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Stepping Hill Hospital A&E rated 'inadequate' amid safety fears

A hospital A&E department has been rated "inadequate" after inspectors found patients at "high risk of avoidable harm".

The Care Quality Commission (CQC) reported a "range of regulation breaches" and a shortage of nurses at Stepping Hill hospital's A&E unit. It also criticised maternity and children's services.

Stockport NHS Foundation Trust's chief executive said the trust had taken "immediate steps" to improve.

The CQC inspected Stepping Hill Hospital in January and February and found A&E performance "had deteriorated significantly" since its last inspection in 2018.

Inspectors found shortcomings "relating to patient-centred care, dignity and respect, safe care and treatment, environment and equipment, good governance, and staffing".

Their report said the service "could not assure itself that staff were competent for their roles" and patient outcomes "were not always positive or met expectations in line with national standards".

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Source: BBC News, 19 May 2020

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Recovery concerns as most ICUs still well above normal capacity

Dozens of intensive care units are still running well over their normal capacity – in some cases more than double – weeks after the peak of demand, figures seen by HSJ reveal.

It contrasts with the picture painted at some government coronavirus press conferences that there is huge “spare capacity” in critical care and has been throughout the outbreak, with Downing Street charts putting England-wide occupancy at around 20% currently.

The government’s assertions include the additional “surge” capacity which was hurriedly established at the start of the outbreak. But intensive care staff have been frustrated by this being labelled spare capacity, when the number of patients being treated is still well above normal levels.

In addition, the ongoing reliance on keeping surge beds open – with ICUs still spilling over other spaces and calling on staff and equipment from other services – will limit hospitals’ ability to resume normal care, such as planned surgery.

Steve Mathieu, a consultant in intensive care medicine in the south of England, said: “The majority of ICUs will currently be operating at over 100 per cent capacity and typically somewhere around 130-150 per cent, although there is significant regional variation".

“There are uncertainties whether this will now represent the ‘new normal’ for the foreseeable future and there is a national need to plan for further potential surges in activity requiring more critical care demand."

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Source: HSJ, 21 May 2020

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NHS scoring system used to identify patients at risk of dying based on flawed evidence, suggests study

Early warning scores are used in the NHS to identify patients in acute care whose health is deteriorating, but medics say it could actually be putting people in danger.

The rollout of an early warning system used in hospitals to identify patients at the greatest risk of dying is based on flawed evidence, according to a study published in the BMJ which suggests that much of the research supporting the rollout of NEWS was biased and overly reliant on scores that could put patients at greater risk..

Medical researchers said problems with NHS England's National Early Warning Scores (NEWS) system had emerged "frequently" in reports on avoidable deaths.

The system sees each patient given an overall score based on a number of vital signs such as heart rate, oxygen levels, blood pressure and level of consciousness. Doctors and nurses can then prioritise patients with the most urgent NEWS scores.

But some professionals have argued that the system has reduced nursing duties to a checklist of tasks rather than a process of providing overall clinical assessment.

Professor Alison Leary, a fellow of the Royal College of Nursing and chair of healthcare and workforce modelling at London South Bank University, told The Independent: “In our analysis of prevention of future death reports from coroners, early warning scores and misunderstanding around their use feature frequently".

“It's clear that some organisations use scoring systems and a more tick box approach to care as they lack the right amount of appropriately skilled staff, mostly registered nurses.”

“Early warning scores might not perform as well as expected and therefore they could have a detrimental effect on patient care,” the authors of the research conclude. “Future work should focus on following recommended approaches for developing and evaluating early warning scores, and investigating the impact and safety of using these scores in clinical practice.”

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Source: The Independent, 21 May 2020

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Coronavirus: Time running out on track and trace, NHS leaders warn

Time is running out to finalise a track and trace strategy that would avoid a potential second surge in coronavirus cases, NHS leaders have said.

The NHS Confederation warned of "severe" consequences to staff and patients if the right system was not established quickly and that lockdown measures should not be eased until a clear plan was in place.

Contact tracing identifies those who may have come into contact with an infected person, either through an app or by phone and email, so they can avoid potentially passing the disease on.

