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Has the government broken the law by putting NHS staff in harm's way?

We don’t yet know the number of NHS staff who have lost their lives in the battle against COVID-19. On Wednesday, Dominic Raab put the figure at 69, but the true figure is considered to be far greater. 

These deaths are not “natural” casualties of the coronavirus pandemic. In fact, they may be the result of a failure in the government’s duty to care for NHS staff, which is why it is vital it is properly investigated under the law.

Since the pandemic reached the UK, we have heard countless reports of doctors and nurses raising the alarm over the lack of personal protective equipment (PPE) when treating COVID-19 patients.

How many of these deaths could have been prevented had sufficient PPE been provided to NHS workers? And if there is a lack of PPE, how did this happen? The health secretary, Matt Hancock, says the biggest challenge is “one of distribution rather than one of supply”. Should more have been done to meet this challenge, and if so what? Does the government have a legal duty to do more to protect the lives of healthcare workers?

There must be investigations into the individual deaths of NHS workers, out of respect to them, and also so that future deaths can be prevented. The evidence appears to be that the government has failed to protect them from risk to their lives, and if that is the case then an investigation will be required by law.

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Source: The Guardian, 25 April 2020

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National alert as ‘coronavirus-related condition may be emerging in children’

A serious coronavirus-related syndrome may be emerging in the UK, according to an “urgent alert” issued to doctors, following a rise in cases in the last two to three weeks, HSJ has learned.

An alert to GPs and seen by HSJ says that in the “last three weeks, there has been an apparent rise in the number of children of all ages presenting with a multisystem inflammatory state requiring intensive care across London and also in other regions of the UK”.

It adds: “There is a growing concern that a [covid-19] related inflammatory syndrome is emerging in children in the UK, or that there may be another, as yet unidentified, infectious pathogen associated with these cases.”

Little is known so far about the issue, nor how widespread it has been, but the absolute number of children affected is thought to be very small, according to paediatrics sources. The syndrome has the characteristics of serious COVID-19, but there have otherwise been relatively few cases of serious effects or deaths from coronavirus in children. Some of the children have tested positive for COVID-19, and some appear to have had the virus in the past, but some have not.

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Source: HSJ, 27 April 2020

Do you work in paediatrics? Have you seen similar trends emerging? What are your thoughts on the concerns raised? Join the conversation in the hub community area: 

 

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UK doctor invents digital flashcards to help COVID-19 patients understand staff

A coronavirus patient’s terrifying hospital experience inspired an NHS doctor to create a flashcard system to improve communication with medical staff wearing face masks.

Anaesthetist Rachael Grimaldi founded CARDMEDIC while on maternity leave after reading about a COVID-19 patient who was unable to understand healthcare workers through their personal protective equipment (PPE).

Her system enables medical staff to ask critically ill or deaf coronavirus patients important questions and share vital information on digital flashcards displayed on a phone, tablet or computer.

The idea went from concept to launch on 1 April in just 72 hours and is now being used by NHS trusts and hospitals in 50 countries across the world.

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Source: The Guardian, 25 April 2020

Read the 'Story behind CARDMEDIC', written by Rachael for the hub

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Coronavirus: Uncertainty over maternity care causing distress

Women say the uncertainty surrounding maternity services during the coronavirus outbreak is "making a stressful situation harder".

The Royal College of Midwives says services may need to be reduced due to COVID-19.

Like many areas in the health sector, staff shortages caused by sickness and workers self-isolating are impacting resources, the college adds.

The BBC asked a group of NHS trusts and boards across the UK about the services they are able to provide during the coronavirus pandemic. Nine trusts in England, five boards in Scotland and one trust in both Wales and Northern Ireland responded.

All 16 bodies said one birth partner could be present during labour, but just over a quarter of those asked are allowing partners on the postnatal ward following the birth. Around a third of trusts and boards that spoke to the BBC are now allowing home births.

In the weeks after a birth, midwives and health visitors are now heavily relying on virtual communication to provide families with postnatal support. Home visits are mostly still happening, but one trust in London said it only allows face-to-face contact when it is "absolutely essential".

