quickly, or you get really sick and wind up in the ICU,” says Akrami, who falls into neither category. Thousands echo her story in online COVID-19 support groups. Outpatient clinics for survivors are springing up, and some are already overburdened. Akrami has been waiting more than 4 weeks to be seen at one of them, despite a referral from her general practitioner.

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Source: Science, 31 July 2020

 

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Whistleblowers’ lawyers “fear retaliation” over NDA

 

Lawyers acting for whistleblowers have told MPs and peers that they can feel intimidated to raise concerns over non-disclosure agreements (NDAs) because of the threat of retaliation.

Whistleblowers themselves have also accused employers’ law firms of using underhand tactics in employment tribunal cases, and the All-Party Parliamentary Group on Whistleblowing said it would move on to look in more detail at the role of lawyers.

The findings came in the group’s first report – focusing on ‘the voice of the whistleblower’ – which found that, although the UK “remains a leading authority on whistleblowing legislation”, the Public Interest Disclosure Act 1998 (PIDA) needed “a radical overhaul”.

Read the full article here.

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Learning the lessons of the past to restore the nation’s health and prevent widening health inequalities post-COVID-19

A healthy population is one of any nation’s most important assets. We have known for a long time that not everyone has the same opportunity to access the things they need to lead a healthy life, such as good quality work and safe secure stable housing. Now we can see that the COVID-19 pandemic is replicating and exacerbating deep-rooted health inequalities. Without concerted action, this health crisis will also become a health inequalities crisis.

The COVID-19 pandemic has brought health inequalities into sharp focus. While every part of the population has been affected by the current crisis, some communities have been hit much harder both by the virus itself and by the measures taken to control its spread.

Evidence is starting to emerge, for example, of the unequal impact of the shutdown of the economy. For example a recent survey of UK households found that the lowest earners have been worst hit by loss of earnings, with the most severe losses for single parents.

The uneven impact of COVID-19 has also highlighted the inequalities faced by Black, Asian and minority ethnic communities. Recent data shows that some ethnic groups are at much higher risk of dying from COVID-19 than the rest of the population (e.g. Black men are four times more likely to have died of COVID-19 than their White peers).

Read full article here.

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New analysis lays bare government’s failure to protect social care from COVID-19

New analysis by the Health Foundation reveals the devastating impact the pandemic has had on social care in England. The independent charity says the findings provide further evidence that the government acted too slowly and did not do enough to support social care users and staff, and that protecting social care has been given far lower priority than the NHS.

The Health Foundation finds that policy action on social care has focused primarily on care homes and that this has risked leaving out other vulnerable groups of users and services, including those receiving care in their own homes (domiciliary care). It also notes that the shortcomings of the government’s response have been made worse by longstanding political neglect and chronic underfunding of the social care system.

Since March there have been more than 30,500 excess deaths* among care home residents in England and 4,500 excess deaths among people receiving domiciliary care. While high numbers of excess deaths of people living in care homes have been well reported, the analysis shows there has been a greater proportional increase in deaths among domiciliary care users than in care homes (225% compared to 208%). And while deaths in care homes have now returned to average levels for this time of year, the latest data (up until 19 June) shows that there have continued to be excess deaths reported among domiciliary care users.

The Health Foundation says that decades of inaction by successive governments have meant that the social care system entered the pandemic underfunded, understaffed, and at risk of collapse.

Read full article here.

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Children's Society latest research: Lives on hold and what it means for young people's well-being

Over the past few months, we have been living in unprecedented and uncertain times as a result of the Covid-19 pandemic. Lockdown measures, school closures and social distancing have all had a substantial impact on the way we live our lives.

But, what have been the experiences of children, young people and their families during this time? And how has children’s well-being been affected?

Our well-being research

Every year we (The Children's Society) measure the well-being of children in the UK through a regular survey, with the findings presented in our Good Childhood Report. This research has shown how, since 2009, children’s well-being in this country has been in decline.

In our 2020 survey, we included a number of questions to gauge the impact of Covid-19 and the resulting social distancing/lockdown measures on children’s lives. The survey was completed between April and June, when the UK was in lockdown.

Our latest briefing, Life on Hold, brings together the findings of these survey questions about Covid-19, together with children’s own accounts. 

Read the full article and findings here.

