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Blood transfusion trial begins for COVID-19 patients in UK

Trials have begun in the UK to test the effectiveness of blood plasma transfusions in treating patients suffering from COVID-19.

NHS Blood and Transplant (NHSBT) have started delivering the first units of convalescent plasma, which contains the antibodies of people who have recovered from coronavirus, to hospitals in England. In total, 14 units have been supplied to Guy’s and St Thomas’ NHS Foundation Trust, Imperial College Healthcare NHS Trust and University Hospitals Birmingham NHS Foundation Trust.

The first transfusions have been administered, NHSBT confirmed on Wednesday, though the efficacy of the treatment will not be known until the trial ends.

Seven hospitals are currently taking part in the trials, which will assess a patient’s speed of recovery and chances of survival, with more expected to join in the coming months as the number of people eligible to donate blood plasma increases.

As of Tuesday, more than 6,500 people had signed up while around 400 donations had been made. Gail Miflin, Chief Medical Officer for NHS Blood and Transplant, said: “We’re delighted the first patients are receiving convalescent plasma transfusions thanks to the generosity of our donors."

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Source: The Independent, 7 May 2020

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Concerns for wellbeing of babies born in lockdown

Concerns for the wellbeing of babies born in lockdown are being raised, as parents struggle to access regular support services.

England's children's commissioner is highlighting pressures facing mothers caring for babies without the usual family and state support networks.

Playgroups are closed and health visitor "visits" are being carried out remotely in most cases. The NHS said adaptations had been made to keep new mothers and babies safe.

The briefing paper from Anne Longfield's office says an estimated 76,000 babies will have been born in England under lockdown so far. But births are not being registered, because of temporary rules tied to the virus pandemic, so even basic information about new babies is not being gathered.

At the same time, support services provided by health visitors and GPs are not readily accessible, with many taking place via phone and video calls or not at all. There are concerns many babies may have missed their developmental health checks, due in the first few weeks of life to pick up urgent developmental needs.

"In some areas, the six-week GP baby check hasn't been available or parents haven't wanted to attend it due to a potential risk of infection," she said.

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Source: BBC News, 7 May 2020

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Urgent referrals rejected for one in three GPs during COVID-19 outbreak

More than three quarters of GPs fear delays to care because of COVID-19 will harm patients, with one in three reporting that urgent referrals have been rejected during the pandemic, a GPonline poll shows.

The poll of 415 GPs found that 77% were concerned that delays to operations and treatments for non-COVID-19 issues would result in patients coming to harm.

Meanwhile, 30% of GPs said they have had an urgent referral rejected during the pandemic. Rejected referrals included two-week-wait referrals for suspected cancer as well as urgent referrals for investigations such as ECGs, echocardiograms and CT scans.

GPs also highlighted concerns over delays to treatment for cancer, with respondents warning that breast cancer surgeries had been postponed or chemotherapy delayed.

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Source: GP Online, 5 May 2020

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Launch of PPE delivery system for care home staff hit by delays

A planned Amazon-style delivery system for personal protective equipment to care workers will not be nationally available for at least another fortnight, the housing and communities secretary has told MPs, before weekly figures for deaths in care and nursing homes which are on course to rise by more than 2,000.

Robert Jenrick told the housing, communities and local government select committee on Monday that the logistics system for PPE could take three more weeks to launch.

Clipper Logistics was contracted by the government at the end of March and care home operators have been increasingly outspoken in their warnings that a lack of masks, aprons, gloves, gowns and face shields is causing the spread of the virus in their facilities and putting workers’ lives at risk. About 340 people a day have been dying in care homes of COVID-19, according to official figures.

The largest private care home provider, HC-One, said on Monday that 703 of its residents had died across the UK while last week, Sam Monaghan, the chief executive of MHA, the largest charitable provider, warned: “Our residents and staff have not received the enhanced level of protection they need. The government will be held to account for this.”