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Source: BBC News, 24 April 2020

Read Patient Safety Learning's latest blog: Home births, fears and patient safety amid COVID-19

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Coronavirus: Care home staff struggling to get tests

Care homes looking after thousands of vulnerable residents have said none of their staff has been tested for coronavirus. Out of 210 care providers spoken to by the BBC, 159 said none of their workers had had a test.

BBC England spoke to care homes and companies across the country, who between them employ nearly 18,000 staff and have almost 13,000 residents. Many said they had seen no testing at all, while others have spoken of struggles to access official test centres after reporting online that they have symptoms. Some have told how staff face long journeys to test centres, with one reporting a three-hour round trip.

On Sunday it was announced that the military will begin testing essential workers in mobile units operating at sites in "hard to reach" areas, including care homes.

Anna Knight runs Harbour House Care Home on the Dorset coast and said getting enough personal protective equipment (PPE) and testing for coronavirus were her biggest challenges.

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Source: BBC News, 26 April 2020

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Shop staff and transport workers must be given masks, say doctors

Shop workers and other essential staff should be provided with face masks to control the spread of coronavirus, according to the British Medical Association (BMA).

The doctors’ union is also calling on the government to ask all members of the public to cover their mouths and noses while outside their homes.

“Common sense tells you that a barrier between people must offer a level of protection, however small,” said Dr Chaand Nagpaul, BMA council chairman.

“The government must pursue all avenues of reducing the spread of infection.

“This includes asking the public to wear face coverings to cover mouths and noses when people leave home for essential reasons.”

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Source: The Independent, 26 April 2020

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GP calls for action after 125 of her care home patients die of COVID-19

“I am really angry about this,” said Dr Anna Down, scanning her computer for figures to show how coronavirus has ravaged her patients living in nursing homes.

“One home had 23 deaths, another lost 19, and another 13,” the Ealing GP said. “In two units 50% of residents died in the space of 10 days.”

Down is the clinical lead at a practice with 1,000 residents on its books in 15 privately run nursing homes in the area of west London hit harder than anywhere in Britain by COVID-19 deaths in the first weeks of the outbreak. In a normal month, she might expect to lose around 28 people. In the last month she has lost 125.

Down has a warning to the rest of the country informed by her practice’s experience: reform how social care handles Covid-19 or face rising deaths and a second devastating wave of infection.

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Source: The Guardian, 22 April 2020

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Hospital chiefs keen to restart operations as covid peak passes

Several acute trust chief executives have told HSJ they are keen to resume more planned operations, as the peak of new coronavirus cases has passed and many hospital beds remain empty.

Some trust leaders said they believed routine elective surgery could be restarted as early as next week. There is also tension between NHS hospitals — some of which are keen to resume their own planned care, especially the more urgent operations — and a desire to use private hospitals, which have been booked out by NHS England.

The government said yesterday the number of people in hospitals with COVID-19 has fallen by 10% over the last week. Around 42% of acute beds are now unoccupied, according to figures seen by HSJ. The peak of new infection cases in hospitals was at about 3,000 on 1 April — the number is now about half that figure.

However, there will be fears nationally about the NHS seeking to return to normal and being caught out by ongoing COVID-19 pressures, or by a second peak of infections. 

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Source: HSJ, 24 April 2020

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Coronavirus: Eyes could be contagious for weeks, study finds

The coronavirus can linger in patients’ eyes for several weeks and could act as a way of spreading the COVID-19 disease, according new study from Italy.

Scientists at Italy’s National Institute for Infectious Diseases hospital in Rome studied the symptoms of an unnamed 65-year-old woman who developed the virus after travelling from the Chinese city of from Wuhan.

When the woman developed conjunctivitis – an eye infection causing redness and itchiness – doctors decided to take regular swabs from her eye. They discovered the virus remained present in “ocular samples” up to 21 days after she was admitted to hospital.

The team said the findings, published in the Annals of Internal Medicine, indicated that eye fluids from coronavirus patients “may be a potential source of infection”.

The study authors said: “These findings highlight the importance of control measures, such as avoiding touching the nose, mouth, and eyes and frequent hand washing.”

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Source: The Independent, 24 April 2020

 

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My A&E department is eerily quiet. I'm worried the very sick are staying away

"I have never seen my A&E department so still, so well-staffed and so uncannily calm," says Steven Fabes, an A&E doctor.

