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

COVID-19: Health workers 'back in eye of storm', says NHS chief

Health workers are "back in the eye of the storm" as coronavirus cases continue to rise, NHS England's chief executive Simon Stevens has said.
It has been the "toughest year" for the NHS, which has treated 200,000 severely ill Covid-19 patients, he added.
Hospitals in England are currently treating more Covid patients than at the peak of the first wave in April.
A government scientific adviser has warned national restrictions are needed to prevent a "catastrophe".
On Monday, a record 41,385 new Covid cases were reported in the UK, though it is thought the infection rate was higher during spring when testing was much more limited.
NHS England said 20,426 people were being treated for the virus in hospitals in England on Monday, which is higher than the previous peak of about 19,000 in April.
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Source: BBC News, 29 December 2020
Sam

Paediatricians sound alarm at huge surge in child eating disorders

Cases of anorexia and other eating disorders have quadrupled in some areas during the coronavirus pandemic, doctors say.
The Royal College of Paediatrics and Child Health (RCPCH) issued an alert to parents, saying the Christmas and new year period can be stressful for young people who struggle with disordered eating.
That comes on top of massive disruption to schooling and other areas of life due to Covid-19 which has led to a loss of physical and social activity, plus money worries and bereavement for some.
“In our tier 4 under 13s mental health inpatient unit we have seen a three- to fourfold increase in children referred to our service with eating disorders, and they are just the tip of the iceberg.” Dr Nancy Bostock, a consultant in Cambridge, said in a statement provided by the college.
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Source: The Independent, 29 December 2020
Sam

All vulnerable people to be vaccinated by ‘late spring’ says head of NHS

All vulnerable people will have been offered a coronavirus vaccination by “late spring” the head of NHS England has said as he warned the health service was “back in the eye of the storm.”  
In a New Year message, Sir Simon Stevens described 2020 as the “toughest year” and he paid tribute to nurses, doctors, therapists and other NHS staff including hospital cleaners, carers and volunteers as well as care home staff.
Sir Simon visited a new vaccination centre on Monday saying: “We think that by late spring with vaccine supplies continuing to come on stream we will have been able to offer all vulnerable people across this country Covid vaccination. That perhaps provides the biggest chink of hope for the year ahead.”
His comments came as the NHS in London was said to be “teetering on the edge” as latest data showed the numbers of hospital admissions in the capital jumped more than 200 per cent since the end of lockdown on 2 December.
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Source: The Independent, 29 December 2020
Sam

Nightingale hospitals stand empty despite surging Covid cases as medics warn of staff shortages

The flagship Nightingale hospital is being dismantled as medics warn that there are not enough staff to run the facilities despite the NHS being at risk of being overwhelmed by coronavirus.
Amid surging virus case numbers, elective surgery is being cancelled as the number of patients in hospitals in England passes the peak of the first wave in April. 
Although the NHS is "struggling" to cope, the majority of the seven Nightingale hospitals, created at a cost of £220 million, have yet to start treating COVID-19 patients during the second wave. The Exeter Nightingale has been treating Covid patients since mid-November. 
The facility at London's Excel centre has been stripped of its beds and ventilators.
The NHS has told trusts to start preparing to use the overflow facilities in the coming weeks, but bosses have failed to explain how they will be staffed.
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Source: The Telegraph, 28 December 2020
Sam

Covid: Essex declares major incident over virus cases

A major incident has been declared in Essex amid fears the number of COVID-19 cases could overwhelm the county's health services.
The Essex Resilience Forum (ERF) said "growing demand" was putting stress on hospitals and social care settings.
On Tuesday Mid and South Essex NHS Trust placed all three of its hospitals on critical alert.
All of Essex is in tier four and the south of the county has some of the worst-affected districts in England.
Essex Police Chief Constable BJ Harrington, who is co-chairman of the ERF, said declaring a major incident allowed it "to seek further support from the government to address the severe pressures which the health system is under".
The forum said the number of patients being treated for Covid in the county had exceeded the levels seen at the peak of the first wave and "these levels are likely to increase further in the coming days".
The ERF - comprised of health services, blue light responders and councils - said issues included "critical care and bed capacity, staff sickness/self-isolation levels and the system's ability to discharge patients quickly into safe environments".
Mr Harrington urged the public to continue only dialling 999 or attending A&E in an emergency.
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Source: BBC News, 30 December 2020
Sam

COVID-19: Oxford-AstraZeneca coronavirus vaccine approved for use in UK

The Oxford-AstraZeneca vaccine has been approved for use in the UK, with the first doses due to be given on Monday amid rising coronavirus cases.
The UK has ordered 100 million doses - enough to vaccinate 50 million people.
This will cover the entire population, when combined with the full order of the Pfizer-BioNTech jab, Health Secretary Matt Hancock said.
It comes as millions more people in England are expected to be placed under the toughest tier four restrictions.
On Tuesday, 53,135 new Covid cases were recorded in the UK - the highest single day rise since mass testing began - as well as 414 more deaths within 28 days of a positive test.
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Source: BBC News, 30 December 2020
Sam

