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Keep up to date with the latest news, research and activity in patient safety.

England campaign targets seriously ill patients avoiding hospitals

A government campaign has been launched to encourage people who are seriously ill with non-coronavirus conditions such as heart attacks to seek help amid concerns some are avoiding hospitals.
The campaign, which will be rolled out this week, aims to encourage people to use vital services – such as cancer screening and care, maternity appointments and mental health support – as they usually would.

The NHS chief executive, Sir Simon Stevens, said delays in getting treatment posed a long-term risk to people’s health.
He stressed that the NHS was still there for patients without coronavirus who needed urgent and emergency services for stroke, heart attack, and other often fatal conditions.
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Source: 25 April 2020, 
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‘Restoration’ of non-covid NHS services gets under way

The government has announced that the “restoration of other NHS services” will start today on a “hospital-by-hospital” basis.
Health and social care secretary Matt Hancock in his daily ministerial coronavirus briefing announced the resumption of healthcare which has been suspended due to coronavirus will begin today. He said the initial focus would be on the most urgent services, citing cancer and mental health as examples.
They will be reintroduced on a locally decided basis, depending on the level the virus is currently impacting different areas and trusts, which varies widely, and how easily they can reintroduce the work, he said.
Mr Hancock, asked about the plan by HSJ during the briefing, indicated that a large-scale return would be enabled because the government is setting out to avoid a so-called second peak of the virus spreading, so the NHS will not need to keep tens of thousands of extra beds free in readiness. Experts and governments around the globe are concerned about the prospect of further peaks of the virus spread as they move to release distancing measures. 
Further NHS England guidance on the plan is expected later this week. 
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Source: HSJ, 27 April 2020
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Patient records can be shared across practices and with 111 after NHS relaxes rules

GPs will now be able to access records for patients registered at other practices during the coronavirus epidemic in a major relaxation of current rules.
The move will allow appointments to be shared across practices, and NHS 111 staff will also have access to records to let them book direct appointments for patients at any GP practice or specialist centre.
The change in policy has been initiated by NHS Digital and NHSX to enable swift and secure sharing of patient records across primary care during the covid-19 pandemic. It means that the GP Connect1 system, currently used by some practices to share records on a voluntary basis, will be switched on at all practices until the pandemic is over.
In addition, extra information including significant medical history, reason for medication, and immunisations will be added to patients’ summary care records and made available to a wider group of healthcare professionals. Usually, individuals must opt in but following the changes only people who have opted out will be excluded.
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Source: The BMJ, 27 April 2020
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Almost 18,000 more people could die of cancer due to coronavirus, study shows

The coronavirus pandemic could lead to almost 18,000 more deaths from cancer in England over the next year and there could also be a 20% spike in fatalities of newly diagnosed cancer patients, according to research by University College London (UCL) and DATA-CAN, the Health Data Research Hub for Cancer.
The figures stem from real-time hospital data for urgent cancer referrals and chemotherapy attendances, which have experienced a 76% and 60% fall, respectively.
Professor Peter Johnson, the NHS Clinical Director for Cancer, has urged people to not hesitate in seeking help or being checked after worrying research showed nearly half of the public have concerns about seeking help.
Moreover, the poll by Portland revealed 1 in 10 people would not contact their GP even if they discovered a lump or a new mole that remained for a week or more.
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Source: BBC News, 28 April 2020
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Intensive care capacity must be permanently doubled, says Nightingale chief

Intensive care capacity in London must be doubled on a permanent basis following the coronavirus pandemic, according to the chief executive of the city’s temporary Nightingale hospital.
Speaking to an online webinar hosted by the Royal Society of Medicine, Professor Charles Knight said London had around 800 critical care beds under normal operations but “there’s a clear plan to double intensive care unit capacity on a permanent basis”.
He added: “We must have a system of healthcare in this country that means, if this ever happened again, that we wouldn’t have to do this, that we wouldn’t have to build an intensive care unit in a conference centre because we had enough capacity under usual operating so that we could cope with surge.”
It would also mean the NHS would no longer be in a position “where lots of patients, as we all know, get cancelled every year for lack of an ITU bed,” he said.
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Source: HSJ, 28 April 2020
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NHS 111 gets new queuing system to handle coronavirus surge

