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

Pharmacy leaders concerned over lack of widespread COVID-19 risk assessment for BAME staff

Pharmacy leaders in the black, Asian and minority ethnic (BAME) communities have expressed concern that assessments of BAME staff’s susceptibility to COVID-19 are not widespread enough in community pharmacy.
NHS England wrote to community pharmacies on 29 April 2020 advising employers to “risk assess staff at potentially greater risk” of COVID-19 after “emerging UK and international data” suggested people from BAME backgrounds are “being disproportionately affected”.
The Faculty of Occupational Medicine later published a risk reduction framework — backed by NHS England — to assist with the risk assessments on 14 May 2020. This was updated on 28 May 2020 to include guidance from the Health and Safety Executive to “help organisations identify who is at risk of harm”.
But speaking to The Pharmaceutical Journal, Elsy Gomez Campos, president of the UK Black Pharmacists’ Association (UKBPA), said she had been told by a small number of community pharmacists that “nothing has been done” in terms of risk assessing BAME staff.
“I know of a few people who have been assessed and that is mainly in hospital,” she said. “In terms of community pharmacists — who I’ve had contact with so far — they haven’t even been asked to have the risk assessment done.”
However, she stressed that not many from the community pharmacy sector have come forward, but “the people who have come forward have said no, it has not been done”.
“People are quite scared to ask as well because it can have repercussions on their employment or their relationships [at work],” she added.
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Source: The Pharmaceutical Journal, 29 May 2020
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Coronavirus cases see small increase and hospital admissions rise as UK lockdown relaxed

New data has shown the number of coronavirus patients being admitted to hospital and intensive care units across the country has risen as lockdown rules are set to be eased further on Monday.
The Public Health England (PHE) data, published on Friday, covers 134 NHS trusts across the country and shows the daily rate of new patients admitted to hospital and critical care with COVID-19 has risen compared to recent weeks, with London experiencing a sharp spike in new admissions in the past week. The south east region also saw an increase.
The surveillance data on the spread of COVID-19 throughout England has also revealed an increase in the number of people testing positive at their GP.
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Source: Independent, 31 May 2020
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COVID-19: Millions of women and children at risk as visits to essential services plummet

The coronavirus pandemic is a “magnifier of inequality” that threatens the wellbeing of women, children, and adolescents worldwide, a roundtable of influential female leaders has heard.
The United Nations has predicted that 47 million women could lose access to contraception resulting in 7 million additional unintended pregnancies over the next six months1 because of “deadly and disabling” COVID-19, the virtual event was told.
There could also be 31 million additional cases of gender based violence in low and middle income countries. Policy makers have a clear duty to protect the most vulnerable and disadvantaged and to tackle the root causes of inequality with targeted policies and resources, the participants concluded.
Henrietta Fore, executive director of Unicef, said that, in countries with already weak health systems, COVID-19 was disrupting medical supply chains and straining financial and human resources. Visits to healthcare centres are declining owing to lockdowns, curfews, and transport disruptions, and as communities remain fearful of infection. 
She cited recent research that indicated there could be an increase in child deaths amounting to an additional 6000 a day over the next six months, and 56 700 more maternal deaths. “This is a statistic we want to avoid. We are concerned about access to services,” she said.
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Source: BMJ, 29 May 2020
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NHS ordered to rush out ‘meaningless’ covid antibody tests ahead of PM’s deadline

NHS pathology labs were given just two days to roll out thousands of antibody tests, amid a push to reach a COVID-19 testing target set out by Boris Johnson.
Earlier this month the Prime Minister set a target of having a testing capacity of 200,000 per day by the end of May. Capacity currently stands at 161,000, Matt Hancock has said.
Until now there has been very limited use of antibody tests, with most capacity used to deliver PCR tests that indicate whether someone currently has the virus. Antibody tests are intended to identify whether someone has previously had the virus.
On 27 May, NHS England and Improvement wrote to local leaders giving them two days’ notice to put in place testing capacity for, and deliver, thousands of antibody tests of staff and patients. 
In one letter to leaders in the south east, seen by HSJ, the regulator said labs were expected to establish capacity and deliver 6,000 tests daily by 29 May. A senior source from London confirmed to HSJ the region had also been given a target of 6,000. There are seven local regions in the NHS, which would indicate around 42,000 tests per day, which if PCR testing continued at the current levels, could enable the government to meet the 200,000 target.
One head of pathology at a trust said: “There is one obvious answer as to why there is suddenly such an urgency to roll this out. While it will be interesting to have the results, there is nothing meaningful we can do with this test data at the moment.”
Another trust director involved in the scheme described the antibody tests as having “no clinical value”.
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Source: HSJ, 29 May 2020
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Coronavirus: 'More than two million' waiting for cancer care in UK

