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Mask guidance downgraded amid reports of failing stock

Public Health England PHE) has made new changes to its guidance on the use of face masks as “a pragmatic approach for times of severe shortage”.

The update came as trust procurement leads reported receiving substandard face masks from national stocks over the weekend, although a PHE spokesman told HSJ that this had not caused the change to guidance.

PHE on Sunday updated its guidance on the use of certain facemasks facing “acute shortages”. The new advice states that FFP2 respirators can be worn without fit testing in lieu of surgical masks in non-surgical settings.

The new guidance says: “This is a pragmatic approach for times of severe shortage of respiratory protective equipment, FFP2 respirators being used in this way will not be carrying out the function they were designed to perform.”

However, FFP2 respirators must still be properly fit-tested in situations where this level of protection is required, the new PHE advice states.

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Source: 4 May 2020

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COVID-19 is no worse in immunocompromised children, says NICE

Doctors should reassure parents and carers of children who are immunocompromised that immunosuppression does not seem to increase the risk of severe COVID-19, the UK National Institute for Health and Care Excellence (NICE) advises in a rapid guideline.

“Covid-19 usually causes a mild, self-limiting illness in children and young people, even in those who are immunocompromised,” NICE says.

Children and teenagers who are immunocompromised and their carers may be feeling particularly anxious and fearful about covid-19, so it is important they are involved in decision making as much as possible, NICE advises. Doctors should also support patients’ and carers’ mental wellbeing through communication and by signposting to charities and support groups.

The guideline says that patients should not avoid their usual appointments unless they have been told to and should continue with their usual treatment. However, face-to-face contact should be reduced where safely possible and alternative approaches such as telephone, video, or email consultations used instead.

When deciding whether to start treatments that affect the immune system, doctors should discuss the risks and benefits with the patient and their carers. If it is safe to delay treatment then watchful waiting should be undertaken.

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Source: BMJ, 1 May 2020

 

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Coronavirus: 'Many said goodbye to loved ones in an ambulance'

As a medical examiner at St George's Hospital, in south London, Dr Nigel Kennea's job is to advise clinical teams on completing death certificates, then support relatives through their grief. But like so much during this pandemic, none of that is straightforward.

"The most harrowing thing is knowing that many said goodbye to their loved ones in an ambulance," he says.

Despite staff "going above and beyond" to support patients in desperate times, using mobile phones and iPads to connect seriously ill patients and their families, contact is just not always possible. Even after a patient's death, social distancing has meant grieving relatives are left in limbo.

"Normally, registering a death is done face-to-face with relatives," Dr Kennea says. "They come in, talk through the admin and how to plan for after death. Now, it's all done on the phone."

Dr Kennea's job is to take an overview of all deaths at the hospital. It's a relatively new role in the UK, introduced last year, which is independent of trusts. Dr Kennea discusses each death at the hospital with the doctors and nurses involved in that patient's care, making sure death certificates are completed correctly and consistently. But with COVID-19 deaths so closely scrutinised, there is added pressure and "some are complicated", he says.

There are also challenges with communicating with patients. When Dr Kennea goes into COVID-19 areas, he has to wear full PPE which has its limits when communicating with patients.

"It's hard to share a smile behind a mask and goggles," he says.

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Source: 1 May 2020

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A ‘tsunami’ of coronavirus survivors could overwhelm NHS rehabilitation services, experts warn

The health service will face a “tsunami” of coronavirus survivors discharged from hospitals needing long-term physical and mental support that the NHS will struggle to provide, The Independent has been told.

Coronavirus can leave patients with lasting physical damage and scarring to their lungs, meaning many could struggle to breathe and move around as well as they did before – in some cases permanently.

Patients admitted to intensive care can also suffer physical effects of being paralysed weeks and almost half who are ventilated with a tube in their windpipe will experience a form of delirium that can include terrifying hallucinations and leave survivors with lasting mental problems including post-traumatic stress.

