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

Hospitals need extra £400m a year to make maternity units safer

Making maternity wards safer for mothers and babies will need £400m of extra spending every year, hospital leaders have told The Independent.
They warn that without increased funding, the NHS will not be able to fully implement recommendations made by an inquiry into poor maternity care at the Shrewsbury and Telford Hospitals Trust – where dozens of babies died or were left brain damaged in the largest maternity scandal in NHS history.
Multiple maternity care failings at hospitals across the country in the past 12 months have sparked concerns over the safety of mothers and their babies with MPs on the Commons Health Select Committee launching an investigation into the issue last year.
Hospital leaders say even just covering existing shortfalls of 3,000 midwives and recruiting 20 per cent more obstetricians, will cost at least £250m a year. To pay for extra anaesthetists, neonatal nurses and other support staff could push the cost to more than £400m.
Chris Hopson, chief executive of NHS Providers, which represents hospital trusts, told The Independent that ministers faced a choice of either making the extra cash available or forcing the NHS to cut money elsewhere.
In a letter to MPs on the committee, Mr Hopson urged them to demand extra funding in its forthcoming report on maternity safety in an effort to force ministers to confront the issue.
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Source: The Independent,9 February 2021,
Sam

Inspectors downgrade hospital A&E where patients left waiting ‘head to toe’

A hospital A&E department has been downgraded by regulators amid fears of “significant risk of harm” to patients after inspectors found some were crammed “head to toe” on trolleys during a surge in coronavirus cases.
The Care Quality Commission (CQC) has told bosses at the Royal Oldham Hospital to urgently improve its A&E service after the November inspection found staff were not following infection rules and patients were at risk of catching the virus.
The inspection confirms reports, revealed by The Independent last year, that patients in the A&E unit were being forced to wait close together for long periods. Whistleblowers from the trust said the practice was unsafe and the president of the Royal College of Emergency Medicine, Katherine Henderson, said it was a “potentially lethal” situation.
The CQC visited the emergency department on 30 November after it said concerns were raised over the safety of patients.
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Source: The Independent, 10 February 2021
Sam

Covid: Care home staff without PPE at start of pandemic - MPs

Care home staff were without personal protective equipment (PPE) early in the pandemic because the government prioritised the NHS, MPs have said.
The Commons Public Accounts Committee said care homes received only a fraction of the PPE needed compared with the health service.
It said social care "was only taken seriously after the high mortality rate in care homes became apparent".
The government said it worked "tirelessly" to provide PPE.
The report from the Public Accounts Committee said many healthcare workers were put in an "appalling situation" where they had to care for people with Covid-19 or suspected Covid-19 "without sufficient PPE to protect themselves from infection". It said the social care sector did not receive "anywhere near enough" to meet its needs.
Health and social care staff suffered PPE shortages, it said, with some forced to reuse single-use items as stocks ran "perilously low".
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Source: BBC News, 10 February 2021
Sam

The third wave hit to elective care

Elective activity levels were significantly lower in January than were achieved before Christmas, according to provisional NHS data seen by HSJ.
In the three weeks to 20 December, the NHS was reporting around 110,000 day cases and 18,000 ordinary admissions each week. But during January these totals dropped to around 85,000 day cases and 10,000 ordinary admissions per week. This equates to a reduction of 23% and 44%, respectively.
Regions that were more severely impacted by the third wave of coronavirus saw steeper reductions as covid pressures forced staff working in routine care services to be redeployed.
In London and the South East, day case activity reduced by around 40 per cent between the same periods, while ordinary admissions fell by around 57%.
Data for the Christmas fortnight was discounted, as activity always falls dramatically in this period.
However, the activity levels in January appear to be significantly higher than those reported in the first wave of coronavirus in the spring.
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Source: HSJ, 10 February 2021
Sam

Long Covid ‘could cost UK around £2,500,000,000 a year’

The MP leading an investigation into coronavirus fears long Covid could cost the UK around £2.5 billion a year. 
Layla Moran believes the emerging crisis is comparable to the impact rheumatoid arthritis has on the health service, with hundreds of thousands of people expected to be dealing with the condition for months. 
The ONS says around one in ten people who test positive will go on to develop long Covid, a catch all term to describe a host of ongoing symptoms in coronavirus patients. More than 1.7 million COVID-19 infections have been reported since Christmas Day in the UK. 
Speaking exclusively to Metro.co.uk, Ms Moran – who chairs the All Party Parliamentary Group (APPG) on coronavirus, said: "The amount of money that we are expecting to spend long term on long Covid could be similar to rheumatoid arthritis. How many people know someone with rheumatoid arthritis? It is going to be higher for long Covid."
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Source: The Metro, 10 February 2021
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More than 100,000 waiting for ‘urgent’ operations

More than 100,000 people were waiting for ‘urgent’ priority two operations in late January, as planned care rates plummeted amid the covid third wave, according to NHS data seen by HSJ.
However, the rate of elective procedures carried out last month appears to have been a lot higher than in the spring wave of coronavirus, despite there being more covid patients in hospital this time.
In the three weeks to 20 December, the NHS was reporting around 110,000 day cases and 18,000 planned overnight admissions each week. But during January these totals dropped to around 85,000 day cases and 10,000 planned overnight admissions per week. This equates to a reduction of 23% and 44%, respectively.
Regions that were more severely impacted by the third wave of coronavirus saw steeper reductions as covid pressures forced staff working in routine care services to be redeployed.
In London and the South East, day case activity reduced by around 40% between the same periods, while elective overnight admissions fell by around 57%.
Read full story (paywalled)
Source: HSJ, 10 February 2021
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Covid vaccine priority for 'severe' asthma