About 2.4 million people in the UK are waiting for cancer screening, treatment or tests, as a result of disruption to the NHS during the past 10 weeks, according to Cancer Research UK.
It estimates 2.1 million have missed out on screening, while 290,000 people with suspected symptoms have not been referred for hospital tests. More than 23,000 cancers could have gone undiagnosed during lockdown.
Chief executive Michelle Mitchell said COVID-19 has placed an "enormous strain on cancer services". "The NHS has had to make very hard decisions to balance risk," she said.
"...there have been some difficult discussions with patients about their safety and ability to continue treatment during this time. Prompt diagnosis and treatment remain crucial to give people with cancer the greatest chances of survival and prevent the pandemic taking even more lives."
To ensure no-one is put at risk from the virus now that cancer care is returning, Cancer Research UK said "frequent testing of NHS staff and patients, including those without symptoms" was vital.
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Source: BBC News, 1 June 2020
 
 
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Global healthcare needs infection control reform, say experts

World leaders in infection control and disease prevention convened online at the inaugural iClean 2020 conference on 28 May to discuss innovative infection control reform in hospitals and aged-care facilities in the wake of the COVID-19 crisis.
Keynote speaker Professor Didier Pittet* said there has never been a more pertinent time to address infection control in our healthcare systems.
“During this devastating COVID-19 pandemic, up to one in five people who contracted the virus globally are healthcare workers, and we saw similar numbers in the SARs and MERS outbreaks."
“Furthermore, aged-care residents accounted for 29% of COVID-19-related deaths in Australia, and this rate is even higher in Europe, the United States and the United Kingdom, who have been hardest hit by the pandemic,” Professor Pittet said.
“We are therefore calling for urgent reform in our approach to cleaning and disinfection in hospitals and aged-care homes.”
Professor Pittet explained that Clean Hospitals — an initiative aiming to create better procedures, training, auditing and management processes — would allow cleaning and infection control managers around the world to improve quality and outcomes.

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Source: Hospital Healthcare, 1 June 2020
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Applications are now open for DigitalHealth.London’s Accelerator programme

DigitalHealth.London is helping health and care professionals turn the idea of digital innovation into tangible improvements in experience and outcomes for patients. Our work is instrumental in giving health and care stakeholders across London insight into the best digital health interventions and tools on the market.
DigitalHealth.London is a collaborative programme delivered by MedCity, and London’s three Academic Health Science Networks – UCLPartners, Imperial College Health Partners, and the Health Innovation Network.
Closing date: Midnight, Sunday 5 July 2020
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How could watchdogs fail so spectacularly to keep care home residents and staff safe?

Care homes are the focus of the COVID-19 outbreak in England and Wales. At least 40% of all coronavirus deaths have occurred in the very places dedicated to keeping people safe in their later years.
The under-reporting of deaths, the lack of personal protective equipment (PPE) and testing available to staff, and the total focus on the NHS at the expense of the social care sector have all contributed to an estimated 22,000 deaths in care homes – places that government had originally advised were “very unlikely” to experience infection.
But how could care homes have been failed so badly, and what checks and balances should have been in place to prevent this?
Care homes in England are regulated by the Care Quality Commission (CQC). One of its key responsibilities is to carry out inspections and visits to ensure providers meet fundamental standards of quality and safety; however, as of 16 March, the regulator stopped all routine inspections to “focus on supporting providers to deliver safe care during the pandemic”.
Had the CQC continued its inspections, it would have been in a position to challenge cases where PPE was being diverted away from care homes to the NHS, and to aid struggling homes in their battle to secure tests for staff and residents. Instead, care homes have effectively been left to fend for themselves.
On top of this, the CQC joined similar bodies in Wales, Scotland and Northern Ireland in refusing to publish detailed data on care home deaths, arguing instead for a need to “avoid confusion” and to protect “the privacy and confidentiality of those who have died and their families”.
Families and the wider public have a right to know when and where COVID-19 outbreaks are happening, and this lack of transparency is deeply troubling.
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Source: The Guardian, 1 June 2020
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Increase in learning disability deaths during the coronavirus outbreak