Attendances in A&E departments across the country are down, in some cases by up to 80%.

There is an obvious reason for the calm: people are not out and about. Pedestrians are not walking out in front of cyclists. Cyclists are not diving over car bonnets. Asthmatics are not wheezing through the fumes of Oxford Street. But there is something more worrying at play, too – people who need us are not coming in.

"I am worried that people who need us are not coming in, scared that hospitals are vectors for infection rather than cure," says Steven.

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Source: The Guardian, 23 April 2020

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Half of UK health workers suffering stress because of Covid-19

Half of health workers are suffering mental health problems such as stress and trauma as a result of dealing with COVID-19, new research reveals.

The pandemic is having a “severe impact” on the mental wellbeing of NHS personnel as well as agency staff, GPs and dentists, with rates of anxiety and burnout also running far higher than usual.

New YouGov polling for the IPPR thinktank found that 50% of 996 healthcare workers questioned across the UK said their mental health had deteriorated since the virus began taking its toll.

That emerged as the biggest impact on staff, just ahead of worries about their family’s safety because of a lack of testing and protective equipment for NHS workers (49%) and concern about their ability to ensure that patients receive high-quality care when the NHS is so busy (43%).

As many as 71% of younger health professionals, who are likely to be inexperienced and early in their careers, said their mental health had deteriorated. More women were affected than men.

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Source: The Guardian, 23 April 2020

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Guy's and St Thomas' launch "3D printing farm"

Guy's and St Thomas' has received its first delivery of face shields created in a specially developed "3D printing farm", in collaboration with 3D printing companies and enthusiasts.

The face shields will be worn by frontline medical staff tending to patients during the ongoing coronavirus pandemic.

Several 3D printing manufacturers have been brought together at Guy's and St Thomas' supply chain hub in Dartford, with over 200 printers working 24 hours a day to make the face shields. This 3D printing farm can produce roughly 1,500 face shields a day.

The face shields are paired with a visor, assembled by a team of volunteers made up of 3D printing enthusiasts, as well as students and staff from King's College London and Brunel University.

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Source: Guy's and St Thomas NHS Foundation Trust, 21 April 2020

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Fears some ambulances 'left Covid patients at home'

Some seriously ill COVID-19 patients in London may not have been taken to hospital by ambulance because of a system temporarily used to assess people, a BBC investigation suggests.

Patients could have "become very sick or died at home" instead, a paramedic claimed.

One family said they had to plead to get hospital care.

Medical professionals use 'NEWS2', as one way of identifying patients at risk of deteriorating, a check normally used for sepsis patients. Under normal circumstances, ambulance teams would blue-light anyone with a score of five or above to hospital.

But on 18 March, LAS workers were told to apply the NEWS2 check to suspected Covid patients and that many of those with a score up to seven could be "suitable for community care", even if there were issues with breathing rate, oxygen supply and consciousness.

But one paramedic, who wanted to remain anonymous because she did not have permission to speak to the media, said she believed that as a result of the NEWS2 advice, crews went to patients "who may have been seen by ambulance before and then suddenly became very sick or even just dropped dead."

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Source: BBC News, 23 April 2020

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‘Exceptionally urgent’ to secure kit used to treat critically ill covid patients

The availability of dialysis equipment used to treat more than a quarter of ventilated COVID-19 patients has reached “critical” levels, HSJ has learned.

Concerns are growing over an “exceptional shortage” of specialist dialysis machines used to treat intensive care patients with acute kidney failure.

Although hospitals are able to deploy alternative machines which are not typically used in intensive care, this is logistically challenging and can carry increased risks for patients.

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Source: HSJ, 22 April 2020

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One in three pharmacists unable to access PPE, finds RPS survey

A third of pharmacists cannot obtain continuous supplies of personal protective equipment (PPE), according to a survey conducted by the Royal Pharmaceutical Society (RPS).

The survey found that 34% of respondents said they were not able to source continued supplies of PPE as they work in the face of COVID-19.

The poll of 445 pharmacists also revealed that 94% were unable to maintain social distancing of two metres from other staff in their pharmacy, mainly because the pharmacies — and the dispensaries in particular — were too small. A further 40% of respondents said they were unable to maintain social distancing of two metres from patients.

