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

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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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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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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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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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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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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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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Shipment of 400,000 delayed protective gowns from Turkey deemed unusable

The shipment of 400,000 gowns from Turkey which was part of a delayed consignment of personal protective equipment (PPE) has been impounded in a warehouse after falling short of UK standards.
The personal protective equipment (PPE) was flown into the UK by the RAF last month, arriving three days late, but has been held in a government warehouse near Heathrow since, the Daily Telegraph said.
During mid-April, when coronavirus deaths in the UK were at their highest, the NHS required 150,000 gowns each day.
Cabinet minister Brandon Lewis said the gowns were “not be of the quality that we feel is good enough for our frontline staff”.
Speaking on Sky News, Mr Lewis said: “Well when we’re securing PPE from around the world you do it based on a set of standards that you’re looking to acquire to, but obviously once it’s here we check that it is good enough for what we want to use and in this instance some of this PPE turned out not to be good enough.”
“I think it is right that if we have got particular standards for what we want our frontline staff to be able to have access to we make sure we stick to that. If something isn’t right, if we’re not even sure about it then I think it is better to be safe and not use that product and stick with products we are confident are the right products and the right standards.”
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Source: ITV News, 7 May 2020
 
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Black people four times more likely to die from coronavirus than white people, ONS figures show

The Office for National Statistics (ONS) has published its first figures analysis Covid-19 related deaths by ethnic group in England and Wales between March 2 and April 10.
The results showed that the risk of death involving the coronavirus among Black, Asian, and minority ethnic (BAME) groups is “significantly higher” than that of those of white ethnicity.
Researchers found that when taking age into account, in comparison to white men and women, black men are 4.2 times more likely to die from a Covid-19-related death and black women are 4.3 times more likely.
People with Bangladeshi, Pakistani, Indian and mixed ethnicities have a raised risk of death, too.
Read full story (paywalled)
Source: The Telegraph, 7 May 2020
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Government acts after claims covid deaths of disabled people are being 'ignored'

Deaths of those with learning disabilities and autism fromCOVID-19 are to be analysed by Public Health England (PHE), HSJ can reveal.
Several senior sources have confirmed PHE has put together a group, which includes independent experts, to analyse mortality data. They had previously not been included in the government’s inquiry into the over-representation of some groups among covid fatalities.
The news comes amid mounting concerns from major charities over the of lack transparency in data collected centrally on the deaths of people from these these groups during the pandemic. 
In a letter yesterday , seen by HSJ, Labour’s shadow secretary for social care Liz Kendall, urged Department of Health and Social Care minister Helen Whately to publish data on deaths reported to the Learning Disabilities Mortality Review Programme (LeDer).
Earlier this week NHS England and NHS Improvement told HSJ the weekly data it is receiving from the national learning disability morality review programme (LeDer) on suspected and confirmed deaths of those with learning disabilities and autism from COVID-19 would not be published until next year.
In her letter Ms Liz Kendall said the Government should “immediately” release the deaths notifications being provided by LeDer along with a “retrospective” analysis from the beginning of the pandemic.
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Source: HSJ, 7 May 2020
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Deaths in mental health hospitals double as COVID-19 spreads

Deaths in mental health hospitals have doubled compared to last year after 54 deaths linked to coronavirus in just three months, it has emerged.
The care watchdog, the Care Quality Commission (CQC), has issued a warning to mental health hospitals that they must take action to protect vulnerable patients.
New data published by the regulator showed there was a total of 106 deaths of people in mental health hospitals between 1 March and 1 May compared to 51 in the same period in 2019. In total 54 of these deaths are from confirmed or suspected coronavirus infections.
The CQC has now written to all mental health hospital providers highlighting its fears over the spread of the virus within secure hospitals and units.
Read full story
Source: The Independent, 8 May 2020
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ICUs advised how to improve staffing ratios as covid pressure eases

Intensive care units (ICU) will be advised how to improve their staffing-to-patient ratios shortly as the number of patients admitted to hospital with COVID-19 falls across the country.
In expectation that the pandemic would put intense pressures on ICUs, staff ratios were relaxed. NHS England told trusts to base their staffing models on one critical care nurse for every six ICU patients, supported by two non-specialist nurses, and one senior ICU clinician for every 30 patients, supported by two middle-grade doctors.
Before the pandemic, guidance from the Faculty of Intensive Care Medicine recommended a ratio of one non-specialist nurse per patient. For senior clinicians the ratio was 1:10
New guidance, expected as early as next week, will encourage trusts to reduce the number of patients per ICU specialist nurses and senior clinicians on a localised basis as part of “transitional arrangements” aimed at moving staffing models back towards normal standards of care, HSJ has been told.
The new guidance, drawn up by NHS England, the Faculty of Intensive Care Medicine and the British Association of Critical Care Nurses, will give trusts recommended staffing ratios based on the occupancy rates of their ICUs. It will tell trusts the existing ratios should be applied if their ICUs are running at four times their normal capacity. For ICUs running at double capacity, this ratio would be reduced to 1:2 for ICU nurses, and 1:15 for senior clinicians.
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Source: HSJ, 8 May 2020
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Covid-19: Allow pharmacists to dispense controlled drugs without prescription, urge specialists