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Source: The Guardian, 4 May 2020

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Testing and contact tracing: a role for local leaders

Local authorities must be at the heart of contact tracing because COVID-19 is best understood as a pattern of local outbreaks rather than a national pandemic, says Sir Chris Ham and Robin Tuddenham in an HSJ article.

Community testing and contact tracing represent our greatest hope for managing the risks to health of COVID-19 until a vaccine and effective treatments become available. Experts in infectious disease base their understanding of this on previous pandemics, and the experience of countries like South Korea and Germany.

Work is underway at pace to resume contact tracking and tracing in England. It is understood that this programme will begin in earnest from 18 May following a pilot on the Isle of Wight. This work is a core part of Matt Hancock’s five-point plan for combating COVID-19, in support of some relaxation of lockdown anticipated soon.

Whilst the pace is understandable, the methods and approach taken are top down, lack an effective role for key regional co-ordination through the Integrated Care Systems/Sustainability and Transformation Partnerships and Local Resilience Forums, and risk marginalising the essential skills of local authorities, GPs and the voluntary and community sector in place, according to Ham amd Tuddenham.

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Source: HSJ, 5 May 2020

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Over 170 carers call UK whistleblower helpline during COVID-19 crisis

More than 170 carers have called a whistleblowing helpline since the start of the COVID-19 outbreak, according to a report that highlights the voices of frontline workers and lays bare a catalogue of safety concerns.

Compassion in Care, which operates the helpline for care workers, says it is seeing the whistleblowing process move at “unprecedented speed” as the coronavirus crisis unfolds, with many concerns being ignored.

With the coronavirus death toll mounting in care homes, the charity’s report flags the “horrendous” unsafe conditions workers are facing amid concerns over lack of personal protective equipment (PPE), as well as the impact on carers’ mental health.

One whistleblower likens the situation to a “war zone” with people struggling to breathe, while another describes the pain of not having the time, because of the overwhelming workload, to even hold distressed residents’ hands.

In a new report, titled When the Silence Wins, Compassion in Care’s founder, Eileen Chubb, who is herself a former care whistleblower, writes: “During this crisis I have experienced the whistleblowing process moving at unprecedented speed, at such a high-volume and involving whistleblowing issues that are without exception extremely serious."

“What is emerging from these cases is a lack of action by employers in response to genuine concerns."

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Source: The Guardian, 6 May 2020

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Coronavirus: Care homes still expected to take COVID-19 hospital patients as deaths mount

Hospitals are continuing to discharge patients infected with Covid-19 into Britain’s struggling care homes, despite new figures showing deaths in the care sector still rising while those in hospitals are falling.

Deputy chief scientific adviser Dame Angela McLean revealed the government was now seriously concerned about the scale of the outbreak in care homes.

She said the number of deaths was now almost half of those in hospitals adding: “There is a real issue that we need to get to grips with.”

In March care homes were told they had to accept thousands of patients discharged from hospitals to help hospitals free up 33,000 beds ahead of the coronavirus surge. But due to a lack of community testing it was not possible to test all patients, meaning the virus may have been able to spread without detection.

Public Health England data last week showed the virus has now established itself in more than 4,500 care homes across the country.

Sarah Scobie from the Nuffield Trust health think tank said: “The vulnerable social care sector is now becoming the epicentre of the COVID-19 pandemic in this country. Despite a very small decrease in overall deaths from the previous week, the numbers in care homes are still growing."

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Source: The Independent, 6 May 2020

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Revealed: the NHS’s plan to protect BAME staff from COVID-19

The NHS faces a new set of wide-ranging requirements as part of a comprehensive plan to mitigate the impact of COVID-19 on black, Asian and minority ethnic staff, HSJ has discovered.

A draft NHS England/NHS Improvement document, seen by HSJ, proposes trusts ensure every staff member has “a risk assessment to keep them safe”. It says the centre will provide: “Guidance and support to employers on creating proactive approaches to risk assessment for BAME staff, including physical and mental health.”