The Care Quality Commission (CQC) have looked at how the number of people who have died during the coronavirus outbreak this year compares to the number of people who died at the same time last year.
They looked at information about services that support people with a learning disability or autism in the 5 weeks between 10 April to 15 May in 2019 and 2020. These services can support around 30,000 people. They found that in that 5 weeks this year, 386 people with a learning disability, who may also be autistic, died. Data for the same 5 weeks last year found that 165 people with a learning disability, who may also be autistic, died. This information shows that well over twice as many people in these services died this year compared to last year. This is a 134% increase in the number of death notifications this year.
This new data should be considered when decisions are being made about the prioritisation of testing at a national and local level.
Kate Terroni, Chief Inspector of Adult Social Care at the Care Quality Commission (CQC) said: "Every death in today's figures represents an individual tragedy for those who have lost a loved one."
"While we know this data has its limitations what it does show is a significant increase in deaths of people with a learning disability as a result of COVID-19. We already know that people with a learning disability are at an increased risk of respiratory illnesses, meaning that access to testing could be key to reducing infection and saving lives."
"These figures also show that the impact on this group of people is being felt at a younger age range than in the wider population – something that should be considered in decisions on testing of people of working age with a learning disability."
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Source: Care Quality Commission, 2 June 2020
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Coronavirus: Care homes mentioned only twice in five months of Sage minutes

The government’s top scientific advisers discussed care homes only twice between January and May, according to newly published minutes.
Records for meetings of the Scientific Advisory Group for Emergencies, or Sage, which is the key group of experts advising ministers on how to react to the COCID-19 outbreak, reveal a lack of discussion about the risks facing care homes.
Between January and May, Sage minutes mention care homes only twice, before the start of lockdown in the UK and weeks before the numbers of deaths made headlines across the country.
Shadow care minister Liz Kendall said she was concerned not enough action had been taken and added: “It is clear that social care and the NHS were not treated equally, nor as two sides of the same coin.”
James Bullion, president of the Association of Directors of Social Services said the publication of the minutes "appears to reinforce the impression that social care has been an afterthought – a secondary consideration after the NHS. This cannot continue."
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Source: The Independent, 1 June 2020
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Coronavirus: Durham County Council accused of 'increasing' deaths

At least 25 people have died at a care home amid claims from an industry body that a council's actions "caused" or "increased COVID-19 deaths".
Melbury Court in Durham is thought to be the care home with the highest number of deaths in the UK. County Durham has had the highest number of care home deaths in England and Wales.
Durham County Council said it "strongly refuted" the claim by the County Durham Care Home Association (CDCHA).
Some patients went from the nearby University Hospital of North Durham to Melbury Court without being tested for coronavirus or after a positive test.
A BBC investigation has discovered that in a conference call in late March, council officials were told plans to move hospital patients into care homes without testing would be disastrous.
The CDCHA offered to find a specific home or homes where COVID-19 positive or untested people could be cared for rather than have them spread around the network, but this was never acted on and now the CDCHA has calculated there has been an outbreak of coronavirus in 81 of the county's 149 care homes.
Maria Vincent, who runs Crosshill Care Home in Stanhope, told the council in March that care homes were not set up to accept COVID-19 patients, and described it as "neglect pure and simple".
Read full story
Source: BBC News, 2 June 2020
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Government censored BAME covid-risk review

The government removed a key section from Public Health England’s review (published Tuesday) of the relative risk of COVID-19 to specific groups, HSJ has discovered.
The review reveals the virus poses a greater risk to those who are older, male and overweight. The risk is also described as “disproportionate” for those with Asian, Caribbean and black ethnicities. It makes no attempt to explain why the risk to BAME groups should be higher.
An earlier draft of the review which was circulated within government last week contained a section which included responses from the 1,000-plus organisations and individuals who supplied evidence to the review. Many of these suggested that discrimination and poorer life chances were playing a part in the increased risk of COVID-19 to those with BAME backgrounds. HSJ understands this section was an annex to the report but could also stand alone.
Typical was the following recommendation from the response by the Muslim Council of Britain, which stated: “With high levels of deaths of BAME healthcare workers, and extensive research showing evidence and feelings of structural racism and discrimination in the NHS, PHE should consider exploring this in more detail, and looking into specific measures to tackle the culture of discrimination and racism. It may also be of value to issue a clear statement from the NHS that this is not acceptable, committing to introducing change.”
One source with knowledge of the review said the section “did not survive contact with Matt Hancock’s office” over the weekend.
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Source: HSJ, 2 June 2020
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ECT depression therapy should be suspended, study suggests

