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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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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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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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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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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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COVID-19: ibuprofen can be used for symptoms, says UK agency, but reasons for change in advice are unclear

UK medicines agencies have changed their advice on ibuprofen to say that the drug can be used to treat patients with symptoms of COVID-19, although the evidence that prompted the revision has not been made public.

The change follows a review by the Commission on Human Medicines’ expert working group on COVID-19 which, along with previous reviews of evidence, concluded that there is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and contracting or worsening of COVID-19.

The group’s review has not been published, but prompted the Medicines and Healthcare Products Regulatory Agency (MHRA), NHS England, and the National Institute for Health and Care Excellence (NICE) to update their advice to say that patients can take paracetamol or ibuprofen for symptoms of COVID-19, such as fever and headache.

This is a change to NICE’s recommendation on 3 April that paracetamol should be used in preference to NSAIDs for managing fever in patients with suspected COVID-19 until more evidence is available.

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Source: BMJ, 17 April 2020

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Coronavirus disproportionately affecting BAME communities in UK, new figures show

More than 16% of people who had tested positive for coronavirus when they died were from black, Asian and minority ethnic (BAME) communities, new data shows.

On Monday, NHS England released data showing the ethnic breakdown of people who have died with coronavirus for the first time.

The statistics come days after a review was announced to examine what appears to be a disproportionate number of BAME people who have been affected by Covid-19.

Last week Downing Street confirmed the NHS and Public Health England will lead the review of evidence, following pressure on ministers to launch an investigation.

Discussing the review, Professor Chris Whitty, the chief medical officer for England, said ethnicity is "less clear" than three others factors in determining who is most at risk from coronavirus.

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Source: The Independent, 21 April 2020

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Masks for public 'could put NHS supplies at risk'

NHS supplies of face masks could be put at risk if the government starts advising the public to wear them, hospital bosses have warned.

The government's scientific advisers are to meet later to discuss whether the public should be urged to wear masks in a bid to combat coronavirus, but Chris Hopson, chief executive of NHS Providers, warned there should be "clear evidence" to justify their use.

He said securing supplies for NHS staff amid huge global demand was "crucial".

The World Health Organization (WHO) has said there is no evidence to support the use of face masks by the general population. It says people who are not in health and care facilities should only wear masks if they are sick or caring for those who are ill.

But the debate around their use in the UK has been gaining momentum in recent weeks, with proponents arguing they can help reduce the risk of people with the virus passing it on to others.

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Source: BBC News, 21 April 2020

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Ventilator manufacturers form ventilator training alliance, create App to help front-line medical workers during COVID-19 pandemic

According to an Allego press release, several of the world’s ventilator manufacturers have formed a Ventilator Training Alliance (VTA) and partnered with Allego to create a mobile app that front-line medical providers can use to access a centralised repository of ventilator training resources.

Dräger, GE Healthcare, Getinge, Hamilton Medical, Medtronic, Nihon Kohden, and Philips have joined this humanitarian training coalition.

The VTA app – powered by learning and readiness platform provider Allego – connects respiratory therapists, nurses and other medical professionals with ventilator training resources from alliance member companies, including instructional how-to videos, manuals, troubleshooting guides, and other ventilator-operation expertise critical to helping responders treat patients suffering from COVID-19-related respiratory distress.

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Source: American Association for Respiratory Care, 16 April 2020

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NHS told to expect ‘huge number’ of legal challenges after pandemic

The NHS should expect a “huge number” of legal challenges relating to decisions made during the coronavirus pandemic, healthcare lawyers have warned.

The specialists said legal challenges against clinical commissioning groups and NHS providers would be inevitable, around issues such as breaches of human rights and clinical negligence claims.

Francesca Burfield, a barrister specialising in children’s health and social care, told HSJ’s Healthcheck podcast: “I think there is going to be huge number of challenges. If and when we move through this there will not only be a public enquiry, [but] I anticipate judicial reviews, civil actions in relation to negligence claims and breach[es] of human rights….”

She said criminal proceedings by the Care Quality Commission or Crown Prosecution Service would also be a possibility, around issues such as deprivation of liberty, neglect, safeguarding, and potential gross negligence manslaughter.

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Source: HSJ, 20 April 2020

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Hospitals washing gowns at 60C to re-use PPE as stocks run low

Some hospitals are washing single-use protective gowns at 60C so they can be used several times by frontline staff because of the ongoing shortage, according to a senior NHS official.

Chris Hopson, the chief executive of NHS Providers, also said hospitals could not rely on government promises that more personal protective equipment (PPE) was on the way – saying there was “relatively low confidence” a shipment of 400,000 gowns would arrive from Turkey on Monday.

The head of the membership organisation for NHS trusts in England said some trusts had taken to “hand-to mouth” arrangements, with one discovering that some types of gowns remained fluid-repellent if washed at high temperatures.

“There is no doubt that at the moment, we have now got trusts who have definitely got shortages of gowns,” Mr Hopson told BBC Radio 4’s Today programme. “Trust leaders are doing absolutely everything they can to try and address that problem.”

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Source: The Independent, 20 April 2020

 

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Don’t bank on a coronavirus vaccine, says Sir Patrick Vallance

The government’s chief scientific adviser has cautioned against banking on a OVID-19 jab, warning that new vaccines are “long shots”.

Oxford University researchers are planning to begin human trials of a vaccine this week and believe that they could have results showing whether it works as early as September.

However, Sir Patrick Vallance, the chief scientific adviser, has cautioned that even if a vaccine shows signs of protecting against the virus, ensuring that it is safe could take much longer.

“All new vaccines that come into development are long shots. Only some end up being successful,” he said yesterday. “Coronavirus will be no different and presents new challenges for vaccine development. This will take time.”

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Source: The Times, 20 April 2020

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Coronavirus: 'I'm the nurse who switches off the ventilator'

Having access to a ventilator can mean the difference between life and death for patients who are seriously ill with COVID-19, but sometimes even these breathing machines cannot save someone's life.

Juanita Nittla is a chief nurse in the intensive care unit (ICU) at London's Royal Free Hospital, and has been working for the NHS as an intensive care specialist nurse for the past 16 years. Switching off ventilators is part of Juanita's job.

The work is traumatic and painful, the 42-year-old says. "Sometimes I feel like I am somewhat responsible for someone's death."

Medical teams face tough decisions about when to stop treatment for patients who aren't getting better. The decision is made after careful consideration, analysing factors such as the age of the patient, underlying health conditions, their response to the virus and likelihood of recovery.

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Source: BBC News, 20 April 2020

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