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NHS staff given conflicting advice over resuscitation of coronavirus patients

Doctors, nurses and paramedics have been given conflicting advice about when to start resuscitation for coronavirus patients, amid fears the procedure could put them at risk of infection.

While Public Health England has said it does not believe CPR creates a risk, the UK’s Resuscitation Council – which is responsible for setting standards for resuscitation in the NHS – has said it believes there is a risk and staff should wear full equipment.

The Independent has seen several examples of different messages being sent out to hospital staff and ambulance workers, and some NHS trusts were forced to change their guidance within a matter of days after PHE changed its stance.

One set of guidance could mean a delay in starting CPR for patients while staff put on protective equipment, while the other means staff could be at risk of being infected with coronavirus.

Ken Spearpoint, a former consultant nurse and resuscitation officer at Imperial College Healthcare Trust, said the situation had led to confusion and created an “ethical dilemma” for some staff who were being forced to choose between the Resus UK’s position and their trust’s guidance.

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Source: The Independent, 6 April 2020

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'High risk' list misses off thousands of people

Thousands of people have been missed off the government's high risk list for Covid-19 despite meeting the criteria.

Among them have been transplant patients, people with asthma and some with rare lung diseases.

Many are worried it will affect their ability to access food and medical supplies as they shield from the virus, unable to leave their homes for at least 12 weeks.

"It's like she's been forgotten," said Bev Pearson, mother of 20-year-old heart transplant patient Lucy Pearson.

Miss Pearson, from Whitsbury in Fordingbridge, Hampshire, had her transplant 14 years ago and still visits hospital for regular check-ups. She has been shielding in the home she shares with her mother, brother and sister - none of whom have been venturing out in an attempt to protect her.

Despite registering her daughter on the government list herself, she said she had received no confirmation.

When she asked her GP she was told it had "nothing to do with the surgery", she added.

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Source: BBC News, 7 April 2020

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Hertfordshire hospital forced to consider who should be refused oxygen

Oxygen supplies at a Hertfordshire hospital inundated with coronavirus patients became so precarious last week that officials considered how to decide who should receive the gas and who should miss out and likely die, the Guardian understands.

The oxygen system at Watford general hospital came close to breaking point on Saturday, when a critical incident was declared and staff had to tell the public not to come to the hospital. Some patients were moved out to prevent the vital system failing.

A senior clinician said: “They were [consulting] the hospital ethics committee every day and considering who they were not going to oxygenate and ventilate if they needed it, and making decisions about who would be triaged to not have oxygen and die.”

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Source: Guardian, 5 April 2020

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NHS worker quit when she was stopped from wearing face mask

A healthcare worker in north-west London quit her job after she was refused permission to wear a protective face mask, the Guardian has learned.

In her resignation letter, Tracy Brennan chastised her superiors at Hillingdon Hospitals NHS foundation trust for forbidding her from wearing a surgical mask she had bought to protect herself – and the patients she was caring for – from contracting the deadly virus.

Brennan, a healthcare assistant, said she had returned to work after self-isolating for 14 days because her daughter had shown symptoms of Covid-19. She said that patients in the ward where she was working, which was not a coronavirus treatment ward, felt comfortable with her wearing the surgical mask and some positively encouraged her to do so.

Brennan wrote: “With a heavy heart and sadness, I feel I have no alternative but to hand this letter in as my formal resignation and will be unable to work my notice due to not being allowed to wear sufficient personal protective equipment (PPE) for the duties I perform.”

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Source: Guardian, 4 April 2020

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Coronavirus UK death toll: why what we think we know is wrong

New figures reveal that what we think we know about the Covid-19 death toll in the UK is wrong. Here’s why.

Every day we get one big figure for deaths occurring in the UK. Everyone jumps on this number, taking it to be the latest toll. However NHS England figures – which currently make up the bulk of UK deaths – in fact reflect the day on which the death was reported, not the actual date of death, which is usually days, sometimes weeks, before it appears in the figures.

The truth is we don’t know how many deaths have taken place the previous day. In fact the headline figure is likely to under-report the number of deaths that actually happened the previous day.

The number we hear about usually counts deaths which took place at an earlier date. The difference matters because by undercounting the number of deaths we are skewing the curve.

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Source: Guardian, 4 April 2020

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Non-acute services to receive 30 million PPE products

Adult social care services are to receive millions of personal protective equipment products following a national audit of personal protective equipment (PPE), HSJ can reveal.

The government will deliver more than 30 million items to local resilience forums in the coming days, for distribution among social care and other front-line services, according to a letter seen by HSJ.