The use of electroconvulsive therapy (ECT) to treat depression should be immediately suspended, a study says. ECT involves passing electric currents through a patient's brain to cause seizures or fits.
Dr John Read, of the University of East London said there was "no place" for ECT in evidence-based medicine due to risks of brain damage, but the Royal College of Psychiatrists said ECT offers "life-saving treatment" and should continue in severe cases.
The National Institute for Health and Care Excellence (NICE) currently recommends the use of ECT for some cases of moderate or severe depression as well as catatonia and mania. However, peer-reviewed research published in the journal Ethical Human Psychology and Psychiatry concludes "the high risk of permanent memory loss and the small mortality risk means that its use should be immediately suspended".
In response to the study, the Royal College of Psychiatrists said ECT should not be suspended for "some forms of severe mental illness".
Dr Rupert McShane, chair of the college's Committee on ECT and Related Treatments, said there was evidence showing "most people who receive ECT see an improvement in their condition".
"For many, it can be a life-saving treatment," he said.
"As with all treatments for serious medical conditions - from cancer to heart disease - there can be side-effects of differing severity, including memory loss."
Read full story
Source: BBC News, 3 June 2020
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Pandemic is having “severe” impact on non-communicable disease care, WHO survey finds

The COVID-19 pandemic has dramatically curtailed the provision of health services for non-communicable diseases, says a survey of 155 countries by the World Health Organization conducted over three weeks in May.
In the survey poorer countries were the most likely to report disrupted services, but some 94% of responding countries had reassigned health ministry staff from work on NCDs to dealing with the pandemic. Hypertension treatment has been partially or completely disrupted in 53% of the countries surveyed, diabetes treatment in 49%, cancer treatment in 42%, and cardiovascular emergency responses in 31% of countries, the survey found.
In the Netherlands, new cancer diagnoses have fallen by 25% since the pandemic lockdown began. In rural India, 30% fewer cardiac emergencies reached health facilities in March 2020 than the previous year.
Rehabilitation services, which are often key to a healthy recovery after severe COVID-19, have been disrupted in 63% of countries surveyed. Screening campaigns have been put on hold in more than half.
WHO’s director general, Tedros Adhanom Ghebreyesus, said, “The results of this survey confirm what we’ve been hearing from countries for a number of weeks now. Many people who need treatment for diseases like cancer, cardiovascular disease, and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”
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Source: BMJ, 3 June 2020
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Coronavirus: Ibuprofen tested as treatment for breathing difficulties in hospital patients

A trial has been launched in the UK to test whether ibuprofen can help with breathing difficulties in COVID-19 hospital patients.
Scientists hope a modified form of the anti-inflammatory drug and painkiller will help to relieve respiratory problems in people who have more serious coronavirus symptoms but do not need intensive care unit treatment.
Half the patients participating in the trial will be administered with the drug in addition to their usual care, while the other half will receive standard care to analyse the effectiveness of the treatment.
Read full story
Source: The Independent, 3 June 2020
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Asymptomatic care workers unknowingly spread coronavirus

Large numbers of staff could have been unknowingly spreading coronavirus through care homes, according to the UK's largest charitable care home provider.
Data from MHA shows 42% of its staff members who recently tested positive were not displaying symptoms. Nearly 45% of residents who had a positive test were also asymptomatic.
MHA operates in England, Scotland and Wales and has fully tested staff and residents in 86 of its 90 homes so far.
A Department for Health and Social Care spokesperson said: "Our priority is to ensure care workers and those receiving care are protected, and the latest statistics show over 60% of care homes have had no outbreak at all.
"We've set out a comprehensive support package for residents and staff, including a £600m infection control fund, testing regardless of whether you have symptoms, and a named clinical lead to support every care home."
In total, 7% of MHA staff and 13% of residents received a positive test result. Routine testing is not yet under way.
MHA CEO Sam Monaghan told BBC Newsnight: "It is not difficult to imagine that a lot of people may not have ended up dying if we'd had earlier testing and we'd been therefore better able to manage infection control in our homes."
Read full story
Source: BBC News, 3 June 2020
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