Experts have warned a long-term lack of funding of NHS rehabilitation services and post-discharge care for ITU patients means the health service will struggle to help the thousands of patients who beat the virus but face a long road to recovery.

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Source: 3 May 2020

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Healthcare workers outside of NHS finding it harder to access testing, survey suggests

Healthcare workers providing support outside of the NHS are finding it harder to access coronavirus tests than their colleagues inside the service, a survey of nurses has suggested.

A poll of 22,000 health and care workers conducted by the Royal College of Nursing found 44% of respondents did not know how to access testing – while 76% said they had not been offered a test.

The problem was also particularly pronounced among the temporary workers, with four in five not offered testing compared to three-quarters of full time workers.

Meanwhile the survey found 79% of those working outside of the NHS had not been offered a test, compared with 75% in the health service.

Dame Donna Kinnair, chief executive and general secretary of the RCN, said: “It is concerning to see that some nursing staff, particularly those outside the NHS, are still having issues accessing COVID-19 testing.

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Source: The Independent, 4 May 2020

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NHS staff coronavirus inquests told not to look at PPE shortages

Inquests into coronavirus deaths among NHS workers should avoid examining systemic failures in provision of personal protective equipment (PPE), coroners have been told, in a move described by Labour as “very worrying”.

The chief coroner for England and Wales, Mark Lucraft QC, has issued guidance that “an inquest would not be a satisfactory means of deciding whether adequate general policies and arrangements were in place for provision of PPE to healthcare workers”.

Lucraft said that “if there were reason to suspect that some human failure contributed to the person being infected with the virus”, an inquest may be required. The coroner “may need to consider whether any failures of precautions in a particular workplace caused the deceased to contract the virus and so contributed to death”.

But he added: “An inquest is not the right forum for addressing concerns about high-level government or public policy.”

Labour warned the advice could limit the scope of investigations into the impact of PPE shortages on frontline staff who have died from COVID-19.

“I am very worried that an impression is being given that coroners will never investigate whether a failure to provide PPE led to the death of a key worker,” said Lord Falconer, the shadow attorney general. “This guidance may have an unduly restricting effect on the width of inquests arising out of Covid-19-related deaths.”

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Source: The Guardian, 29 April 2020

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Britons will suffer health problems from COVID-19 for years, warn doctors

Many people in Britain are likely to suffer from physical and mental problems for several years after the COVID-19 epidemic has subsided. That is the grim message from doctors and psychologists who last week warned that even after lockdown measures had been lifted thousands of individuals would still be suffering.

Some of these problems will be due directly to the impact that the virus has had on those it has infected, especially those who went through life-saving interventions in intensive care units (ICUs) in hospital. In addition there will be a considerable impact on vulnerable people affected by the lockdown and isolation.

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Source: The Observer, 2 May 2020

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Deaths in care homes: what do the numbers tell us?

The Chief Scientific Adviser reportedly warned the government in January that the care homes sector in the UK was particularly vulnerable to COVID-19 – and that has unfortunately proved to be the case.

With care home deaths now being reported daily, what do the numbers tell us about this group? Have care home residents been disproportionately affected? And is there a chance the crisis could belatedly mark the start of better times for a sector in danger of collapse?

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Source: Nuffield Trust, 1 May 2020

 

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Hundreds of ventilators UK bought from China 'are wrong type and could kill patients if used'

Hundreds of ventilators the UK government bought from China to relieve a major shortage are the wrong type and could kill patients, senior doctors have warned in a newly uncovered letter.

The medical staff behind the letter say the devices were designed for use in ambulances rather than hospitals, had an "unreliable" oxygen supply and were of "basic" quality.

Seen by Sky News' partner organisation NBC, the document also claims the ventilators cannot be cleaned properly, are an unfamiliar design and come with a confusing instruction manual.