London faces ‘ticking time bomb’ over oxygen supplies as another hospital issues warning to staff

Concerns are mounting over the number of coronavirus patients being admitted to hospitals in London as another NHS trust in the capital issued an urgent warning over its oxygen supplies.
On Tuesday afternoon, the North Middlesex University Hospital Trust warned clinicians the numbers of coronavirus patients it was treating “was putting a strain” on the oxygen system, sparking several alarms.
The trust currently has around 200 patients using oxygen with the trust consuming 2,400 litres of oxygen a minute. It normally uses around 1000 litres a minute and has a limit of 3,000 above which the system could cut out.
It is only the latest hospital to face the problem – which is caused by the sheer demand for oxygen by sick Covid patients, which is more than the hospital piping can physically deliver.
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Source: The Independent, 30 December 2020
Sam

COVID-19: Expedite vaccination or deaths will surge, researchers warn

Deaths from COVID-19 in England in the first half of 2021 could exceed those seen in the whole of 2020 unless the vaccination programme is vastly increased and a national lockdown implemented—with educational settings closed for at least a month—researchers have warned.
In a preprint released on 24 December, researchers from the London School of Hygiene and Tropical Medicine used modelling to compare the effects of varying COVID-19 restrictions on the virus spread, hospital and intensive care admissions, and deaths from 15 December 2020 to 30 June 2021. The model took account of the new variant spreading rapidly in southern England, which it estimated to be 56% more transmissible than non-variant COVID-19.
The study, which has yet to be peer reviewed, said that control measures similar to the November national lockdown would be “unlikely to reduce the effective reproduction number to less than 1, unless primary schools, secondary schools, and universities are also closed.” It added that it would be necessary to “greatly accelerate vaccine rollout to have an appreciable impact in suppressing the resulting disease burden.”
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Source: BMJ, 29 December 2020
Sam

Oxford vaccine: People with allergies and pregnant women can now get inoculation, updated guidance says

People with allergies and pregnant women can now be given the country’s two approved COVID-19 vaccines, the medical regulator said on Wednesday.
Previous advice from the Medicines and Healthcare products Regulatory Agency (MHRA) said people with a range of allergies to food and medicines should not be given the Pfizer vaccine.
Dr June Raine, the MHRA’s chief executive, said growing evidence from a pool of at least 800,000 people in the UK and around 1.5 million people in the US who have had the vaccine has "raised no additional concerns".
This, she continued, "gives us further assurance that the risk of anaphylaxis can be managed through standard clinical guidance and an observation period following vaccination of at least 15 minutes.
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Source: The Independent, 30 December 2020
Sam

COVID-19: Frontline doctors speak out about struggle to maintain care standards

Frontline doctors have testified to deteriorating conditions in hospitals in London and the south east as the NHS deals with a surge in COVID-19 cases.
Speaking to the Independent SAGE group of experts on 30 December, Jess Potter, a respiratory doctor in east London, told how she and colleagues were afraid of resources running out.
“My greatest fear is having a patient that I cannot provide lifesaving treatment to,” she said. “We had one of our largest medical intakes yesterday, the vast majority with coronavirus. What do we do when we run out of resources, and who is going to provide that guidance? It will harm our patients and our staff, because we have a set of values by which we practise, and we will have to reduce the level of care we deliver.”
She added, “Back in April I never saw a case where we didn’t provide a bed to a patient who needed it in intensive care, and decisions were taken as if in normal times. Now I hear from medics across the country that things are very bad, and the situation is the same as in April, if not worse. We are afraid of what will happen if we don’t act now.”
Sonia Adesara, a doctor in London, spoke to Independent SAGE after a set of night shifts at her trust and told of a chronic shortage of continuous positive airway pressure (CPAP) capacity.
“In the past few days, despite my hospital significantly increasing intensive and critical care capacity, our intensive care unit has been full, and there is no spare CPAP capacity. Medics are spending shifts trying to closely monitor all of our patients who are on the highest level of oxygen that we can give with a normal mask, assessing who is most unwell and unstable—and then frequently checking on patients who are on CPAP and then swapping people [around]."
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Source: BMJ, 31 December 2020
Sam

Covid vaccine: UK doctors criticise rescheduling of second doses

Plans to delay giving the second dose of a Covid vaccine to more than 500,000 people who have received the first jab have caused outcry among doctors who say cancelling appointments wastes time, causes confusion among patients and is potentially unethical.
On Wednesday the government announced a change to its Covid vaccination strategy, saying second doses of the newly approved Oxford/AstraZeneca vaccine and the previously approved Pfizer/BioNTech jab would now be given up to 12 weeks after the first dose.
The move applies to people scheduled to have their second dose of the Pfizer jab after 4 January, as well as those yet to receive either jab. The government said it hoped the approach would mean as many people as possible soon have some protection against the disease.
However, the announcement caused controversy, with Pfizer and BioNTech warning that two doses of their vaccine were required for maximum protection against Covid and that they did not have evidence that the first dose alone offered protection after three weeks.
Now doctors have said cancelling appointments for the second dose will take huge amounts of time and could lead to confusion.