The stock should not be sent to acute trusts or ambulance services, the letter, from health and social care secretary Matt Hancock and housing, communities and local government secretary Robert Jenrick, stated.

Describing an “urgent need” for PPE in front-line services, Mr Hancock and Mr Jenrick asked local planners to distribute this latest batch of stock “only where there is a clear and pressing need”.

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Source: HSJ, 6 April 2020

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Expectant mothers turn to freebirthing after home births cancelled

When Victoria Gianopoulos-Johnson got a call from her midwife to say her home birth would be cancelled, panic took hold. She says she “lost it” for two days, crying constantly, gripped by uncertainty and then anger. Now she has reached the decision to have a free birth, also known as unassisted childbirth.

Maternity rights groups say there has been a rise in the number of women seeking advice about freebirthing owing to pressures on hospitals and new restrictions around birth partners.

More than a fifth of birthing centres and more than a third of homebirth services have closed due to a shortage of midwives and concerns about ambulance response times.

Alison Edwards, of Doula UK, whose 700 members advocate for expectant mothers, says she has seen a threefold increase in calls about freebirthing in the last fortnight.

“Initially women were concerned about staff shortages,” says Edwards. “Now they don’t want to go to hospital at all, it’s about infection. It is inevitable that some who should not be freebirthing because they are in a high-risk category will give birth at home because they fear the alternative – infection from [coronavirus] or spending time in hospital without their partner’s support.”

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Source: Guardian, 5 April 2020

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Coronavirus: Nearly 400 care groups 'face protection shortages'

Almost 400 care companies which provide home support across the UK have told the BBC they still do not have enough personal protective equipment (PPE).

Without protection, providers say they may not be able to care for people awaiting hospital discharge.

Of 481 providers, 381 (80%) said they did not have enough PPE to be able to support older and vulnerable people.

The government said it was working "around the clock" to give the sector the equipment it needs.

The BBC sent questions to the nearly 3,000 members of the UK Homecare Association.

About a quarter of respondents said they have either run out of masks or have less than a week's supply left.

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Source: BBC News, 6 April 2020

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'Dial 999 for stroke emergencies despite coronavirus'

People who may be having a stroke should still call 999 for emergency medical care, even during the coronavirus pandemic, say UK experts.

They are concerned that many are not seeking urgent help when they most need it, possibly due to fear of the virus or not wanting to burden the NHS.

Any delay in seeking help can lead to disability or even death, warns the Stroke Association. Prompt assessment and treatment saves lives, it says.

Data suggest people are currently staying away from hospitals, which is fine unless you really need care.

Latest figures for England and Scotland suggest attendance to Emergency Departments has dropped by over a third on the same week last year. Those who need urgent medical help should still attend, say experts.

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Source: BBC News, 6 April 2020

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NHSE to act over fears covid-19 focus could ‘do more harm than virus’

National NHS leaders are to take action over growing fears that the “unintended consequences” of focusing so heavily on tackling covid-19 could do more harm than the virus, HSJ has learned. 

NHS England analysts have been tasked with the challenging task of identifying patients who may not have the virus but may be at risk of significant harm or death because they are missing vital appointments or not attending emergency departments, with both the service and public so focused on covid-19. 

A senior NHS source familiar with the programme told HSJ: “There could be some very serious unintended consequences [to all the resource going into fighting coronavirus]. While there will be a lot of covid-19 fatalities, we could end up losing more ‘years of life’ because of fatalities relating to non-covid-19 health complications.

“What we don’t want to do is take our eye off the ball in terms of all the core business and all the other healthcare issues the NHS normally attends to."

“People will be developing symptoms of serious but treatable diseases, babies will be born which need immunising, and people will be developing breast lumps and need mammograms.”

HSJ understands system leaders are hopeful that in the coming days they will be able to assess the scale of the problem, and the key patient groups, and then begin planning the right interventions and communications programme to tackle it.

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Source: HSJ, 5 April 2020

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Singapore to open-source national coronavirus encounter-tracing app and the Bluetooth research behind it

Singapore plans to open source a smartphone app its digital government team has developed to track citizens' encounters with coronavirus carriers.

The app, named TraceTogether, and its government is urging citizens to run so that if they encounter a Coronavirus carrier, it’s easier to trace who else may have been exposed to the virus. With that info in hand, health authorities are better-informed about who needs to go into quarantine and can focus their resources on those who most need assistance.

The app is opt-in and doesn’t track users through space, instead recording who you have encountered. To do so, it requires Bluetooth and location services to be turned on when another phone running the app comes into range exchanges four nuggets of information - a timestamp, Bluetooth signal strength, the phone’s model, and a temporary identifier or device nickname. While location services are required, the app doesn't track users, instead helping to calculate distances between them.