Cabinet Office minister Michael Gove triumphantly announced the arrival of "300 ventilators from China" to help treat COVID-19 patients on 4 April. But the letter of warning from doctors was issued just nine days later.

"We believe that if used, significant patient harm, including death, is likely," it says.

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Source: Sky News, 30 April 2020

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Hospital chiefs 'increasingly frustrated' with UK testing failures

Hospital leaders have launched a strident attack on the government’s coronavirus testing strategy, as it became clear that the target of 100,000 daily tests by 30 April would be comprehensively missed.

NHS Providers, which represents foundation trusts in England, rounded on ministers for “a series of frequent tactical announcements” to expand testing criteria, and dismissed the 100,000 target as a “red herring” that distracted from their failures.

Just 33,000 people were tested for COVID-19 in the latest 24-hour period – a record high for a single day – according to official figures. Dominic Raab, the first secretary of state, said that more than 52,000 tests were carried out, but this total is apparently bolstered by 19,000 retests.

Test capacity was now more than 73,000 a day, he said – still considerably below the target set by the health secretary, Matt Hancock, at the start of April.

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Source: The Guardian, 30 April 2020

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Severely ill eating disorder patients getting least support, says leading expert

Patients with the most severe eating disorders have received the least support during the COVID-19 pandemic, a leading expert has warned.

Dr Agnes Ayton, chair of the Royal College of Psychiatrists eating disorder faculty, told HSJ that although it was an achievement that services had implemented digital consultations so quickly, for the most severe and high-risk patients this would not work as well.

She also warned that some specialist eating disorder units across the country have had to limit admissions and run below full capacity. 

Her warning comes after a leading charity for eating disorders, Beat, said it has seen a 35% increase in calls to its national helpline since the pandemic began.

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Source: HSJ, 1 May 2020

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High-risk pregnancies could be missed due to pandemic, experts warn

Experts have raised fears that high-risk pregnancies may be missed due to the coronavirus pandemic, leading to a potential rise in stillbirths and neonatal deaths.

During a session of Westminster’s Health and Social Care Committee, Gill Walton, the Chief Executive of the Royal College of Midwives, said there was a “fear” among pregnant women presenting themselves to maternity services during the COVID-19 outbreak.

Former health secretary Jeremy Hunt, who chairs the committee, said one of the most important elements of maternity safety was to identify higher-risk pregnancies early “so that interventions can be made to prevent stillbirths, complications, or even the death of a baby”.

Mr Hunt added the President of the Royal College of Obstetricians, Dr Edward Morris, had told him he is “worried that some higher-risk pregnancies may be being missed” because of fewer face-to-face appointments and missed scans.

Asked whether she shared that concern, Ms Walton told MPs: “I do share that concern. Some of that is related to the fear of the pregnant population and presenting to maternity services during the pandemic."

"That fear then prevents them sometimes just picking up the phone to call their midwife to say that may be concerned about not feeling well, or that they’ve got reduced foetal movements.”

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Source: The Independent, 1 May 2020

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Coronavirus death rates more than double in more deprived areas, figures show

Death rates from coronavirus in the most deprived parts of England are more than double than in less deprived areas, according to new figures that show London is the worst-hit part of the country.

The mortality rate for the most deprived areas for March and early April was 55.1 deaths per 100,000 population – compared with 25.3 deaths per 100,000 in the least deprived areas, according to the Office for National Statistics (ONS).

The statistics show London has by far the highest mortality rate, with 85.7 deaths per 100,000 persons. This was found to be “statistically significantly higher” than any other region – almost double the next highest rate.

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Source: The Independent, 1 May 2020

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Coronavirus: Home secretary urged to do more to relax drug rules to help ease end-of-life suffering

The government is under pressure to go further on measures to relax rules on powerful painkillers such as morphine to prevent patients suffering “unnecessary pain and distress in the last days of their lives”.

