Lifting lockdown must be handled better this time round to avoid a surge in Covid that could overwhelm the NHS, doctors say.
The British Medical Association has published a blueprint for how it thinks England should proceed with any easing. It includes replacing the "rule of six" with a two-households restriction to reduce social mixing and banning travel between different local lockdown tiers.
Government has yet to say if or exactly how England will exit on 2 December.
It will decide next week, based on whether cases have fallen enough and how much strain hospitals are under.
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Source: BBC News, 18 November 2020
A top teaching hospital has blamed covid measures for a dramatic rise in the number of trolley waits in its accident and emergency department.
In October, 111 patients at Cambridge University Hospitals (CUH) Foundation Trust, which runs Addenbrooke’s Hospital, waited more than 12 hours for admission, despite the region’s relatively low covid rates.
CUH recorded just nine 12-hour waits in September and 27 in August. It had no 12-hour waits in either June or July this year, and in October 2019, it had only one.
The trust also had 761 patients who waited more than four hours from the decision to admit to admission last month, out of a total of 2,998 emergency admissions.
CUH director of operations Holly Sutherland said: “We have had to reorganise the hospital to meet infection control requirements and to reduce the risk of covid-19 transmission. With limited side room availability due to the age of our facilities, this has reduced the number of beds in the hospital by around 100 and has impacted on patient flow from the emergency department."
“We would like to apologise to anyone affected by this, and to reassure our patients that their safety is our utmost priority and we are doing everything we can to treat them as quickly as possible.”
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Source: HSJ, 18 November 2020
A coroner has urged ministers to revisit plans to make it possible to hold inquests into babies that are stillborn after a baby died due to “excessive force” during an attempted forceps delivery.
Senior coroner Caroline Beasley-Murray has written to the Ministry of Justice after she was forced to stop hearing evidence into the death of baby Frederick Terry, known as Freddie, who died under the care of the Mid and South Essex Hospitals Trust on 16 November, last year.
An inquest into his death was started in September where Freddie was found to have died after suffering hypovolaemic shock as a result of losing a fifth of his blood when his skull was fractured during a traumatic birth attempt. In a report on the case the coroner said: “Baby Frederick Joseph Terry was delivered by caesarean section, after a failed forceps attempted delivery on 16 November 2019 and death was confirmed after 40 minutes of resuscitation attempts."
"The evidence showed that baby Freddie's very serious scalp and brain injuries were sustained during the failed forceps attempted delivery and, but for these, baby Freddie would have survived as a perfectly formed, healthy baby."
The coroner said the injuries he sustained implied “an excessive degree of force” in the application of the forceps, which are curved metal instruments that fit around a baby’s head and are designed to help deliver the baby.
The inquest had to be stopped from hearing any more evidence because coroners are not able to investigate stillborn babies.
As part of her report, the coroner said: “It would have been helpful for there to have been, during the course of the inquest, an exploration, in the course of evidence, of the treatment and care provided to baby Freddie and his parents at the time of delivery.
"Currently there is no legislation to cover the holding of a coroner’s inquest into a stillbirth. In March 2019, the Government issued a consultation on coronial investigations of stillbirths It would be helpful for this important topic to be progressed, whatever the ultimate jurisdictional decisions.”
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Source: The Independent, 17 November 2020
Covid patients could be left to languish in hospital and block NHS beds amid delays in setting up “hot” care homes dedicated to receiving them, health chiefs have warned.
A plan to reduce care home coronavirus outbreaks by setting up “hot homes” to receive infected people discharged from hospital is running late after dozens of councils missed a government deadline to nominate locations.
By the end of October every area of England was supposed to have at least one facility approved for Covid-positive discharges, the government pledged last month. It was part of an attempt to prevent a repeat of the spring pandemic, which killed more than 18,000 residents after thousands of patients were discharged into care homes without tests.
But as hospital admissions with Covid continue to rise, only 67 out of 151 local authorities have one set up, according to figures from the Care Quality Commission (CQC).
NHS Providers, which represents NHS trusts, said the delays were adding to discharge problems, causing increasing patient stays and a growing number of “super-stranded” patients.
“While the new discharge requirements are well-intentioned and aimed at protecting the most vulnerable in care homes, the challenge of implementing the changes has created blockages across mental health, acute and community beds,” said Miriam Deakin, the director of policy and strategy at NHS Providers.
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Source: The Guardian, 18 November 2020
BBC News investigation has uncovered failures in the diagnosis of serious medical issues during private baby scans.
