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

CQC plan to restart inspections needed like ‘hole in head’, says Confed

The Care Quality Commission (CQC) has issued a plan for re-starting routine inspections — but has been warned by the NHS Confederation that the health service needs this “like a hole in the head”.
The organisation said there would be a “managed return” of “routine inspections” in the autumn.
It also stated in a statement today: ”Inspectors are now scheduling inspections of higher risk services to take place over the summer.” But the CQC later insisted to HSJ that this was not a change to its current policy, in place since the beginning of the UK COVID-19 peak, as it would only be inspecting in response to information it receives which raises “serious concerns”.
The CQC suspended its routine inspections in March – and has instead been calling healthcare providers and only physically attending where there are serious concerns about harm, abuse or human rights breaches.
The new approach to regulation, which the CQC called its “emergency support framework”, was criticised by 11 older people’s and disabled groups, which said the decision not to carry out routine inspections broke human rights and equalities laws.
Read full story
Source: HSJ, 17 June 2020
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A&E appointments should be introduced in response to coronavirus, says Royal College head

Appointments to be seen in A&E could be introduced permanently in response to coronavirus, the president of the Royal College of Emergency Medicine has said. 
Dr Katherine Henderson said it would cause "enormous harm" to patients if Britain returned to crowded casualty units with "elastic walls".
Instead, she said patients should be given a "contact point" such as the NHS 111 line to book a slot in an emergency department, or to be seen directly by a specialist or diverted to the care they need. 
"The old way of doing things involved emergency departments having elastic walls," Dr Henderson told MPs. "We were able to have an infinite number of patients. We were never able to say: 'We're full, we're at capacity.' We now need to recognise that we can't do that."
Read full story (paywalled)
Source: The Telegraph, 16 June 2020
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NHS contact-tracing app originally set for May launch is now planned 'for winter'

The NHS contact-tracing app will not be ready before winter, a health minister has said, despite initially being promised in mid-May.
Lord Bethell said the Department of Health was "seeking to get something going for the winter". But, he told a committee of MPs, the app wasn't "the priority at the moment".
Lord Bethell confirmed the government still planned to introduce a contact-tracing app, describing it as "a really important option for the future".
The app has been the subject of a trial on the Isle of Wight, where the Department of Health says it has been downloaded by 54,000 people.
Lord Bethell said the trial had been a success, but admitted that one of its principal lessons had been that greater emphasis needed to be placed on manual contact tracing.
Asked why the app had taken so long to release, Lord Bethell told the Science and Technology Committee the Isle of Wight trial had shown that people "weren't frightened of it, as we were worried that they might be" - and had also provided "concrete examples" of successes in breaking transmission chains. But he admitted there had been "technical challenges", as well as an "ongoing battle" to persuade people the system was safe and privacy-protecting.
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Source: Sky News, 18 June 2020
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Coronavirus: What is the true death toll of the pandemic?

At least another 130,000 people worldwide have died during the coronavirus pandemic on top of 440,000 officially recorded deaths from the virus, according to BBC research.
A review of preliminary mortality data from 27 countries shows that in many places the number of overall deaths during the pandemic has been higher than normal, even when accounting for the virus.
These so-called "excess deaths", the number of deaths above the average, suggest the human impact of the pandemic far exceeds the official figures reported by governments around the world.
Some will be unrecorded COVID-19 victims, but others may be the result of the strain on healthcare systems and a variety of other factors.
Read full story
Source: BBC News, 18 June 2020
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Psychological first aid in emergencies training for frontline staff and volunteers

Frontline staff and volunteers at the forefront of the national coronavirus response across England will be able to access a new Psychological First Aid (PFA) training course, the Minister for Mental Health Nadine Dorries has announced.
The course, which has been developed by Public Health England, will be available to frontline workers and volunteers dealing with the public during the coronavirus pandemic.
The free online course enables responders to develop their skills and confidence in providing key psychological support to people affected by coronavirus, including on issues such as job worries, bereavement or isolation as they carry out their vital work as part of the ongoing coronavirus response.
It will also help to develop understanding of how emergencies like the coronavirus pandemic can affect us all, how to recognise people who may be at increased risk of distress, and how to offer practical and emotional support.
Minister for Mental Health Nadine Dorries said:
“Supporting each other’s mental health and wellbeing is more important than ever during these challenging and uncertain times. Staff and volunteers in many different roles are working tirelessly to provide crucial support at this time and are often a critical touchpoint in identifying those who may be affected.
“This new training course will help to support the incredible work of frontline workers to support those most in need both through the coronavirus outbreak and beyond, equipping them with vital tools to deliver psychological first aid.”
Read press release
Source: GOV.UK, 15 June 2020
 
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UK virus-tracing app switches to Apple-Google model