On Tuesday the health secretary, Matt Hancock, announced staff in care homes and hospices would be allowed to “re-use” controlled drugs such as morphine and midazolam, with medication prescribed for one patient used for another where there is an immediate need.

But the Home Office today confirmed to The Independent that it had no plans to extend the rules to the care of patients in their own homes – a restriction experts and charities have warned could leave people suffering at the end of their lives.

The government announced the changes following concerns over the supply of drugs. 

The Royal College of GPs (RCGP) welcomed the changes announced by Mr Hancock, calling them “a significant step forward”, but added: “This only applies to patients living in care home and hospice settings, so there is still work to be done to ensure patients living in their own homes have appropriate access to necessary medication in a timely way.”

Last week the RCGP wrote to home secretary Priti Patel warning that people were suffering unnecessarily due to problems accessing drugs.

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Source: The Independent, 30 April 2020

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PPE 'designed for women' needed on frontline

There is growing concern that standard personal protective equipment (PPE), which often has a unisex design, doesn't always fit women properly.

The Department of Health said the kit is designed to protect "both genders". However, healthcare workers are saying that even the smallest sizes are too big for some women - who make up 77% of the NHS workforce, according to NHS Digital figures from 2018.

If it is too big it can be less effective in providing a complete barrier to the virus.

"PPE is designed to be unisex and offer protection for both genders, although some products are available in different sizes to enable fit to both small and larger frames," said the Department of Health, in a statement.

But the Royal College of Nursing has described "one-size-fits-all" personal protective equipment as "problematic" and "restrictive" when it can be worn for up to 12 hours during shifts. PPE includes gloves, masks, gowns and face shields.

"Nurses can find it very difficult to treat patients if this equipment is so uncomfortable it makes them hot and unwell," said Rose Gallagher, professional lead for infection prevention and control.

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Source: BBC News, 29 April 2020

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Coronavirus 'as deadly as Ebola in hospital'

People needing hospital treatment for coronavirus are as likely to die as those with Ebola, claim UK researchers. The warning comes as the largest study in Europe showed at least a third of hospital patients with COVID-19 die.

The disease is mild for most and can be treated at home, but scientists said people needed to realise how dangerous the infection could be. Obesity, ageing and being male greatly increase the risk of death, according to the data from 166 British hospitals.

Medical details on nearly 17,000 coronavirus patients in England, Wales and Scotland have been analysed and it shows that 49% survived and were discharged, 33% have died and 17% were still being treated.

"Some people persist in believing that Covid-19 is no worse than a bad dose of flu - they are gravely mistaken," said Calum Semple, the Chief Investigator on the trial, and a Professor in Child Health and Outbreak Medicine at the University of Liverpool.

"The crude case fatality rate for people who are admitted to hospital with severe Covid-19 is 35% to 40%, which is similar to that for people admitted to hospital with Ebola. People need to hear this and get it into their heads... this is an incredibly dangerous disease."

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Source: BBC News, 29 April 2020

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Coronavirus: What is the hidden health cost?

The rising death toll from coronavirus is never far from the headlines, but hidden behind the daily figures is what public health experts refer to as the "parallel epidemic". This is the wider impact on people's health that is the result of dealing with a pandemic.

UK chief medical adviser Prof Chris Witty has been referring to this with increasing frequency during the daily briefings, speaking about the "indirect" costs of coronavirus.

But what is it, and how significant could it be?

Routine treatments, such as hip and knee replacements, were cancelled across the UK. This alone will have a significant impact on people's lives, though it is unlikely to kill anyone. However, the pandemic has also had a knock-on effect on emergency care. Data collected by Public Health England from a sample of A&E departments in England shows attendances have halved since the pandemic started. The trend has prompted NHS leaders to urge patients to come forward for treatment.

Cancer screening has been suspended in Wales, Scotland and Northern Ireland and drastically cut back in England. But it is not only an issue for cancer patients, people with chronic conditions like diabetes or kidney disease may face trying to manage their conditions remotely without the regular face-to-face contact they would have with health professionals. 