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Source: The Guardian, 31 December 2020
Sam

Roll out covid vaccinations to frontline staff ‘immediately’, says NHS England

COVID-19 vaccinations should now be “immediately” rolled out to frontline staff, NHS England has told trust leaders.
New instructions from the national body follow the approval today of the Oxford/AstraZeneca coronavirus vaccine, which NHS England said will “substantially to accelerate vaccine delivery”. Until now, only limited quantities of the Pfizer/BioNTech vaccine have been available.
NHS staff are in the second priority category for covid vaccines, behind care home residents and alongside over 80s. But there have been complaints from clinicians around the country that they have been unable to get the jab, as well as uncertainty about how the vaccine deliveries should be divided between the priority groups.
A letter to local leaders from NHS England says that until now, healthcare workers who have been identified at highest risk of serious illness from covid-19 have been given the vaccine in unfilled appointment slots.
The letter, from chief executive Sir Simon Stevens and senior officials, now states: “Increased supply means that vaccination can also now immediately be expanded to frontline health and social care workers.”
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Source: HSJ, 31 December 2020
Sam

NHS staff face burnout as Covid hospital admissions continue to rise

England’s chief nurse has said that NHS and care staff are working incredibly hard to cope with record numbers of COVID-19 patients, amid concern that frontline staff are close to burnout.
Ruth May pleaded with the public to follow the coronavirus advice to help relieve the pressure on hospital staff, after two days of record hospital admissions.
Adrian Boyle, the vice-president of the Royal College of Emergency Medicine, told BBC Breakfast that health employees were “tired, frustrated and fed up”.
He said: “What is it going to be like over the next couple of months? I don’t know, I am worried. We are very much at battle stations.
“There will be short-term surges of morale but people are tired, frustrated and fed up, as everybody is, whether they work in hospital or not. The people who go into emergency medicine expect it to be tough from time to time.
“There is a real worry about burnout.”
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Source: BBC News, 1 January 2021
Sam

Covid: 12-week vaccine gap defended by UK medical chiefs

The UK's chief medical officers have defended the Covid vaccination plan, after criticism from a doctors' union.
The UK will give both parts of the Oxford and Pfizer vaccines 12 weeks apart, having initially planned to leave 21 days between the Pfizer jabs.
The British Medical Association said cancelling patients booked in for their second doses was "grossly unfair".
But the chief medical officers said getting more people vaccinated with the first jab "is much more preferable".
Pfizer has said it has tested the vaccine's efficacy only when the two vaccines were given up to 21 days apart.
But the chief medical officers said the "great majority" of initial protection came from the first jab.
"The second vaccine dose is likely to be very important for duration of protection, and at an appropriate dose interval may further increase vaccine efficacy," they said.
"In the short term, the additional increase of vaccine efficacy from the second dose is likely to be modest; the great majority of the initial protection from clinical disease is after the first dose of vaccine."
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Source: BBC News, 1 January 2021
Sam

Elderly fall victims having to wait six hours for ambulances dealing with Covid patients

Elderly people who suffer falls are having to wait up to six hours for an ambulance because of rising Covid pressures, a medical body has warned. 
The delays are due to paramedics having to prioritise 999 calls from people suffering from coronavirus related breathing difficulties.
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Source: The Telegraph, 1 January 2021
Sam

New data reveals the 23 trusts with over a third of beds occupied by covid patients

Twenty-three hospital trusts had more than a third of their core bedbase occupied by COVID-19 patients on Tuesday, and occupancy is still rising at all but one.
Three trusts (North Middlesex in north London, as well as Medway and Dartford and Gravesham in Kent) had more than half of general and acute beds occupied by patients who had the virus, and others were not far behind.
Several trusts saw their covid occupancy share up by more than 10 percentage points in a week — a rate of growth which would soon see them entirely filled by covid patients, a situation with radical consequences for emergency hospital care in those areas.
London as a whole had a third of these beds occupied by patients with COVID-19.
HSJ has analysed data published for the first time by NHS England last night. The data concerns the status of adult general and acute beds, which make up the large majority of the acute bedbase. They do not include intensive care, which is also now under huge pressure in London, the south east and the east of England. Most hospitals in these areas are stretching IC capacity above normal levels.
Such high covid occupancy in both intensive care and the core bedbase is putting severe strain on hospitals’ ability to treat other patients. Most or all of the trusts under the greatest pressure have now cancelled routine planned surgery, and many are struggling with crowding, delays getting patients into and out of emergency departments due to the space available, and a lack of staff.
Read full story (paywalled)
Source: HSJ, 1 January 2021
Sam
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