An overflow system has been added to NHS 111 to help deal with the “huge increase” in calls during the coronavirus pandemic.
People displaying coronavirus symptoms who are contacting 111 either via telephone or online are now being diverted to the overspill system, freeing up space for non-covid related enquiries.
The tool has been developed by software company Advanced — alongside NHSX, NHS England and NHS Improvement — for its patient management system Adastra, which is used by 80% of NHS 111 providers in England.
The overspill add on, which started being rolled out earlier this month, can be accessed by clinicians who are working from home, including those who have been redeployed in the NHS, as well as those in 111 call centres. 
Ric Thompson, managing director of health and care at Advanced, said the new queuing extension was developed to handle the “huge increase in the number of calls to 111 but also the need to bring back many thousands of retired clinicians”.
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Source: HSJ, 29 April 2020
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Coronavirus: What is the hidden health cost?

The rising death toll from coronavirus is never far from the headlines, but hidden behind the daily figures is what public health experts refer to as the "parallel epidemic". This is the wider impact on people's health that is the result of dealing with a pandemic.
UK chief medical adviser Prof Chris Witty has been referring to this with increasing frequency during the daily briefings, speaking about the "indirect" costs of coronavirus.
But what is it, and how significant could it be?
Routine treatments, such as hip and knee replacements, were cancelled across the UK. This alone will have a significant impact on people's lives, though it is unlikely to kill anyone. However, the pandemic has also had a knock-on effect on emergency care. Data collected by Public Health England from a sample of A&E departments in England shows attendances have halved since the pandemic started. The trend has prompted NHS leaders to urge patients to come forward for treatment.
Cancer screening has been suspended in Wales, Scotland and Northern Ireland and drastically cut back in England. But it is not only an issue for cancer patients, people with chronic conditions like diabetes or kidney disease may face trying to manage their conditions remotely without the regular face-to-face contact they would have with health professionals. 
The pandemic is also the 'perfect storm' for mental health.
The full impact could take years to unravel.
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Source: BBC News, 29 April 2020
 
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Coronavirus 'as deadly as Ebola in hospital'

People needing hospital treatment for coronavirus are as likely to die as those with Ebola, claim UK researchers. The warning comes as the largest study in Europe showed at least a third of hospital patients with COVID-19 die.
The disease is mild for most and can be treated at home, but scientists said people needed to realise how dangerous the infection could be. Obesity, ageing and being male greatly increase the risk of death, according to the data from 166 British hospitals.
Medical details on nearly 17,000 coronavirus patients in England, Wales and Scotland have been analysed and it shows that 49% survived and were discharged, 33% have died and 17% were still being treated.
"Some people persist in believing that Covid-19 is no worse than a bad dose of flu - they are gravely mistaken," said Calum Semple, the Chief Investigator on the trial, and a Professor in Child Health and Outbreak Medicine at the University of Liverpool.
"The crude case fatality rate for people who are admitted to hospital with severe Covid-19 is 35% to 40%, which is similar to that for people admitted to hospital with Ebola. People need to hear this and get it into their heads... this is an incredibly dangerous disease."
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Source: BBC News, 29 April 2020
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PPE 'designed for women' needed on frontline

There is growing concern that standard personal protective equipment (PPE), which often has a unisex design, doesn't always fit women properly.
The Department of Health said the kit is designed to protect "both genders". However, healthcare workers are saying that even the smallest sizes are too big for some women - who make up 77% of the NHS workforce, according to NHS Digital figures from 2018.
If it is too big it can be less effective in providing a complete barrier to the virus.
"PPE is designed to be unisex and offer protection for both genders, although some products are available in different sizes to enable fit to both small and larger frames," said the Department of Health, in a statement.
But the Royal College of Nursing has described "one-size-fits-all" personal protective equipment as "problematic" and "restrictive" when it can be worn for up to 12 hours during shifts. PPE includes gloves, masks, gowns and face shields.
"Nurses can find it very difficult to treat patients if this equipment is so uncomfortable it makes them hot and unwell," said Rose Gallagher, professional lead for infection prevention and control.
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Source: BBC News, 29 April 2020
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BAME NHS workers could be given roles reducing risk from coronavirus under new guidance