Revised legislation allowing pharmacists to supply some controlled drugs without prescription must be enacted “without delay” to protect patients and to support clinicians, experts have said.
Last week (28 April) the UK home secretary, Priti Patel, laid legislation before parliament that allows for a relaxation of the regulations for prescribing controlled drugs, to ensure access is not delayed during the COVID-19 pandemic. The relaxation would allow pharmacists, in a pandemic situation, to supply some drugs that were previously only supplied to a patient by doctors on prescription. It would also allow pharmacists, in cases of shortages, to alter dosages or substitute drugs without having to go back to the prescribing doctor to seek a new prescription.
But the changes can be triggered only with the express permission of the home secretary, who has so far not given this despite the legislation being tabled to be used in situations of crisis.
Ian Hamilton, an academic at the University of York with an interest in addiction and mental health, who coordinated the letter, told The BMJ that although it was positive that the home secretary laid the legislation before parliament, it needed to be activated now.
He said, “Each day there’s a delay our concern is that the potential for suffering just goes on.”
“The problem with this is that if somebody is in a lot of pain and they’re really severely short of breath, that in itself is problematic because it can trigger a cardiac arrest. A worst case scenario is that someone could actually die because of a two or three hour delay in getting morphine. So this is something that I think is essential for healthcare workers to have.”
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Source: The BMJ, 7 March 2020
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New face cover for cancer test patients to stop COVID-19 spread

Surgeons have invented a new device to make it safer to diagnose some cancers during the coronavirus pandemic.
Most nose and throat investigations have been cancelled due to increased risks of medics contracting COVID-19 via patients' coughs and sneezes.
Two consultants have developed a device that clips over patients' masks and protects front-line workers. The West Midlands-based doctors want to raise £50,000 they say is enough to make devices for use across the NHS.
Chris Coulson, a consultant ear, nose and throat surgeon at University Hospitals Birmingham NHS Foundation Trust, said procedures involving an endoscope to examine the nose or throat were known to put clinicians at a significantly increased risk of contracting coronavirus.
"When clinicians carry out a nasendoscopy it can make patients cough, sneeze, and splutter - which risks spreading the virus to doctors, nurses and therapists," he said.
His company endoscope-i Ltd, co-founded with Ajith George, a consultant head and neck surgeon at University Hospitals North Midlands, has now developed the SNAP. It clicks on to a conventional surgical mask, creating a hole through which the clinician can pass an endoscope directly into a patient's nose. A valve means, despite there being a hole, any coughs, sneezes or splutters are caught within the mask.
Mr George said: "If we can raise the money needed to produce the devices, we can keep looking after patients and ensure that diagnosis and treatment is not delayed."
Read full story
Source: BBC News, 11 May 2020
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More people dying at home during COVID-19 pandemic – UK analysis

About 8,000 more people have died in their own homes since the start of the coronavirus pandemic than in normal times, a Guardian analysis has found, as concerns grow over the number avoiding going to hospital.
Of that total, 80% died of conditions unrelated to COVID-19, according to their death certificates. Doctors’ leaders have warned that fears and deprioritisation of non-coronavirus patients are taking a deadly toll.
Doctors’ leaders have warned that some sick people are too scared to go to hospital and are aware that much of the usual NHS care had been suspended in the pandemic. “These figures underline that the devastation wrought by Covid-19 spreads far beyond the immediate effects of the illness itself,” said Dr Chaand Nagpaul, the council chair of the British Medical Association.
“While all parts of the NHS have rallied round in a bid to meet the immediate rocketing demand caused by the pandemic, more than half of doctors in a recent BMA survey have told us that this is worsening the care of non-Covid patients.”
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Source: The Guardian, 8 May 2020
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UK health watchdog may investigate coronavirus deaths

The deaths of more than 50 hospital and care home workers have been reported to Britain’s health and safety regulator, which is considering launching criminal investigations, the Guardian has learned.
The Health and Safety Executive (HSE), which investigates the breaking of safety at work laws, has received 54 formal reports of deaths in health and care settings “where the source of infection is recorded as COVID-19”. These are via the official reporting process, called Riddor: Reporting of Injuries, Diseases and Dangerous Occurrences.
Separately, senior lawyers say any failures to provide proper personal protective equipment (PPE) may be so severe they amount to corporate manslaughter, with police forces drawing up plans to handle any criminal complaints.
Despite weeks of pleading, frontline medical staff complain that PPE is still failing to reach them as hospitals battle the highly contagious virus. Senior barristers say criminal investigations should be launched, and that there are grounds to suspect high-level failures.
Read full story
Source: The Guardian, 10 May 2020
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