The pandemic is also the 'perfect storm' for mental health.

The full impact could take years to unravel.

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Source: BBC News, 29 April 2020

 

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NHS 111 gets new queuing system to handle coronavirus surge

An overflow system has been added to NHS 111 to help deal with the “huge increase” in calls during the coronavirus pandemic.

People displaying coronavirus symptoms who are contacting 111 either via telephone or online are now being diverted to the overspill system, freeing up space for non-covid related enquiries.

The tool has been developed by software company Advanced — alongside NHSX, NHS England and NHS Improvement — for its patient management system Adastra, which is used by 80% of NHS 111 providers in England.

The overspill add on, which started being rolled out earlier this month, can be accessed by clinicians who are working from home, including those who have been redeployed in the NHS, as well as those in 111 call centres. 

Ric Thompson, managing director of health and care at Advanced, said the new queuing extension was developed to handle the “huge increase in the number of calls to 111 but also the need to bring back many thousands of retired clinicians”.

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Source: HSJ, 29 April 2020

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Intensive care capacity must be permanently doubled, says Nightingale chief

Intensive care capacity in London must be doubled on a permanent basis following the coronavirus pandemic, according to the chief executive of the city’s temporary Nightingale hospital.

Speaking to an online webinar hosted by the Royal Society of Medicine, Professor Charles Knight said London had around 800 critical care beds under normal operations but “there’s a clear plan to double intensive care unit capacity on a permanent basis”.

He added: “We must have a system of healthcare in this country that means, if this ever happened again, that we wouldn’t have to do this, that we wouldn’t have to build an intensive care unit in a conference centre because we had enough capacity under usual operating so that we could cope with surge.”

It would also mean the NHS would no longer be in a position “where lots of patients, as we all know, get cancelled every year for lack of an ITU bed,” he said.

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Source: HSJ, 28 April 2020

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Almost 18,000 more people could die of cancer due to coronavirus, study shows

The coronavirus pandemic could lead to almost 18,000 more deaths from cancer in England over the next year and there could also be a 20% spike in fatalities of newly diagnosed cancer patients, according to research by University College London (UCL) and DATA-CAN, the Health Data Research Hub for Cancer.

The figures stem from real-time hospital data for urgent cancer referrals and chemotherapy attendances, which have experienced a 76% and 60% fall, respectively.

Professor Peter Johnson, the NHS Clinical Director for Cancer, has urged people to not hesitate in seeking help or being checked after worrying research showed nearly half of the public have concerns about seeking help.

Moreover, the poll by Portland revealed 1 in 10 people would not contact their GP even if they discovered a lump or a new mole that remained for a week or more.

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Source: BBC News, 28 April 2020

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Patient records can be shared across practices and with 111 after NHS relaxes rules

GPs will now be able to access records for patients registered at other practices during the coronavirus epidemic in a major relaxation of current rules.

The move will allow appointments to be shared across practices, and NHS 111 staff will also have access to records to let them book direct appointments for patients at any GP practice or specialist centre.

The change in policy has been initiated by NHS Digital and NHSX to enable swift and secure sharing of patient records across primary care during the covid-19 pandemic. It means that the GP Connect1 system, currently used by some practices to share records on a voluntary basis, will be switched on at all practices until the pandemic is over.

In addition, extra information including significant medical history, reason for medication, and immunisations will be added to patients’ summary care records and made available to a wider group of healthcare professionals. Usually, individuals must opt in but following the changes only people who have opted out will be excluded.

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Source: The BMJ, 27 April 2020

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‘Restoration’ of non-covid NHS services gets under way

The government has announced that the “restoration of other NHS services” will start today on a “hospital-by-hospital” basis.