It follows the Prime Minister's pledge to introduce a "world-beating" contact tracing system in England from June.

Niall Dickson, chief executive of the confederation, which represents health and care leaders, welcomed Boris Johnson's pledge made at Prime Minister's Questions on Wednesday. But in a letter to Health Secretary Matt Hancock, Mr Dickson said without a clear strategy the UK was at greater risk of a second peak of the virus.

He said a strategy should have been in place sooner and if the right system was not instigated rapidly the ramifications for the NHS "could be severe".

Speaking on the Today programme, Mr Dickson said: "We are absolutely clear that contact tracing is the right thing to do, it is absolutely critical, it has got to be in place to prevent any notion of a second surge if the lockdown is being further released."

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Source: 21 May 2020

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GPs warned to stock up on flu jabs as NHS fears double risk this winter

GPs have been warned of a double risk from flu and COVID-19 this winter which could hit the NHS just months after its recovery from the coronavirus surge.

NHS England has told practices to stock up on flu vaccines while discussions are ongoing as to whether to widen the eligibility for flu jabs to try and protect as many people as possible from September onwards.

A second wave of coronavirus during winter, when the NHS is typically under strain from flu could overwhelm services with those most at risk from flu similarly vulnerable to coronavirus.

In a letter from NHS chiefs, including chief medical officer Chris Whitty, GPs were told: “Flu vaccination is one of the most effective interventions we have to reduce pressure on the health and social care system this winter. We are currently seeing the impact of COVID-19 on the NHS and social care, and this coming winter we may be faced with co-circulation of COVID-19 and flu.

“Those most at risk from flu are also most vulnerable to COVID-19. We must do all we can to help protect them this winter.”

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Source: The Independent, 20 May 2020

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Coronavirus: Cancer surgery delays risk 'thousands' of deaths

The NHS must ensure cancer-surgery delays do not cost more lives than the number of COVID-19 patients saved, the Institute of Cancer Research says.

In some cancers, a three-month delay could make the difference between a tumour being curable or not, Prof Clare Turnbull said.

And her modelling suggested delaying surgery risked thousands of additional deaths.

NHS England is already urging people to seek help for worrying symptoms, but by the end of April, cancer referrals had dropped by an estimated 70%.

Cancer doctors have told BBC News of having to make difficult decisions to postpone some patients' care during the coronavirus crisis.

As normal service resumed, the NHS should prioritise "certain cancer types in particular", Prof Turnbull said.

Lung and colorectal cancers, for example, were particularly fast moving. But for others, such as prostate and certain breast cancers, treatment could more safely be delayed.

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Source: BBC News, 20 May 2020

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Agency is criticised over its investigation into baby’s death from hypoxia

The coroner investigating the botched birth of a baby boy who died from hypoxia has strongly criticised the Healthcare Service Investigation Branch (HSIB) over its report on his death.

Karen Henderson, who conducted the inquest into the death of baby Theo Young in May 2018 at East Surrey Hospital said that the HSIB had asked Surrey and Sussex Healthcare NHS Trust not to undertake its own investigation, “effectively preventing the recognition of causes of concern and therefore being unable to undertake any immediate and necessary remedial action at the earliest opportunity to prevent future deaths.”

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Source: BMJ, 19 May 2020

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Second more deadly wave of coronavirus 'to hit Europe this winter'

European countries should brace themselves for a deadly second wave of coronavirus infections because the pandemic is not over, the World Health Organization’s top official in Europe has said. 

In an exclusive interview with The Telegraph, Dr Hans Kluge, director for the WHO European region, delivered a stark warning to countries beginning to ease their lockdown restrictions, saying that now is the "time for preparation, not celebration".

Dr Kluge stressed that, as the number of cases of COVID-19 in countries such as the UK, France and Italy was beginning to fall, it did not mean the pandemic was coming to an end. The epicentre of the European outbreak is now in the east, with the number of cases rising in Russia, Ukraine, Belarus and Kazakhstan, he warned.