In a major U-turn, the UK is ditching the way its current coronavirus-tracing app works and shifting to a model based on technology provided by Apple and Google.
The Apple-Google design has been promoted as being more privacy-focused. However, it means epidemiologists will have access to less data.
The government now intends to launch an app in the autumn, but it says the product may not involve contact tracing at that point. Instead the software may be limited to enabling users to report their symptoms and order a test.
Baroness Dido Harding - who heads up the wider Test and Trace programme - will only give the green light to actually deploying the Apple-Google technology if she judges it to be fit for purpose, which she does not believe is the case at present. It is possible this may never happen.
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Source: BBC News, 18 June 2020
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Coronavirus: Nurses' leaders urge 'care for those who caring'

Nurses' leaders want all healthcare employers - including the NHS - to "care for those who have been caring" during the coronavirus crisis.
The Royal College of Nursing (RCN) is calling for better risk assessments; working patterns and mental health care for those on the front line. It warns many may be suffering from exhaustion, anxiety and other psychological problems.
The Department of Health and Social Care said support was a "top priority".
The RCN has released an eight-point plan of commitments it wants to see enforced to mark the 100 days since the World Health Organization (WHO) declared a pandemic.
Amongst its suggestions are a better COVID-19 testing regime for healthcare workers and more attention paid to the risks posed to ethnic minority nurses.
It says employers and ministers "must tackle the underlying causes which have contributed to worse outcomes for Bame staff".
Read full story
Source: BBC News, 19 June 2020
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COVID-19 could widen mental health inequalities for a generation, warns charity

The COVID-19 pandemic could entrench and exacerbate inequalities in mental health for a generation unless action is taken, the Centre for Mental Health has warned.
In a report published on Thursday, the charity warned that the lockdown would put greater pressure on groups whose mental health was already poor beforeCOVID-19 hit, such as women and children experiencing violence and abuse, and ethnic minority communities.
The pandemic will leave an “unequal legacy of complicated bereavement, trauma, and economic repercussions which will push more people towards financial insecurity and poverty, significant risk factors for poor mental health,” the report said.
“Unequal experiences of grief, loss, trauma, injustice, and abandonment all add to the psychological damage caused by COVID-19.”
The report, backed by 12 mental health charities and the Royal College of Psychiatrists, said that the government must prioritise race equality and support “trauma informed” approaches for all people whose lives had been affected by COVID-19.
Read full story
Source: BMJ, 19 June 2020
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Covid fears may be keeping expectant mothers from attending needed hospital check ups

Doctors fear a rise in stillbirths and babies with impaired growth because pregnant women were too scared to seek help during the pandemic.
At a Royal Society of Medicine webinar on pregnancy and Covid, medics expressed concern that women in need of urgent attention had kept away from maternity services, for fear of catching the infection.
In other cases, those with worrying symptoms which could mean their baby was at risk may have stayed away because they feared putting pressure on services, doctors said.
Dr Maggie Blott, head of obstetrics at the Royal Free London Foundation trust, said: “A lot of the work that we do is is prevention, and a lot of women that we see, turn up for hospital as an emergency - have concerns around abdominal pain, reduced foetal movements, all sorts of things.”
Read full story (paywalled)
Source: The Telegraph, 18 June 2020
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COVID-19: Low dose steroid cuts death in ventilated patients by one third, trial finds

Low dose dexamethasone reduces deaths in patients hospitalised with COVID-19 who need ventilation, according to preliminary results from the RECOVERY trial.
The drug was also found to reduce deaths by one-fifth in other hospitalised patients receiving oxygen only, but no benefit was seen among COVID-19 patients who did not need respiratory support.
The chief investigators from the University of Oxford trial said that the findings represent a “major breakthrough” which is “globally applicable” as the drug is cheap and readily available.
Peter Horby, Professor of Emerging Infectious Diseases at the University of Oxford and a chief investigator on the trial, added, “This is the only drug that has so far been shown to reduce mortality, and it reduces it significantly. It is a major breakthrough.”
Read full story
Source: BMJ, 16 June 2020
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Health experts criticise UK's failure to track recovered COVID-19 cases

The UK’s failure to report how many people have recovered from COVID-19 has been criticised by public health experts, who say a huge proportion of cases have remained “invisible” to the health service.
Britain is an outlier internationally in not reporting the number of people who have recovered from COVID-19 alongside statistics on deaths and numbers of identified cases. Chile is the only other nation not to share this information out of the 25 countries with the highest reported incidence.
A failure to monitor those who test positive for COVID-19 outside of hospital has left people feeling unsupported and alienated from the health system, the experts say. There is concern that because the majority of community cases have not been logged in patient records, it will be more challenging to research the long-term consequences of the disease.
Prof Devi Sridhar, the chair of global public health at the University of Edinburgh, said: “Not tracking people in the community, for me, [is] so astonishing. These people are completely invisible in the health system.”
Read full story
Source: The Guardian, 18 June 2020 
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NHS England considers ‘mandated’ system-level waiting lists