The results of the survey, which ran between 14 and 20 April 2020, have come after Public Health England (PHE) updated its PPE guidance on 10 April 2020, which recommends that pharmacy staff only wear fluid-resistant (type IIR) surgical masks (FRSMs) when in “contact with possible or confirmed cases of COVID-19” and not around other pharmacy staff.

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Source: The Pharmaceutical Journal, 22 April 2020

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Deaths of NHS staff from COVID-19 analysed

In recent weeks, there has been sustained public and media interest in the death from COVID-19 of health and social care workers. Both mainstream and social media outlets have been reporting on these deaths individually or collectively, but there has been no formal analysis of this data. 

The deaths of 119 NHS staff have now been analysed by three leading clinicians and the results are been published by HSJ.

HSJ highlights three key findings from the analysis:

1. The disproportionately high rate of BAME individuals among those who have died;

2. The absence of those members of staff considered at high risk of viral exposure and transmission; and

3. The overall rate of fatalities compared to the population.

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Source: HSJ, 22 April 2020

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Thousands missing out on cancer diagnosis

Delays in diagnosing and treating people with cancer could lead to more years of lost life than with COVID-19, according to a leading cancer expert.

A drop-off in screening and referrals means roughly 2,700 fewer people are being diagnosed every week, Cancer Research UK says.

Cancer screening has paused in Wales, Scotland and Northern Ireland, with few invitations sent out in England.

People are still advised to contact their GP with worrying symptoms.

But Richard Sullivan, professor of cancer and global health at King's College London, said there was more fear of Covid-19 than of having cancer at the moment. With GPs more difficult to contact than normal, this was resulting in a "dramatic drop-off" in referrals to specialists, he said.

"Most modellers in the UK estimate excess of deaths is going to be way greater than we are going to see with Covid-19," he said.

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Source: 22 April 2020, BBC News

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Military appalled by planning fiasco over NHS protective kit

Military personnel have criticised the NHS for its “appalling” handling of distributing personal protective equipment. The armed forces are helping with the distribution of equipment and staff have been seconded to help planning across seven hubs.

A senior army source lambasted the health service for its logistics for PPE, alleging that masks, aprons, gloves and other items were being assigned to hospitals without regard to relative need, leading to oversupply in some areas and shortages in others.

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Source: The Times, 22 April 2020

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Coronavirus death toll in UK twice as high as official figure

The coronavirus pandemic has already caused as many as 41,000 deaths in the UK, according to a Financial Times analysis of the latest data from the Office for National Statistics.

The estimate is more than double the official figure of 17,337 released by ministers on Tuesday, which is updated daily and only counts those who have died in hospitals after testing positive for the virus. The FT extrapolation, based on figures from the ONS that were also published on Tuesday, includes deaths that occurred outside hospitals updated to reflect recent mortality trends.

The ONS data also showed that deaths at home and in care homes had also jumped sharply during the pandemic. In the week ending 10 April, deaths in care homes reached 4,927, almost double the figure of 2,471 a month earlier.

The ONS said on Tuesday it had asked Public Health England to investigate why care home deaths were rising so sharply.

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Source: The Financial Times, 22 April 2020

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NHS data sharing failure ‘exasperating and could cause error’

Significant concerns about the NHS’ refusal to share data with councils have emerged in a letter from a leading council chief executive and clinical commissioning group accountable officer. 

Steven Pleasant, chief executive of Tameside Metropolitan Borough Council and accountable officer of Tameside and Glossop CCG, said the failures are “becoming increasingly exasperating”, in a letter intended for the Ministry of Housing, Communities and Local Government’s shielding sounding board.

Steven said he understands NHS Digital has decided the most recent version of the list cannot be shared with councils even though it is being shared with police, fire, voluntary organisations and companies offering logistical support.

“I am sure that you will appreciate that this is counterproductive and frustrating given that local authorities are leading and coordinating the response to the most vulnerable in communities,” he wrote.

He also raised concerns about how the NHS’ shielded patients team is passing on to councils information about people needing additional support — for instance, if the recipient’s food parcel stock is running low, requiring the council to step in. Welfare concerns and medication information could also need to be passed on. Mr Pleasant said although his council had asked for this information to be provided via email, staff “have been told by the NHS shielding team that they do not have permission to do this and that details can only be provided verbally over the phone”.