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NHS People Plan 2020/21 response by The Health Foundation

NHS People Plan provides a stop-gap but leaves glaring omissions

'Two years after it was first promised, the NHS is still waiting for a long-term workforce plan. Some of the measures announced in today’s People Plan are positive. As the plan acknowledges, it is important to learn from the impressive changes made by NHS staff during the pandemic. And improving support for people from black and minority ethnic communities – who make up one fifth of the NHS workforce – is rightly a top priority. 

'But there are glaring omissions. The NHS went into the pandemic with a workforce gap of around 100,000 staff, yet the plan does not say how this will be addressed in the medium term. This is particularly concerning at a time when our recruitment of nurses from abroad has dropped dramatically. These details are missing because the NHS is still waiting on government to set out what funding will be available to expand the NHS workforce – without which the NHS cannot recruit and retain the doctors, nurses and other staff it needs. 

'While this plan at least provides a stop-gap to help get the NHS through the winter, there is no equivalent plan for social care – a sector suffering from decades of political neglect and the devastating impact of COVID-19 on care users and staff. A comprehensive workforce plan for both the NHS and social care is needed now more than ever'.

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Scandal-hit NHS trust admits negligence over death of six-week-old baby

Hospital trust ‘truly sorry that mistakes were made in care’ of Luchii Gavrilescu, who died after being sent home from hospital with undiagnosed tuberculosis.

An NHS trust investigated over maternity care failings has apologised after a six-week-old child was found to have died due to mistakes at one of its hospitals.

East Kent Hospitals University Trust was embroiled in a major scandal after The Independent revealed the trust had seen more than 130 babies over a four-year period suffer brain damage as a result of being starved of oxygen during birth. A report into the trust concluded in April that there had been “recurrent safety risks” at its maternity units.

Read full article here.

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Matt Hancock - the future of healthcare

Health and social care secretary Matt Hancock delivered a ‘future of healthcare’ speech to the Royal College of Physicians on Thursday and laid out seven lessons from the health and care response to Covid-19 that he wants to see retained. If followed through, some of his points would mark significant shifts in policy and Conservative thinking. However, Hancock said it was important to “build better” in the way that London was built better after the Great Fire in 1666.

Hancock’s seven points were: the NHS must value people and ‘bust bureaucracy’ that gets in their way; the future is “collaboration not competition”; “better technology means better healthcare”; the NHS must be open to other sectors; planning and funding will be “system first”; and social care and public health need more attention. On tech, Hancock said consultations will be digital first, and there will be a new focus on interoperability and data sharing.

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Fifth of GP partners remove BAME staff from patient-facing work in pandemic

More than one in five GP partners said they removed practice staff away from face-to-face care due to ethnicity during the pandemic, a Pulse survey has revealed. 

The survey in June revealed that 84 of the 378 respondents said that ‘ethnicity was a crucial factor in removing anyone in your practice away from face-to-face assessments’.

Around 70% of respondents said they had been counting ethnicity as a factor when risk assessing staff.

See full article here

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All GP consultations should be remote by default, says Matt Hancock

All GP appointments should be done remotely by default unless a patient needs to be seen in person, Matt Hancock has said, prompting doctors to warn of the risk of abandoning face-to-face consultations.

In a speech setting out lessons for the NHS and care sector from the coronavirus pandemic, the health secretary claimed that while some errors were made, “so many things went right” in the response to Covid-19, and new ways of working should continue. He said it was patronising to claim that older patients were not able to handle technology.

The plan for web-based GP appointments is set to become formal policy, and follows guidance already sent to GPs on having more online consultations. But the Royal College of GPs (RCGP) hit back, saying it would oppose a predominantly online system on the grounds that both doctors and patients benefited from proper contact.

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Duncan Selbie's (PHE) Friday Message - 31 July 2020

This week, Public Health England (PHE) Chief Executive's message covers the social care sector's management of COVID-19 outbreaks and the exemplary work in Hammersmith and Fulham Council, PHE's Better Health campaign, new reports on greenspaces and global disaster risk reduction, and our studies to support musicians and artists during the pandemic.

Read full article here.

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Launch of NHS People Plan (2020-21)

"We are the NHS: People Plan 2020/21 – action for us all, along with Our People Promise, sets out what our NHS people can expect from their leaders and from each other.  It builds on the creativity and drive shown by our NHS people in their response, to date, to the COVID-19 pandemic and the interim NHS People Plan. It focuses on how we must all continue to look after each other and foster a culture of inclusion and belonging, as well as take action to grow our workforce, train our people, and work together differently to deliver patient care.