More than 200 studios across the UK now sell ultrasound scans, with hundreds of thousands being carried out each year.
But the BBC has found evidence of women not being told about serious conditions and abnormalities.
The Care Quality Commission says there is good quality care in the industry but it has a "growing concern".
Private baby scanning studios offer a variety of services.
Some diagnose medical issues while others market themselves as providers of souvenir images or video of the ultrasound. Most sell packages providing a "reassurance scan" to expectant mums.
Many women BBC News spoke to said they had positive experiences at private studios, but we have also learned of instances where women said they were failed.
Charlotte, from Manchester, attended a scan in Salford with one of the biggest franchises, Window to the Womb, to record her baby's sex for a party and check its wellbeing.
BBC News has learned the sonographer identified a serious abnormality that meant the baby could not survive, where part or all of its head is missing, called anencephaly.
But rather than refer her immediately to hospital and provide a medical report, Charlotte was told the baby's head could not be fully seen and recommended to book an NHS anomaly scan.
She was also given a gender reveal cannon and a teddy bear containing a recording of its heartbeat as a present for her daughter.
"I was distraught," Charlotte said. "You've bonded with that baby."
"It's like a deep cut feeling," she added. "All of it could have just been avoided, we could have processed the news all together as a family because I was with my mum and dad, I would have had the support there."
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Source: BBC News, 18 November 2020
A hospital trust in Bristol has been accused of risking lives after raising its patient-to-nurse ward ratio to dangerously high levels, having allegedly dismissed staff concerns and national guidance on safe staffing.
University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) has introduced a blanket policy across its hospitals that assigns one nurse to 10 patients (1:10) for all general adult wards. This ratio, which previously stood at 1:6 or 1:8 depending on the ward, rises to 1:12 for nights shifts.
The new policy, which is applicable to Bristol Royal Infirmary (BRI) and Weston General Hospital, also extends to all specialist high-care wards, which treat patients with life-threatening conditions such as epilepsy and anaphylaxis.
Nurses at the trust have expressed their anger over the decision, saying they were never fully consulted by senior officials. Many are fearful that patient safety will be compromised as the second coronavirus wave intensifies, culminating in the unnecessary loss of life.
“Patients who would have extra nursing staff because they are very acutely unwell and need close observation I think are going to unnecessarily die,” one nurse at BRI told The Independent.
“Or if they survive, they’ll suffer long-term conditions because things were missed as they don’t have the staff at their bed side to watch the deterioration.”
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Source: The Independent, 18 November 2020
An Essex maternity department has been served with further warnings by the Care Quality Commission (CQC) and again rated “inadequate”.
Serious concerns were raised about the services at Basildon University Hospital in the summer, after several babies were found to have been starved of oxygen and put at risk of permanent brain damage.
Despite the CQC issuing warning notices to Mid and South Essex Foundation Trust in June 2020, a subsequent visit on 18 September found multiple problems had persisted.
The CQC’s findings at Basildon included:
the service was short-staffed and concerns were not escalated appropriately
multidisciplinary team working was “dysfunctional”, which sometimes led to safety incidents
doctors, midwives and other professionals did not support each other to provide good care.
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Source: HSJ, 19 November 2020
PRESS RELEASE
(London, UK, 19 November 2020) – The charity Patient Safety Learning and the Royal College of GPs have published new guidance to help patients with post COVID-19 syndrome (also known as Long COVID) understand the support they can expect from their GP.
This guidance draws on the RCGP's recent summary and top tips for GPs caring for patients with post COVID-19 syndrome. Both these documents have been produced in advance of more detailed national guidance being developed by the National Institute of Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of GPs, due to be published in December 2020.
Helen Hughes, Chief Executive of Patient Safety Learning, said:
“We have used the RCGP’s guidance to produce a simple patient-friendly guide to help support people living with Long COVID in the interim period before more detailed guidance is produced by NICE.
We hope that this guidance will empower and inform patients, providing them with an evidence-based document that can be shared with those around them. We believe that this will also help raise awareness of the health challenges these patients are facing so that their health and recovery needs can be better met.”
Professor Martin Marshall, Chair of the Royal College of GPs, said:
“It’s important that patients experiencing debilitating prolonged effects of Covid-19, which we know affect a small but significant number of people who have had the virus, feel that they have the understanding and support of the GPs and other healthcare professionals delivering their care. To this end we hope this guidance is helpful for them. The RCGP is working hard to ensure that the long term effects of Covid-19 are recognised, especially in those who were never admitted to hospital, and that our GP members have interim guidance whilst waiting for formal national guidance, currently being developed by NICE, SIGN and the College, to be published.”