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Source: The Telegraph, 20 May 2020

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Coronavirus: Hundreds of learning disability deaths in just eight weeks, new data shows

More than 460 people with a learning disability have died from coronavirus in just eight weeks since the start of the outbreak in England.

New data shows between the 16 March and 10 May 1,029 people with a learning disability died in England, with 45 per cent, 467, linked to coronavirus.Overall the number of deaths during the eight weeks is 550 more than would be expected when compared to the same period last year.

The charity Mencap warned people with a learning disability were “being forgotten in this crisis” and called for action to tackle what it said could be “potentially discriminatory practice.”

It highlighted the percentage of Covid-19 related deaths among learning disabled people was higher than those in care homes, where the proportion of Covid-19 deaths was 31 per cent for the same period.

The data has been published after an outcry over the lack of transparency about the impact of Covid-19 on mental health patients and people with a learning disability or autism.

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Source: The Independent, 19 May 2020

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Fault warning for Emerade 500 adrenaline pens

People carrying Emerade 500 microgram adrenaline auto-injector pens should return them and get hold of a prescription for a different brand.

A fault has been detected in the pens, meaning the dose of adrenaline may not be delivered when needed for people with severe allergies.

The official advice comes from the Medicines and Healthcare products Regulatory Agency (MHRA).

Alternative brands - EpiPen and Jext - are available up to 300 micrograms.

"Action has been taken to protect patients, following detection of a fault in one component of the Emerade adrenaline auto-injector pens," an MHRA spokesperson said.

"Patients should return all Emerade 500 microgram pens to their local pharmacy once they have a new prescription and have been supplied with pens of an alternative brand."

If an Emerade pen does need to be used before a patient can get hold an alternative pen, the advice is that it should be pressed very firmly against the thigh. If this does not work, the patient should immediately use their second pen.

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Source: BBC News, 19 May 2020

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Coronavirus: Delirium 'may be common' in Covid seriously ill

Delirium and confusion may be common among some seriously-ill hospital patients with COVID-19, a study in The Lancet suggests.

Long stays in intensive care and being ventilated are thought to increase the risk, the researchers say. 

Doctors should look out for depression, anxiety and post-traumatic stress disorder (PTSD) after recovery, although most patients, particularly those with mild symptoms, will not be affected by mental health problems.

The evidence is based on studies of patients with severe acute respiratory syndrome (Sars) and Middle-East respiratory syndrome (Mers), as well early data on COVID-19 patients.

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Source: BBC News, 19 May 2020

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Cancer referrals are being rejected by hospitals, GPs warn

Suspected cancer patients are being refused hospital appointments despite being referred by GPs, it has emerged.

Family doctors working for one NHS trust in north east London claimed that hundreds of referrals had been rejected in recent weeks.

Many were for ultrasounds and chest X-rays and were sent via the two-week wait system, in which suspected cancer patients referred by GPs are seen within a fortnight.

A rejection letter sent from Whipps Cross hospital seen by Pulse magazine, said the referral had been “due to the Covid-19 pandemic”. 

It added: “Following triage by a consultant radiologist, your imaging request has been assessed as non-urgent and cancelled.”

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Source: The Telegraph (18 May 202)

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COVID-19 disruption could erase decade’s worth of global vaccine coverage for childhood diseases, Unicef warns

Global efforts to vaccinate children against fatal diseases such as measles and polio could be set back a decade due to the disruption caused by the coronavirus pandemic, Unicef has warned.

Immunisation campaigns and routine vaccine services have been suspended across the world to limit the transmission of COVID-19, leaving countries with weak health systems susceptible to a resurgence in preventable illnesses once lockdown restrictions are lifted and societies reopen.

More than 25 vulnerable countries have placed their immunisation programmes for measles on hold, while the delivery of Ebola vaccinations across central Africa, in countries such as the Democratic Republic of the Congo (DRC) and Central African Republic (CAR), has similarly been suspended or curtailed.

“Our immediate concern is with disruption to currently available vaccines,” Dr Robin Nandy, global chief of immunisation at Unicef, told The Independent. “We expect to go back maybe five to 10 years. The longer the disruptions continue, the more concerned we are as it builds the number of susceptible kids in populations.