The document, Addressing Impact of Covid-19 on BAME Staff in the NHS, will call for five actions:

1. Every member of staff, current and returning, will have a risk assessment to keep them safe.

2. Every organisation with a CEO, and for primary care CCGs and ICSs, needs a BAME co-leader.

3. Diversity at every level of the health and care system starts with the podium, through our senior decision-making forums and across all organisations and at all levels of the workforce.

4. A bespoke health and wellbeing (including rehab and recovery) offer for BAME staff will be developed and rolled out for the system.

5. Every part of the system will use guidance on increasing diversity and inclusion in communications will be produced, led by the system.

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Source: HSJ, 6 April 2020

 

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Cancer survivor urges people not to ignore symptoms and get checked by GP

A Nottingham mum recovering from breast cancer surgery said she 'hates to think' what could have happened, if she had let the cancer go undetected.

Claire Knee, 45 of Beeston, was diagnosed with breast cancer in March shortly before lockdown measures were introduced.

Having felt slightly off and noticing lumps in her breast, she was encouraged to contact her GP who referred her for tests. After a serious of diagnostic tests at Nottingham City Hospital's Breast Institute, specialists confirmed the presence of a tumour in the early stages. Surgeons successfully removed the tumour from her right breast amid the pandemic and Claire has been recommended some follow up treatment.

She now wants to share her experience of seeking help and getting treatment to advise others who may be showing signs of cancer but are too scared to contact their GP.  

"Looking back I just think that if I hadn’t made the call to my GP I would be walking around with undetected breast cancer, which could still be growing now. I would urge anyone in similar circumstances to contact their GP and get checked - even if it’s just for peace of mind.”

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Source: Nottinghamshire Live, 4 May

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Matt Hancock faces judicial review threat over 'do not resuscitate' orders

The health secretary Matt Hancock has been threatened with a judicial review amid fears patients’ human rights are at risk from the incorrect use of controversial do not resuscitate orders during the coronavirus pandemic.

Ministers have been told they should use emergency powers to issue a direction to doctors and nurses in the NHS requiring them to comply with the law on do not attempt resuscitation orders (DNARS) and to ensure patients are properly consulted.

In recent weeks there have been a number of reports of patients having DNARs put in place without their knowledge or in GPs imposing blanket decisions, prompting a warning letter from NHS England’s chief nurse last month.

The legal action is being brought by Kate Masters, the daughter of Janet Tracey, who died at Addenbrooke's hospital in 2011 after a DNAR was put in place without her knowledge.

In 2014, Tracey's husband David won a landmark victory at the Court of Appeal which gave patients a new legal right to be consulted by doctors when DNARS were being considered. Not consulting a patient was a breach of their human rights, the court ruled.

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Source: The Independent, 6 May 2020

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Pregnancy support helplines report dramatic spike in urgent enquiries as coronavirus turmoil puts mothers at risk

Pregnancy support helplines are experiencing a massive spike in distressed pregnant women asking for urgent help as charities warn coronavirus upheaval is placing pregnant women at risk.

Frontline service providers warn mothers-to-be are anxious about whether they will be denied pain relief options and be separated from their newborn babies due to them being put in neonatal units.

Birthrights, a maternity care charity, found enquiries to its advice line in March were up by 464 per cent in comparison to March last year. Women getting in touch also raised concerns about home birth services being withdrawn, midwifery-led birth centres shutting their doors and elective caesareans being discontinued due to the COVID-19 crisis.

Baby charity Tommy’s experienced a 71% surge in demand for advice from midwives on its pregnancy helpline last month. The organisation warned coronavirus turmoil is placing pregnant women at risk after their midwives answered 514 urgent calls for help in April which is a sizeable rise from the 300 enquiries they would generally get.