“We believe this significantly increases the chances of error and presents significant risk… around incorrect information being captured,” he wrote.

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Source: HSJ, 21 April 2020

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Nurse shortage causes Nightingale hospital to turn away patients

Dozens of patients with Covid-19 have been turned away from the NHS Nightingale hospital in London because it has too few nurses to treat them, the Guardian can reveal.

The hospital has been unable to admit about 50 people with the disease and needing “life or death” care since its first patient arrived at the site, in the ExCeL exhibition centre, in London’s Docklands, on 7 April. Thirty of these people were rejected because of a lack of staff.

The planned transfer of more than 30 patients from established London hospitals to the Nightingale was “cancelled due to staffing issues”, according to NHS documents seen by the Guardian.

The revelation raises questions about the role and future of the hospital, which up until Monday had only treated 41 patients, despite being designed to include almost 4,000 beds.

One member of staff said: “There are plenty of people working here, including plenty of doctors. But there aren’t enough critical care nurses. They’re already working in other hospitals and being run ragged there. There aren’t spare people [specialist nurses] around to do this. That’s the problem. That leads to patients having to be rejected, because there aren’t enough critical care nurses.”

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Source: The Guardian. 21 April 2020

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Shrewsbury maternity scandal: Hundreds of families sent letters as inquiry cases near 1,200

An independent investigation into one of the worst maternity safety scandals in NHS history has written to 400 families today as the number of cases under investigation swell to almost 1,200.

Despite the coronavirus crisis the review, chaired by midwifery expert Donna Ockenden, is continuing its work investigating poor maternity care at the Shrewsbury and Telford Hospitals Trust where dozens of babies died or suffered brain damage as a result of poor care over several decades.

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Source: The Independent, 21 April 2020

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Hancock: Staff should be free to speak out over coronavirus concerns

NHS staff should “feel free” to speak out about problems like protective equipment shortages, Matt Hancock has said, despite many having been warned not to do so.

The health and social care secretary told the daily coronavirus briefing on 21 April that it’s “totally normal” for NHS staff to raise concerns about personal protective equipment shortages in their areas and said “transparency is important”.

HSJ has heard from multiple senior local NHS leaders that they have been given strong warnings not to communicate externally about the COVID-19 response, with national officials seeking to closely grip information given to the media.

There have been several reports of healthcare professionals having been “gagged” by hospitals and NHS bodies, with some reports of threats of disciplinary action if they raise concerns on social media or speak to journalists. 

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Source: HSJ, 21 April 2020

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NHS staff given flawed coronavirus tests

Coronavirus tests given to thousands of NHS staff so they could return to work have been found to be flawed and should no longer be relied on, a leaked document reveals. 

The memo from Public Health England (PHE), sent earlier this month, warns of "degraded" performance, meaning the results are less reliable than first thought. 

Almost 100,000 NHS and social care workers and their relatives have now undergone tests in an effort to get as many staff back to the frontline as possible. 

But the memo, dated April 11, reveals that "discordant results" have been identified in the tests, run by PHE and NHS laboratories, requiring ambiguous samples to be re-checked.

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Source: The Telegraph, 22 April 2020

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COVID-19: increasing demand for dialysis sparks fears of supply shortage

More than a quarter of patients with COVID-19 on ventilators also need renal support in the form of dialysis, raising concerns that there could be significant supply problems as countries attempt to stock up on the required fluid and plastic consumables.

Nephrology consultant Graham Lipkin told The BMJ, “This is an under-recognised challenge. While the original focus has been on whether we have enough ventilators and intensive care beds, it has become apparent that there is a high incidence of acute kidney injury (AKI) requiring some form of renal replacement therapy (RRT) through dialysis. With the volume of people coming into intensive care, there are increasing challenges to capacity across the system.”

Lipkin, who is president of the Renal Association, has been working with NHS England to develop new clinical guidelines for the prevention and optimal management of AKI in hospital. The guidance aims to reduce the incidence of AKI and therefore the demand for dialysis.

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Source: BMJ, 21 April 2020

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