“What we’re trying to avoid is countries recovering from the current Covid pandemic then being hit by another outbreak of a vaccine-preventable disease.”

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Source: The Independent, 18 May 2020

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Thousands of Covid-19 cases missed due to late warning on smell loss, say experts

Tens of thousands of cases of COCID-19 may have been missed because of delays in warning the public that loss of taste and smell is a key symptom that should lead to self-isolation or testing, experts say.

The four chief medical officers of the UK have finally made official what many scientists had been saying for weeks: that anosmia, or loss of smell, should be added to the other two main warning symptoms, a continuous cough and high temperature. Those who experience any of the three symptoms should isolate for seven days and their families for 14 days.

Prof Tim Spector from King’s College London and his team said data from 1.5 million people who downloaded their symptom-reporting app suggested 50,000 to 70,000 people in the UK had been missed. As early as 1 April, they warned that people with anosmia should self-isolate.

They were joined by ear, nose and throat surgeons, who said loss of taste and smell could be one of the few markers for people who were otherwise asymptomatic and potentially able to infect other people without realising they were a risk.

Their professional body, ENT-UK, said they had been calling for eight weeks for anosmia to be listed as a marker for asymptomatic carriers. It issued a joint statement with the British Rhinology Society (BRS) on 20 March, it said. “We estimate that many hundreds of thousands of patients in the UK have developed anosmia as a result of COVID-19,” said Prof Claire Hopkins, the BRS president.

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Source: Guardian, 18 May 2020

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Coronavirus: Half a million access suicide prevention course

More than half a million people have accessed online training that aims to prevent suicide in the last three weeks alone, a charity has said.

The Zero Suicide Alliance said 503,000 users completed its online course during lockdown. It aims to help spot the signs that a person may need help.

It comes as health leaders warned front-line workers tackling coronavirus could suffer from mental ill health.

NHS England launched a mental health hotline to support staff last month.

The alliance's Joe Rafferty said the true impact of the coronavirus on mental health will not be known until the pandemic ends, but he said "the stress and worry of the coronavirus is bound to have impacted people's mental health".

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Source: BBC News, 18 May 2020

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Spread of COVID-19 in hospitals causing national ‘concern’

The leader of the NHS’ pandemic testing programme has highlighted concerns about the rate of COVID-19 transmissions in hospitals, HSJ can reveal.

NHS England’s patient safety director Dr Aidan Fowler told an industry webinar that he and his team “are concerned about the rates of nosocomial spread within our hospitals”.

Dr Fowler leads the NHS and Public Heath England testing programme (know as “pillar one”). He said the concerns had led to a focus on discovering where transmissions of covid-19 are occurring in hospitals, and how the NHS can reduce the rate of staff and patients becoming infected while on the NHS estate.

His comments come as the NHS attempts to restart the provision of routine elective care and prepares for a significant increase in emergency admissions. The NHS has been told to create separate areas for covid positive and negative patients where possible, regardless of what they are being treated for. Patients are being to self-isolate at home for two weeks before attending hospital for treatment.

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Source: HSJ, 18 March 2020

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Coronavirus: NHS hospitals accused of using crisis as excuse to deny women caesarean sections

Hospitals have been refusing requests for caesarean sections during the COVID-19 outbreak despite official guidance and NHS England advice that they should go ahead.

Multiple NHS trusts have told women preparing to give birth since March that requests for a caesarean section will not be granted due to the viral pandemic.

It has led to accusations from the charity Birthrights that the coronavirus outbreak is being used as an excuse to promote an ideology that more women should have a natural birth.

Maria Booker, from Birthrights, told The Independent: “We continue to be contacted by women being told they cannot have a maternal request caesarean and we are concerned that in some places coronavirus is being used as an excuse to dictate to women how they should give birth, which contravenes NICE (National Institute for Health and Care Excellence) guidance.

Official guidance from NICE says women should be offered a caesarean section where they insist it is what they want.