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Source: The Register, 26 March 2020

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Increasing physical health check coverage for those with serious mental illness

City and Hackney Clinical Commissioning Group might have the fifth highest prevalence of serious mental illness in England, but last year it achieved the highest physical health check coverage in the country.

This was down to a collaborative approach by the CCG, local trust, GPs, heath informatics, a voluntary sector exercise and diet specialist organisation, and service users themselves.

This alliance model for primary care SMI physical health was named mental health innovation of the year at the HSJ awards.

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Source: HSJ, 20 March 2020

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Children may be COVID-19 ‘collateral damage’

Children may have died from non-coronavirus illnesses because they are not coming to hospital quickly enough, amid concerns NHS 111 may be giving flawed advice to stay away, according to senior paediatricians.

HSJ understands the concern about 111 giving the wrong advice to parents who should travel to hospital had been “escalated” to national leaders.

Several senior paediatric leaders in London raised serious concerns to HSJ. They said several children in the past week had been admitted to intensive care in London, and had been harmed — and, in some cases, died — because of the issue, though they did not want to identify particular hospitals or cases. The sources said it was a national problem.

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Source: HSJ, 3 April 2020

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Covid-stricken city calls in Babylon to ‘relieve pressure’

Royal Wolverhampton Trust (RWT) has become the first provider to sign a deal with Babylon Health for citywide coverage of a new COVID-19 app, HSJ has learned.

Digital health provider Babylon announced earlier this month the creation of a “covid-19 care assistant” app, which provides patients with digital triage, a live chat service, a symptom tracker and video consultation.

RWT’s deal covers around 300,000 patients registered to a Wolverhampton GP, and all trust staff regardless of where they live. Earlier this year, RWT announced a 10-year deal with Babylon to develop a “digital-first integrated care” model.

The new COVID-19 app will be made available to staff today and will then be rolled out to the general public next week.

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Source: HSJ, 3 April 2020

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UK healthcare regulator brands resuscitation strategy unacceptable

Elderly care home residents have been categorised “en masse” as not requiring resuscitation, in a strategy branded unacceptable by the healthcare regulator.

People in care homes in Hove, East Sussex and south Wales are among those who have had “do not attempt resuscitation” (DNAR) notices applied to their care plans during the coronavirus outbreak without proper consultation with them or their families, MPs and medical unions fear.

Care homes in Leeds have reported that district nurses have been asking them to “revisit do not resuscitate conversations with people who said they didn’t want them” and a care worker in Wales told the Guardian that after a visit from a GP, all 20 of their residents had DNAR notices attached to their plans.

DNAR notices are a common part of care plans and many people wish to have them in place because, in the event of cardiac arrest, attempts to resuscitate can cause serious trauma, including broken bones. But the Care Quality Commission and other medical bodies are so concerned about the blanket application of the notices that it has issued a warning to stop.

“It is unacceptable for advance care plans, with or without DNAR form completion, to be applied to groups of people of any description,” the notice states. “These decisions must continue to be made on an individual basis according to need.”

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Source: The Guardian, 1 April 2020

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Oak Springs: Third fatality at Liverpool care home where 52 have symptoms

On any normal day the Oak Springs Care home in Liverpool is a hive of activity, laughter ringing out as its elderly residents enjoy dancing, creative crafts and bingo.

Yesterday it was quiet, the inhabitants confined to their bedrooms and stark notices on the door warning visitors against entering, as word spread that a third resident had died in hospital that morning after a corona-virus diagnosis. Of the 66 remaining residents, 52 are exhibiting symptoms.

Four were put on end-of-life care plans this week, a situation described by Andrea Lyons, the general manager, as “our absolute worst nightmare”.

She said: “These are people who we love, who we spend more time with than our families. It has been difficult beyond the worst you can imagine”.

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Source: The Times, 2 April 2020

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Coronavirus testing plans in chaos

Boris Johnson has been forced to shift strategy on the government’s testing regime for coronavirus after criticism of the slow pace of checks being carried out on frontline NHS staff.

Private laboratories are now being drafted in to do the tests where before these were being performed through a centralised process.

The prime minister accepted last night that mass testing was the way out of the crisis and said in a tweet that it would “eventually unlock the puzzle of coronavirus”.

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Source: The Times, 2 April 2020

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Coronavirus: Special needs parents in 'survival mode'

A father has described the "huge impact" of losing respite care for his young daughter who has complex special needs.

Tim Clarke and his wife Ana look after their six-year-old daughter Molly at home in Worcester. The family normally receives a few hours of outside care and educational help a week, but that ended with the coronavirus pandemic.