Notes to editors:
1. The new Patient Safety Learning and RCGP guidance can be found here: Post COVID-19 syndrome: What support can patients expect from their GP?
2. Patient Safety Learning is a charity and independent voice for improving patient safety. We harness the knowledge, insights, enthusiasm and commitment of health and social care organisations, professionals and patients for system-wide change and the reduction of avoidable harm. We believe patient safety is not just another priority; it is a core purpose of health and social care. Patient safety should not be negotiable.
3. The RCGP guidance for GPs can be found here: RCGP, Management of the long term effects of COVID-19. The RCGP response and top tips for caring for our patients, V1 30 October 2020.
Death rates for a major emergency abdominal surgery are almost eight times higher at some outlier hospitals compared with top performers, a national report has found.
A review of emergency laparotomies in England and Wales has identified six hospitals as having much higher-than-average 30-day mortality rates for the surgery between December 2018 and November 2019.
Hospitals identified by the annual National Emergency Laparotomy Audit as having the best outcomes, such as Stepping Hill Hospital and Salford Royal Hospital, had mortality rates of around 2.5%.
But the review, published this month, found some hospitals, such as George Eliot Hospital, had 30-day mortality rates for emergency laparotomies as high as 19.6%
The national 30-day mortality rate for emergency laparotomies in England and Wales was 9.3% last year and has fallen consistently since the review started in 2013.
Some trusts told HSJ that data collection issues were partly to blame for the high mortality rates recorded in the review.
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Source: HSJ, 20 November 2020
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A world-leading children’s hospital has been accused of a “concerted effort” to cover up the mistakes that led to the death of a toddler.
Jasmine Hughes died at London’s Great Ormond Street Hospital aged 20 months after suffering acute disseminated encephalomyelitis (ADEM), a condition in which the brain and spinal cord are inflamed following a viral infection.
Doctors said that her death in February 2011 had been caused by complications of ADEM. But an analysis of detailed hospital computer records shows the toddler died after her blood pressure was mismanaged – spiking when she was treated with steroids then allowed to fall too fast. Experts say this led to catastrophic brain damage.
Although the detailed computer records were supplied to the coroner who carried out Jasmine’s inquest, crucial information concerning her blood pressure was not included in official medical records that should hold the patient’s entire clinical history.
Dr Malcolm Coulthard, who specialises in child blood pressure and medical records examination, carried out the analysis of the files, comprising more than 350 pages of spreadsheets. Dr Stephen Playfor, a paediatric intensive care consultant, examined the computer records and came to the same conclusion as Dr Coulthard, that mismanagement of Jasmine’s blood pressure by Great Ormond Street and Lister Hospital, in Stevenage, was responsible for her death.
Dr Coulthard told The Independent: “As a specialist paediatrician, it is with great regret and disappointment that I have concluded that the doctors' records in Jasmine Hughes’ medical notes fail to reflect the truth about her diagnosis and treatment.”
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Source: The Independent, 20 November 2020
The NHS is going into this winter with 5,500 fewer general acute beds than last year, NHS England data has revealed.
The numbers of general and acute beds open overnight from July to September this year was 94,787 compared with 100,370 for the same period in 2019, a fall of 5.6% or 5,583 beds.
The reduction in bed numbers is thought to be partly because of covid infection control measures, such as creating more distance between beds. HSJ reported this week that Cambridge University Hospitals Foundation Trust had taken nearly 100 beds out of use to allow for better social distancing.
The figures showed significant regional differences. London had 8% fewer beds available compared with last year, while the East of England and the North East only had 3.4% fewer. The North West, which has been badly affected by the second wave of covid, had 6.6% fewer beds than last year.
NHS Providers deputy chief executive Saffron Cordery said: “We have been arguing for some time that the NHS is short of beds as we head into winter… This is a real problem as trusts deal with pressures posed by the virus, growing demand for urgent and emergency care and the work to recover the backlog of routine operations.”
Nuffield Trust deputy director of research Sarah Scobie said: “This drop in the number of beds available bears out our warning that infection control will mean a loss of capacity even between waves of the virus. Many of these will have been beds too close to others for physical distancing. This is why it will be so difficult to return to previous rates of activity while the virus remains at large, worsening waiting times and forcing difficult decisions about who gets priority."