NHS England has warned hospitals they need to “make every effort” to avoid cancelling caesarean sections and work with neighbouring trusts to transfer women if necessary. It said surgery should only be suspended in “extreme circumstances” where there is a shortage of obstetricians or anaesthetists.

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Source: The Independent, 17 May 2020

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Coronavirus test results waits 'undermining confidence'

The government needs to make sure its coronavirus testing strategy is fit for purpose instead of focusing on hitting targets, says the Royal College of GPs (RCGP).

In a letter to Health Secretary Matt Hancock, chairman Prof Martin Marshall said long wait times were "undermining confidence" in the results. Health professionals were also concerned about the accuracy of some test results, he said.

The government said "95% of tests" were processed "in less than 48 hours". 

Ensuring there are enough tests to meet demand is part of the government's five tests it says must be met before easing lockdown restrictions. However, the absence of a clear strategy had left patients vulnerable, according to Prof Marshall.

He said the RCGP did not currently believe the testing strategy was capable of working to prevent a second wave of infections and "secure the overall health of the population".

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Source: BBC News, 16 May 2020

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Up to 20% of hospital patients in England got coronavirus while in for another illness

Up to a fifth of patients with COVID-19 in several hospitals contracted the disease over the course of the pandemic while already being treated there for another illness, NHS bosses have told senior doctors and nurses.

Some of the infections were passed on by hospital staff who were unaware they had the virus and were displaying no symptoms, while patients with coronavirus were responsible for the others.

The figures represent NHS England’s first estimate of the size of the problem of hospital-acquired COVID-19, which Boris Johnson last week said was causing an “epidemic” of deaths. In a national briefing last month on infection control and COVID-19, NHS England told the medical directors and chief nurses of all acute hospitals in England that it had found that 10%-20% of people in hospital with the disease had got it while they were inpatients.

Senior doctors and hospital managers say that doctors, nurses and other staff have inadvertently passed on the virus to patients because they did not have adequate personal protective equipment (PPE) or could not get tested for the virus.

Doctors say that hospital-acquired COVID-19 is a significant problem and that patients have died after becoming infected that way. One surgeon, who did not want to be named, said: “Multiple patients my department treated who were inpatients pre lockdown got the bug and died. Obviously the timeline supports that they acquired it from staff and other patients.”

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Source: The Guardian, 17 May 2020

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Five key areas identified ahead of restarting NHS services

A joint letter from the Health Foundation, The King’s Fund and Nuffield Trust has been delivered to the Health and Social Care Select Committee identifying five key aspects which need addressed ahead of their evidence session on delivering core NHS and care services during and beyond the coronavirus pandemic.

Health and Social Care Secretary Matt Hancock told the House of Commons on 22 April 2020 that the pandemic had reached its peak and talked of his intention to ‘gradually reopen’ the NHS as soon as it was safe to do so.

For the joint authors of the letter, before any services look to begin being restarted key areas need addressed including a reliable supply of PPE to protect staff and a clear understanding within the system of the full extent of unmet need – particularly important as at present, from a big picture view, it is not clear how many services have been suspended.

The joint letter puts five key questions to the Select Committee to address:

  1. How and when will appropriate infection prevention and control measures be available for all settings delivering care, and what impact will these have on capacity to reopen?
  2. How will the system understand the full extent of unmet need?
  3. How will the public’s fear of using NHS and social care services be reduced?
  4. What is the strategy for looking after and growing the workforce?
  5. Can the system improve as it recovers?

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Source: National Health Executive, 14 May 2020

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'Make or break' moment to break PTSD

NHS staff are at risk of high rates of post-traumatic stress disorder (PTSD) if they don't get the right support as the coronavirus outbreak subsides, health service adviser Prof Neil Greenberg has said.

For now there's a national focus on health and care workers. Public billboards praise them, millions turn out on the street for a weekly round of applause and volunteers have been rushing to help in any way they can. But the height of the crisis is when many staff will be in coping mode. It's when things slow down - and the clapping stops - that, psychologists believe, the real risk of difficulties will arise.

People may need months or even years of "active monitoring" of their mental health after things return to some semblance of normality, according to Prof Greenberg, a world-leading expert in trauma at King's College London.