NHS trusts could be asked to create shared waiting lists for elective care under plans being considered by national leaders.
HSJ understands that NHS England chief executive Sir Simon Stevens is to write to all NHS organisations early next month to lay out plans for phase three of the recovery from covid. The letter is expected to focus on the importance of working at a system level to get more services up and running.
Senior NHS sources said the recovery plans are likely to include proposals for creating pooled system-level waiting lists between trusts, but there is still internal debate over the extent to which changes could effectively be mandated; for example, by attaching significant incentive funds. The move appears to be aimed at ensuring an “equitable level of care” across a patch.
In a statement, NHSE said individual providers’ would ultimately still have responsibility and accountability for their waiting lists, even where this might be “supplemented” by system-wide arrangements.
Read more
Source: HSJ, 19 June 2020
Patient Safety Learning

Coronavirus: New saliva test to be piloted in Southampton

A new coronavirus test which could replace the existing a nose and throat swab is being piloted in Southampton.
People will be able to simply spit into a pot at home before the sample is sent off to check whether they have COVID-19.
If successful, the saliva test could become an alternative to the existing swab which some people find uncomfortable and can provoke coughing and spluttering.
Read full story
Source: The Independent, 22 June 2020
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‘White leaders under pressure’ to prove black lives matter

Incoming Health Education England chief executive Navina Evans said the momentum created by the death of George Floyd and the Black Lives Matter movement meant there was now increased “pressure on white leaders” to act on racism and discrimination in the service.
Dr Evans praised a letter written by Birmingham and Solihull Mental Health Foundation Trust chief executive Roisin Fallon-Williams, in which she admitted to being “culpable” and “complicit” in failing to fully understand the inequality and discrimination faced by people with black, Asian or other minority ethnic backgrounds.
“That was great to see, and as you can see from the reactions to her letter people were really, really pleased to have it acknowledged,” she said.
However, Dr Evans added: “As well as that [acknowledgement] there needs to be action”.
Read full story
Source: HSJ, 22 June 2020
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10 million on NHS waiting lists by Christmas

Leading clinicians have written to Boris Johnson warning the UK faces a "second health catastrophe" because so many non-Covid patients are missing out on treatment as a result of the pandemic.
The letter warns that “lives are being put at risk” and that action is needed immediately. It comes as new figures show as many as one in six (10 million) people will be on the NHS waiting list by the end of the year.
The letter, signed by ten specialists, including cancer doctors, patient safety experts, CQCs and medical negligence lawyers, states: “We are increasingly concerned about the impact, including avoidable harm and death caused by the continuing unavailability of urgent diagnostics and treatment for thousands of non-COVID patients. 
“The backlog of such cases is now significant and worsening. We implore the central and devolved Governments of the UK to take urgent strategic action, including in co-ordination and co-operation with each other, to prevent this becoming a second and perhaps even more serious health catastrophe arising from the pandemic in the UK.”
The letter was also signed by barrister Theo Huckle QC, Professor John Fairclough of Swansea and Cardiff Met Universities, Nick Brown of Doughty Street Chambers and Helen Hughes, Chief Executive, Patient Safety Learning.
Cases which have come to the attention of the signatories include Sherwin Hall, 27, a father of one from Leeds, who made 13 visits to hospital during the COVID-19 lockdown before getting a cancer diagnosis for the pain in his groin.
He said of his case: “I am very angry at the way I have been treated due to COVID-19 and the delay on my cancer treatment and now I am fighting for my life.
Read full story
Source: Express, 21 June 2020
 
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Doctors warn ‘culture of fear’ in NHS could prevent whistleblowing

Doctors have warned that a “culture of fear” in the NHS may prevent life-saving lessons being learned about COVID-19 after a leading hospital consultant emailed scores of staff saying those responsible for “leaks” would be found and fired.
Dr Daniel Martin OBE, head of intensive care for serious infectious diseases at the Royal Free hospital, emailed a report to colleagues at the peak of the pandemic with a note claiming that the trust would “track any leaks to the media” and then “offer you the chance to post your P45 on Facebook for all to see.”
The email, which described journalists at one respected newspaper as “parasites”, was sent to dozens of nurses and junior doctors. It has been examined by Liberty Investigates, the investigative journalism unit of the civil rights group Liberty, and the Guardian, after being shared by a recipient who said they found the language “intimidating”.
 Whistleblowers UK, the non-profit group, said it had been made aware of the email by a separate individual who was also concerned about its contents.
The Royal Free London trust said the email was “badly worded” and did not reflect trust policy. However, the trust said it was an open and transparent organisation that “does everything it can to encourage our staff to raise concerns and, if necessary, whistleblow”.
Read full story
Source: The Guardian, 22 June 2020
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