Jane Brewin, the charity’s chief executive, said: “Antenatal care is vital for the wellbeing of mother and baby – but the coronavirus outbreak means that many don’t know who they can ask for help, or don’t want to bother our busy and beloved NHS."

“Although services are adapting, they are still running, so pregnant women should not hesitate to raise concerns with their midwife and go to appointments when invited. The large increase in people contacting us demonstrates that coronavirus is creating extra confusion and anxiety for parents-to-be, making midwives’ expert advice and support even more important at this time.”

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Source: The Independent, 5 May 2020

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International Day of the Midwife 2020

Today is International Day of the Midwife. Each year since 1992, the International Confederation of Midwives leads global recognition and celebration of the great work midwives do. 

Take a look at some of the resources and blogs we have recently published on the hub highlighting the work midwives are doing to support mothers and families during the coronavirus pandemic and the challenges services face.

Home births, fears and patient safety amid COVID-19

Midwifery during COVID-19: A personal account

Guidance for provision of midwife-led settings and home birth in the evolving coronavirus (COVID-19) pandemic

Birthrights: COVID-19

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Coronavirus: Lockdown psychiatric care 'severely disrupted'

Isolation during lockdown is exacerbating psychosis in some patients, a consultant psychiatrist at a leading mental-health trust warns.

Steve Church said the South London and Maudsley NHS Trust had now had to shift its focus to crisis management.

He leads the psychosis recovery team, one of the trust's five teams helping patients struggling with their mental health during the coronavirus pandemic. Some have had to move homes to isolate and many no longer visit the clinic.

Dr Church, who has been working in the field for almost three decades, said: "In normal times, and we're not in normal times, the whole treatment is about trying to help people not self-isolate, trying to help people to re-engage with society.

"Self-isolation is one of the red flag-hallmarks of somebody becoming unwell in the first place, where they take themselves into a psychosis-induced lockdown."

One of his patients, Tracey, told Dr Church, in a phone consultation, staying at home had increased her hallucinations. "It's been quite daunting," she said. "I do hear the voices a little bit more now. They're domineering - they tell me to run across the road and they're following me and they say horrible and nasty things."

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Source: BBC News, 5 May 2020

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COVID-19 'sheds light on health inequalities in North East'

A leading doctor has called on the government to address regional health inequalities surrounding coronavirus.

Dr George Rae, the British Medical Association's regional chairman for the North East, has written an open letter saying the area is "suffering disproportionately". He said it was "time to ask why" and wanted action to "close the gap".

A government spokesman said it was working "incredibly hard" to protect the nation's public health.

"This is gravely disconcerting," Dr Rae wrote.

"Not only does this mean that we're suffering from a disproportionate amount of serious cases and deaths but also that, as a consequence, gradual lockdown measures may be affected - prolonging the hurt caused to our local economy. Covid-19 has shone a light on the health inequalities in the North East".

"What we need now is action from the government to close this gap and reduce the vulnerability of people in the North East to many medical conditions and, indeed, any future viruses."

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Source: BBC News, 5 May 2020

 

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NHS coronavirus tracing app ‘will have unintended consequences’, senior official says

An NHS app that aims to track the spread of coronavirus is being rolled out for the first time, as part of a trial on the Isle of Wight.

Council and healthcare workers will be the first to try the contact-tracing app, with the rest of the island able to download it from Thursday. The app aims to quickly trace recent contacts of anyone who tests positive for the virus.

However, the new NHS coronavirus app will have “unintended consequences”, according to the head of the unit developing it.

Officials do not know “exactly how it will work”, Matthew Gould, chief executive of NHSX, told a parliamentary committee. “There will be unintended consequences, there will for sure be some things we have to evolve,” he said.

Privacy campaigners have raised concern over the potential for “mission creep” with the data that will be gathered on people’s movements and contact with others.

The Health Service Journal reported that it has not yet passed tests on cyber security, performance and clinical safety needed to be included in the NHS app library.

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Source: The Independent, 4 May 2020

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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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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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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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