The NHS in England is providing crisis support to its staff. But it hasn't produced a formal long-term plan to offer extra psychological services in the aftermath of the pandemic.

It's what happens after the trauma that is "most predictive of what people will be like in terms of their mental health", according to Prof Greenberg. How well people are supported and how much stress they're put under as they try to recover can make or break whether someone manages well or develops far more serious difficulties including PTSD.

"If we muck it up then that's going to make the trauma they've already had much more difficult to deal with," he says.

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Source: BBC News, 15 May 2020

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Coronavirus: real care home death toll double official figure, study says

More than 22,000 care home residents in England and Wales may have died as a direct or indirect result of COVID-19, academics have calculated – more than double the number stated as passing away from the disease in official figures.

Academics at the London School of Economics (LSE) found that data on deaths in care homes directly attributed to the virus published by the Office for National Statistics significantly underestimated the impact of the pandemic on care home residents and accounted for only about 4 out of 10 of the excess deaths in care settings recorded in recent weeks in England and Wales.

The figures suggest the impact of the virus in care homes is finally reducing. They are based on reports filed directly from care home operators to the regulator, the Care Quality Commission. Care Inspectorate Wales has said Covid was confirmed or suspected in a further 504 cases in homes up to the 8 May in Wales.

But academics at the care policy and evaluation centre at the LSE found that when excess deaths of other care residents and the deaths of care home residents from Covid-19 in hospitals are taken into account, the toll that can be directly and indirectly linked to the virus pandemic is likely to be more than double the current official count.

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Source: The Guardian, 13 May 2020

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Quarter of people who die from coronavirus in England have diabetes

More than a quarter of all NHS patients who have died after being infected with COVID-19 had diabetes, according to new statistics from NHS England.

Between 31 March and 12 May, a total of 5,873 patients with diabetes died in hospital from COVID-19, 26% of all coronavirus deaths.

It is the first time data on hospital deaths and underlying health conditions has been revealed by the NHS.

People with diabetes have previously been described as being at moderate risk from the virus and were not part of the groups told to shield themselves in their homes due to fears they were at extreme risk.

The NHS England data does not specifically say whether type 1 or type 2 was more prevalent among deaths. It said work was underway to understand the deaths data to include examining the type of diabetes, ethnicity and weight of those who died.

NHS England said it was working with Diabetes UK to provide support and advice to patients via its helpline which will include volunteer clinical advisers.

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Source: Independent, 15 May 2020

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Coronavirus: Reopening NHS services must be safe, unions say

Rapid testing and an adequate supply of protective equipment must be in place when the NHS reopens services cancelled during the peak of the coronavirus oubreak, health unions have said.

The unions have put forward a nine-point plan for the NHS to reopen safely as lockdown restrictions ease.

NHS England has told hospitals to restart routine and non-urgent operations and procedures which were put on hold to create more capacity for COVID-19 patients. But 16 unions, including Unison, the Royal College of Nursing, Unite and GMB, said they wanted the NHS to continue to operate a "safety-first" approach as outpatient clinics and operations resume.

They said they wanted to avoid a repeat of the PPE supply problems which "sapped" staff confidence and "caused widespread and unnecessary anxiety".

Unison's Sara Gorton, who also chairs the NHS group of unions, said the health sector faced another "crucial test" after handling the outbreak. 

She added: "As hospitals get busier, and clinics and other services begin to reopen, the safety of staff and patients is paramount. But this can't happen without plentiful and constant PPE supplies."

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Source: BBC News, 15 May 2020

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Coronavirus latest news: A&E admissions fall to lowest figure on record, new NHS data shows

A&E admissions in the UK have fallen to the lowest on record, with a 57% year-on-year drop in attendances in England, new NHS data shows.

The latest figures show a dramatic fall in demand for emergency treatment, falling below one million attendances per month for the first time since records began in 2010.

The coronavirus crisis has placed additional strain on NHS resources, but is thought to have had the opposite effect on A&E, with the public staying at home and avoiding hospitals where possible.

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Source: The Telegraph, 14 May 2020

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