Molly has been diagnosed with autism and also has medical issues including a cyst on her brain.

One charity worker from the Pathological Demand Avoidance (PDA) Society, a condition which is on the autism spectrum, described parents of children with special needs as being in "survival mode".

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Source: BBC News, 1 April 2020

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Online triage tools to be ‘rapidly procured’ to manage COVID-19 pressures

The procurement of digital tools to support online primary care services during the coronavirus outbreak are to be fast-tracked for providers who don’t have the resources.

In a letter sent to primary care providers and commissioners, GP surgeries were told to move to a triage-first model of care as soon as possible as the NHS bolsters its response to COVID-19.

The letter, sent by medical director for primary care, Nikita Kanani, and director of primary care strategy and NHS contracts, Ed Waller, states practices and commissioners should promote online consultation services where they are in place or “rapidly procure” them.

“Rapid procurement for those practices that do not currently have an online consultation solution will be supported through a national bundled procurement,” wrote in the letter.

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Source: Digital Health, 30 March 2020

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Doctors told not to prioritise coronavirus over patients with other serious conditions

Doctors have been reminded not to prioritise coronavirus patients at the expense of others in new ethical guidance backed by royal colleges.

There are increasing concerns that patients are not getting treatment for serious problems, including strokes or heart attacks, because they are afraid to go to hospitals.

The guidelines were drawn up by the Royal College of Physicians (RCP) amid worries that a shortage of ventilators and beds could force doctors to make difficult decisions on which patients get lifesaving treatment.

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Source: The Times, 2 April 2020

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Virus patients more likely to die may have ventilators taken away

Stable coronavirus patients could be taken off ventilators in favour of those more likely to survive, it emerged on Wednesday, as another sharp rise in deaths left the UK braced for the outbreak to reach up to 1,000 deaths a day by the end of the week.

In a stark new document issued by the British Medical Association (BMA), doctors set out guidelines to ration care if the NHS becomes overwhelmed with new cases as the outbreak moves towards its peak.

Under the proposals, designed to provide doctors with ethical guidance on how to decide who should get life-saving care when resources are overstretched, hospitals would have to impose severe limits on who is put on a ventilator. Large numbers of patients could be denied care, with those facing a poor prognosis losing the potentially life-saving equipment even if their condition is improving.

The BMA suggested that younger, healthier people could be given priority over older people and that those with an underlying illness may not get treatment that could save them, with healthier patients given priority instead.

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Source: The Guardian, 1 April 2020

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Major acute tells staff to work despite isolation guidance

A major hospital trust has told staff they should attend work even if a household member is showing covid-19 symptoms, contrary to national guidance.

Newcastle Upon Tyne Hospitals Foundation Trust’s occupational health department has told staff who had reported having family members with covid-19 symptoms they were still expected to attend work.

In the email exchanges seen by HSJ, some as recently as a couple of days ago, the trust’s occupational health department was clear there was an NUTH policy agreement with Public Health England.

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Source: HSJ, 1 April 2020

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At-risk NHS workers told to put their health first as volunteer doctor dies

Healthcare professionals have been told to consider not treating patients with the COVID-19 coronavirus if they themselves would be put at risk, part of new ethical guidance that calls on doctors to prioritise some ailments over the pandemic.

The new recommendations for healthcare professionals over 70 years, or with pre-existing conditions, to put themselves first when tackling the pandemic comes following the death of a doctor who returned to the frontlines as a volunteer following a call to arms from the government.

The guidance from the Royal College of Physicians (RCP) makes up part of a sweeping list of ethical considerations faced by healthcare workers in the face of the global pandemic.

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Source: The Independent, 2 April 2020

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Coronavirus: Parents are allowed to visit sick children in hospital during outbreak

Hospitals should allow parents to be with children who are being treated for the coronavirus, NHS England has confirmed, after a 13-year-old boy died without any family members beside him.

Under its national guidance to hospitals, parents are considered essential visitors, but hospitals do have discretion to suspend visitors if it is “considered appropriate”. Anyone who has symptoms of COVID-19 should not be allowed to visit a hospital.

NHS England confirmed the position after 13-year-old Ismail Mohamed Abdulwahab died at King’s College Hospital in south London in the early hours of Monday without any family members present. A statement by his family suggested he was alone because of the risk of infection.

On its website the hospital repeated the guidance sent to trusts by NHS England that states children are allowed one parent or carer as a visitor, but declined to explain why his family were not with him.

The end-of-life charity Marie Curie has also called on doctors to allow families to be with their loved ones, describing it as an “important part of their duty of care”.

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Source: The Independent, 2 April 2020

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