NHS staff from black, Asian and minority ethnic (BAME) backgrounds should be “risk-assessed” and possibly moved away from patient-facing roles during the coronavirus crisis, according to official guidance.
A letter from NHS England acknowledges UK data showing these workers are being “disproportionately affected by Covid-19” and urges health trusts to make “appropriate arrangements”.
Public Health England has been asked to look into the issue by the Department of Health, the letter from NHS chief executive Sir Simon Stevens and chief operating officer Amanda Pritchard said.
“In advance of their report and guidance, on a precautionary basis we recommend employers should risk assess staff at a potentially greater risk and make appropriate arrangements accordingly,” he added.
This could mean BAME health workers being relocated away from patient-facing roles or ensuring they are adequately fitted with personal protective equipment (PPE).
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Source: The Independent, 30 April 2020
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Coronavirus: Home secretary urged to do more to relax drug rules to help ease end-of-life suffering

The government is under pressure to go further on measures to relax rules on powerful painkillers such as morphine to prevent patients suffering “unnecessary pain and distress in the last days of their lives”.
On Tuesday the health secretary, Matt Hancock, announced staff in care homes and hospices would be allowed to “re-use” controlled drugs such as morphine and midazolam, with medication prescribed for one patient used for another where there is an immediate need.
But the Home Office today confirmed to The Independent that it had no plans to extend the rules to the care of patients in their own homes – a restriction experts and charities have warned could leave people suffering at the end of their lives.
The government announced the changes following concerns over the supply of drugs. 
The Royal College of GPs (RCGP) welcomed the changes announced by Mr Hancock, calling them “a significant step forward”, but added: “This only applies to patients living in care home and hospice settings, so there is still work to be done to ensure patients living in their own homes have appropriate access to necessary medication in a timely way.”
Last week the RCGP wrote to home secretary Priti Patel warning that people were suffering unnecessarily due to problems accessing drugs.
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Source: The Independent, 30 April 2020
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NHS staff coronavirus inquests told not to look at PPE shortages

Inquests into coronavirus deaths among NHS workers should avoid examining systemic failures in provision of personal protective equipment (PPE), coroners have been told, in a move described by Labour as “very worrying”.
The chief coroner for England and Wales, Mark Lucraft QC, has issued guidance that “an inquest would not be a satisfactory means of deciding whether adequate general policies and arrangements were in place for provision of PPE to healthcare workers”.
Lucraft said that “if there were reason to suspect that some human failure contributed to the person being infected with the virus”, an inquest may be required. The coroner “may need to consider whether any failures of precautions in a particular workplace caused the deceased to contract the virus and so contributed to death”.
But he added: “An inquest is not the right forum for addressing concerns about high-level government or public policy.”
Labour warned the advice could limit the scope of investigations into the impact of PPE shortages on frontline staff who have died from COVID-19.
“I am very worried that an impression is being given that coroners will never investigate whether a failure to provide PPE led to the death of a key worker,” said Lord Falconer, the shadow attorney general. “This guidance may have an unduly restricting effect on the width of inquests arising out of Covid-19-related deaths.”
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Source: The Guardian, 29 April 2020
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Hospital chiefs 'increasingly frustrated' with UK testing failures

Hospital leaders have launched a strident attack on the government’s coronavirus testing strategy, as it became clear that the target of 100,000 daily tests by 30 April would be comprehensively missed.
NHS Providers, which represents foundation trusts in England, rounded on ministers for “a series of frequent tactical announcements” to expand testing criteria, and dismissed the 100,000 target as a “red herring” that distracted from their failures.
Just 33,000 people were tested for COVID-19 in the latest 24-hour period – a record high for a single day – according to official figures. Dominic Raab, the first secretary of state, said that more than 52,000 tests were carried out, but this total is apparently bolstered by 19,000 retests.
Test capacity was now more than 73,000 a day, he said – still considerably below the target set by the health secretary, Matt Hancock, at the start of April.
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Source: The Guardian, 30 April 2020
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Coronavirus death rates more than double in more deprived areas, figures show

Death rates from coronavirus in the most deprived parts of England are more than double than in less deprived areas, according to new figures that show London is the worst-hit part of the country.
The mortality rate for the most deprived areas for March and early April was 55.1 deaths per 100,000 population – compared with 25.3 deaths per 100,000 in the least deprived areas, according to the Office for National Statistics (ONS).
The statistics show London has by far the highest mortality rate, with 85.7 deaths per 100,000 persons. This was found to be “statistically significantly higher” than any other region – almost double the next highest rate.
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Source: The Independent, 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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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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