This plan sets out practical actions for employers and systems, as well as the actions that NHS England and NHS Improvement and Health Education England will take, over the remainder of 2020/21. It includes specific commitments around:

  • Looking after our people – with quality health and wellbeing support for everyone
  • Belonging in the NHS – with a particular focus on tackling the discrimination that some staff face
  • New ways of working and delivering care – making effective use of the full range of our people’s skills and experience
  • Growing for the future – how we recruit and keep our people, and welcome back colleagues who want to return

The arrival of COVID-19 acted as a springboard, bringing about an incredible scale and pace of transformation, and highlighting the enormous contribution of all our NHS people. The NHS must build on this momentum and continue to transform – keeping people at the heart of all we do."

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Survey shows 60% of health visiting teams affected by Covid-19 redeployment

The redeployment of health visitors to support the national coronavirus response has left remaining staff with increased workloads, worsened mental health and fears that the needs of children are being missed, a new survey has revealed.

In the wake of Covid-19, University College London (UCL) gathered the views of 663 health visitors in England to find out how the pandemic had affected their work. Overall, 60% of respondents reported that at least one member of their team had been redeployed between 19 March and 3 June. Of teams that had lost staff, 41% reported that between six and 50 colleagues had been moved elsewhere during that period.

The combination of increased caseloads and limited face-to-face contacts left “widespread concern” among health visitors that the needs of many children would be missed in the peak of the outbreak, found the survey. Study authors raised concerns about the “significant negative impacts” that increased workload and pressures had on staff wellbeing and mental health.

Read the full article here.

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Leeds Teaching Hospitals launch patient and volunteer support fund

Leeds Teaching Hospitals has launched a support fund for patients, their relatives and volunteers who may be struggling financially due to the coronavirus pandemic.

The fund is intended to assist (but is not limited to):

  • Bereaved relatives facing immediate financial pressures until their personal financial affairs are sorted eg having weekly bills to meet and no immediate access to bank accounts
  • Patients isolating for 14 days in advance of admission to hospital and suffering income loss, excess cost or other financial hardship as a result
  • Patients, their immediate families or volunteers who have experienced significant household income loss as a result of the pandemic and are struggling with financial obligations
  • Those experiencing significant increases in costs as a direct result of the pandemic, eg increased childcare costs

Read the full article here

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Coronavirus (COVID-19) Infection Survey pilot: England, 24 July 2020

Initial data from the COVID-19 Infection Survey. This survey is being delivered in partnership with IQVIA, Oxford University and UK Biocentre.

Full article here

Table of contents in the report:

 

1.       Main points

2.       Number of people in England who had COVID-19

3.       Regional analysis

4.       Incidence rate

5.       Test sensitivity and specificity

6.       COVID-19 Infection Survey data

7.       Collaboration

8.       Glossary

9.       Measuring the data

10.    Strengths and limitations

11.     Related links

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Coronavirus: Thousands of COVID-19 survivors could be diagnosed with sepsis, charity warns

People are being warned to familiarise themselves with the symptoms of sepsis after a study found that as many as 20,000 COVID-19 survivors could be diagnosed with the condition within a year.

One in five people who receive hospital treatment for the coronavirus are at risk, according to the UK Sepsis Trust.

Sepsis is triggered when the body overreacts to an infection, causing the immune system to turn on itself - leading to tissue damage, organ failure and potentially death.

If spotted quickly, it can be treated with antibiotics before it turns into septic shock and damages vital organs.

Read the full article here.

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1,000-year-old eye infection potion found to tackle antibiotic-resistant infections

Antibiotic resistance is an increasing challenge for modern medicine as more naturally occurring antimicrobials are needed to tackle infections capable of resisting treatments currently in use.

New research from the University of Warwick has investigated natural remedies to fill the gap in the antibiotic market, taking their cue from a 1,000-year-old text known as Bald's Leechbook.

Read the full article here.

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Falls team on the up thanks to North Wales volunteers

A dedicated team of 32 volunteers are hitting the roads across North Wales assisting the Welsh Ambulance Service in dealing with fallers.

Based out of the Ambulance headquarters in St Asaph, the Community First Responder Falls Team was launched on 30 April this year and has already assisted almost 250 people.

The team was created to use the talents and experience of the familiar Community First Responders (CFRs) who had to be stood down from their normal duties at the start of the Covid-19 pandemic.

Read the full article here.

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