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Source: HSJ, 19 November 2020
People aged 50 to 64 in England will be able to get a free flu jab from 1 December in an attempt to fight the "twin threats" of flu and COVID-19.
The group has been added to a list of people who are already eligible for a flu jab in England, such as those over 65 and health and social care workers.
Thirty million people are being offered the vaccine in England's largest flu-immunisation programme to date.
Health Secretary Matt Hancock said it was a winter "like no other".
"We have to worry about the twin threats of flu and COVID-19," he said, adding that the coronavirus pandemic meant it was "more important than ever" that people got their flu jabs.
Mr Hancock told BBC Breakfast that all over 50s would be able to get the vaccine by January.
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Source: BBC News, 20 November 2020
A drug used to treat rheumatoid arthritis appears to help patients who are admitted to intensive care with the most severe coronavirus infections, researchers say.
Tocilizumab, a medicine that dampens down inflammation, improved outcomes for critically ill patients, according to early results from an international trial investigating whether the drug and others like it boost survival rates and reduce the amount of time patients spend in intensive care.
The findings have not been peer-reviewed or published in a journal, but if confirmed by more trial data, the drug will be on track to become only the second effective therapy for the sickest Covid patients, following positive results for the steroid dexamethasone earlier this year.
“We think these are very exciting results, we are encouraged by them,” said Prof Anthony Gordon, of Imperial College London, the UK’s chief investigator on the REMAP-CAP trial. “It could become the standard of care once we have all the data reviewed by guidelines groups, and also drug regulators.”
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Source: The Guardian, 20 November 2020
As more people suffer lasting symptoms from Covid including fatigue, ME patient advocates fear they will get bad advice,
Based on current estimates, about 10% of COVID-19 patients develop lasting symptoms, one of the most common being fatigue. The underlying mechanism is still unclear, but possible explanations include reduced oxygen supply to tissues caused by heart or lung damage, or muscle weakness from prolonged bed rest.
However, some doctors are increasingly concerned about the overlap between long Covid and another largely virus-triggered illness: “It’s extraordinary how many people have a postviral syndrome that’s very strikingly similar to myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS),” said the US’s top public health official, Dr Anthony Fauci, in July. “They just don’t get back to normal energy or normal feeling of good health.”
Like people with ME/CFS, many long-Covid patients report headaches, brain fog, sleep problems, a racing heart, joint and muscle pain and fatigue. Some also experience a relapse of fever, muscle pain and exhaustion, known as “post-exertional malaise”, if they exercise beyond their capabilities.
“There are so many similarities between long Covid and ME/CFS it leads me to believe the underlying pathology is probably the same – except that long Covid is presenting as an epidemic, whereas ME/CFS has presented in a very sporadic way, and by no means in such large numbers in such a short space of time,” said Dr William Weir, a consultant in infectious diseases with a special interest in ME.
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Source: The Guardian, 19 November 2020
Young, low risk patients with ongoing symptoms of COVID-19 had signs of damage to multiple organs four months after initially being infected, a preprint study has suggested.
Initial data from 201 patients suggest that almost 70% had impairments in one or more organs four months after their initial symptoms of SARS-CoV-2 infection.
The results emerged as the NHS announced plans to establish a network of more than 40 long covid specialist clinics across England this month to help patients with long term symptoms of infection.
The prospective Coverscan study examined the impact of long covid (persistent symptoms three months post infection) across multiple organs in low risk people who are relatively young and had no major underlying health problems.
The research has not yet been peer reviewed and could not establish a causal link between organ impairment and infection. But the authors said the results had “implications not only for [the] burden of long covid but also public health approaches which have assumed low risk in young people with no comorbidities.”
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Source: BMJ, 17 November 2020
Hospitals across England could see oxygen supplies at worse levels this winter than at the peak of the first coronavirus wave – when some sites were forced to close to new admissions.
An alert to NHS hospitals this week warned that because of the rise in admissions of COVID-19 patients, there is a risk of oxygen shortages.
Trusts have been ordered to carry out daily checks on the amount of oxygen in the air on wards to reduce the risk of catastrophic fires or explosions.
The problem is not because of a lack of oxygen but because pipes delivering the gas to wards will not be able to deliver the volume of gas needed by all patients.
This can trigger a cut-off in supply and a catastrophic drop in pressure, meaning patients would be denied the oxygen they need to breathe.
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Source: The Independent, 20 November 2020
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