Health and social care secretary Matt Hancock in his daily ministerial coronavirus briefing announced the resumption of healthcare which has been suspended due to coronavirus will begin today. He said the initial focus would be on the most urgent services, citing cancer and mental health as examples.

They will be reintroduced on a locally decided basis, depending on the level the virus is currently impacting different areas and trusts, which varies widely, and how easily they can reintroduce the work, he said.

Mr Hancock, asked about the plan by HSJ during the briefing, indicated that a large-scale return would be enabled because the government is setting out to avoid a so-called second peak of the virus spreading, so the NHS will not need to keep tens of thousands of extra beds free in readiness. Experts and governments around the globe are concerned about the prospect of further peaks of the virus spread as they move to release distancing measures. 

Further NHS England guidance on the plan is expected later this week. 

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Source: HSJ, 27 April 2020

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Hospitals hit by drug shortages for coronavirus victims in intensive care wards

Intensive care units across the country are running out of essentials, including anaesthetics and drugs for anxiety and blood pressure, after a “tripling of demand” sparked by the coronavirus pandemic.

Six senior NHS doctors working on the front line, and drugs industry sources, say that the health service is running out of at least eight crucial drugs. Hospitals in London, Birmingham and the northwest of England have been especially badly hit.

Doctors said they were being forced to use alternatives to their “drug of choice”, affecting the quality of care being provided to COVID-19 patients. They also warned that some second-choice drugs might be triggering dangerous side effects such as minor heart attacks.

Ron Daniels, an intensive care consultant in the West Midlands, said the shortages had become “acute” already. “We don’t know what we’re going to run out of next week,” he said. “Safety isn’t so much the issue — it’s quality. It may be that we’re subjecting people to longer periods of ventilation than we would normally because the drugs take longer to wear off.”

Daniels added that some of the “second-line drugs” being used might be challenging to a patient’s heart: “We might be causing small heart attacks or subclinical heart attacks.”

Ravi Mahajan, president of the Royal College of Anaesthetists, said work was being carried out to “preserve” key drugs for those most in need.

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Source: The Times, 26 April 2020

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England campaign targets seriously ill patients avoiding hospitals

A government campaign has been launched to encourage people who are seriously ill with non-coronavirus conditions such as heart attacks to seek help amid concerns some are avoiding hospitals.

The campaign, which will be rolled out this week, aims to encourage people to use vital services – such as cancer screening and care, maternity appointments and mental health support – as they usually would.

The NHS chief executive, Sir Simon Stevens, said delays in getting treatment posed a long-term risk to people’s health.

He stressed that the NHS was still there for patients without coronavirus who needed urgent and emergency services for stroke, heart attack, and other often fatal conditions.

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Source: 25 April 2020, 

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Millions of patients 'avoiding calls to GP' during COVID-19 pandemic

Four in ten people are not seeking help from their GP because they are afraid to be a burden on the NHS during the pandemic, polling by NHS England reveals.

The findings – from a survey of 1,000 people – are the latest in a wave of evidence that fewer people are seeking care for illnesses other than those related to coronavirus during the pandemic.

GP online reported on 20 April that data collected by the RCGP showed a 25% reduction in routine clinical activity in general practice, and figures from Public Health England (PHE) and the British Heart Foundation show that A&E attendances overall and patients going to hospital for heart attacks are down 50%.

Warnings that patients' reluctance to come forward could put them at risk come as leading charities warned that suspension of some routine GP services during the pandemic could also lead to a 'future crisis' if control of conditions such as asthma and COPD deteriorate.

Professor Carrie MacEwen, chair of the Academy of Medical Royal Colleges, said: 'We are very concerned that patients may not be accessing the NHS for care because they either don’t want to be a burden or because they are fearful about catching the virus.

'Everyone should know that the NHS is still open for business and it is vitally important that if people have serious conditions or concerns they seek help. This campaign is an important step in ensuring that people are encouraged to get the care they need when they need it.'

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Source: GP online, 25 April 2020

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