People previously admitted to hospital or needing "continuous or repeated" steroid use because of asthma are to be prioritised for the Covid vaccine.
The most severe cases will fall into priority-group four, the "clinically extremely vulnerable", who should have received a letter advising they shield.
And the government has now confirmed the rest who meet the above category will be included in group six, the clinically "at risk", including some but not all those usually eligible for a free flu jab.
It follows patients' calls for clarity.
The government said it was following independent experts' advice.
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Source: BBC News, 11 February 2021
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NHS urged to back plan to help patients harmed by mistakes

Patients and families who suffer avoidable harm as a result of mistakes in the NHS should be given targeted help and support to recover.
Campaign group the Harmed Patients Alliance and patient safety charity Action against Medical Accidents (AvMA) believe the NHS needs to develop a specific harmed patient pathway to care for families affected by errors in their care.
They are hoping to define what the pathway will look like in partnership with families, patients and NHS trusts with the idea of piloting an approach in the NHS and getting it adopted nationally.
There are more than two million safety incidents reported in the NHS every year, with more than 10,000 incidents resulting in severe harm and death.
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Source: The Independent, 11 February 2021
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Doctors warn intensive care units still face months of extra pressure

Hospitals across the UK opened more than 2,250 extra intensive care beds to cope with the demand from coronavirus patients during the last 12 months – the equivalent of 140 new intensive care units.
In a new report, the Intensive Care Society (ICS) warned pressure on hospitals could last for many more months with makeshift beds for critical care patients having to stay open, hampering efforts to restart more routine services.
The ICS said that 20,675 patients had been admitted to intensive care in England, Wales and Northern Ireland by 5 February. It said patients had a median length of stay in the first wave of 12 days, a lot longer than normal with 2,251 extra beds occupied in January 2021 compared to last year.
The ICS warned thousands of extra staff drafted in to look after critical care patients would be needed for months to come and this was despite staffing levels been stretched to dangerous levels.
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Source: The Independent, 10 February 2021
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Arthritis drug cuts Covid deaths, scientists discover

A drug used to treat rheumatoid arthritis could cut the number of Covid deaths and speed up recovery, a new scientific trial has found.
The drug, tocilizumab, could save the lives of one in 25 coronavirus patients in hospital and reduce the need for ventilators in intensive care.
Researchers say around half of the people admitted to hospital with coronavirus could benefit from the treatment.
Scientists from the nationwide Recovery trial said when tocilizumab was given alongside the steroid dexamethasone, it reduced the absolute risk of mortality by four percentage points. The medicine was already being used by the NHS to treat some coronavirus patients after early results last month showed it reduced the risk of death as well as time spent in hospital by up to 10 days.
As a result of the latest findings, the health secretary said the drug would be made more widely available on the NHS to help treat Covid patients.
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Source: The Independent, 11 February 2021
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Covid: Disabled people account for 6 in 10 deaths in England last year

Nearly 6 out of every 10 people who died with coronavirus in England last year were disabled, figures suggest.
Some 30,296 of the 50,888 deaths between January and November were people with a disability, Office for National Statistics (ONS) data shows. It also suggests the risk of death is three times greater for more severely disabled people.
Charities have called for urgent government action, describing the data as "horrifying and tragic".
The ONS figures suggest disabled people were disproportionately affected by the pandemic - accounting for 17.2% of the study population but nearly 60% of coronavirus deaths.
Among women, the risk of death involving coronavirus was 3.5 times greater for more-disabled women - defined as having their day-to-day activities "limited a lot" by their health - compared with non-disabled women.
For less-disabled women, defined as having their day-to-day activities "limited a little", the risk was two times greater.
Compared to non-disabled men, the data showed that the risk was 3.1 times greater for more-disabled men, and 1.9 times greater for less-disabled men.
Looking at people with a medically diagnosed learning disability, the risk of death involving Covid was 3.7 times greater for both men and women compared with people who did not have a learning disability.
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Source: BBC News, 11 February 2021
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One in four critical care units got busier in past week

The number of patients in critical care grew at one in four English hospital trusts in the past week, despite overall covid-19 occupancy falling, HSJ can reveal.
It comes with adult critical care occupancy still very high in many areas — 10 trusts still have at least double the number of patients that they normally have space for. It highlights the ongoing pressure still on hospitals, with the prime minister due to decide in coming days on a timetable for loosening lockdown.
HSJ analysis of NHS sitrep data shows that 31 trusts (of a total 125 general acute trusts) saw the number of critically ill adults climb between 2 and 9 February.
Twenty-five of these trusts were either at or above their total capacity available last winter. The critical care units still seeing increasing pressure when compared to last year are spread nationally, but are predominantly in Yorkshire, Midlands and the North West, where the covid third wave peaked later.
Read full story (paywalled)
Source: HSJ, 11 February 2021
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Healthcare staff must be given time to recuperate from pandemic, say leaders

The NHS must have a realistic and steady approach to resuming services disrupted by the pandemic that explicitly recognises the need for staff to recover, NHS leaders have said.
In a letter to the prime minister leaders from the NHS Confederation, which represents healthcare providers, warned, “The NHS cannot recover its services at the same rate of increase when staff are so exhausted.”
The letter noted that there were over 5000 more patients with COVID-19 in UK hospitals right now that at the peak of the first wave and that this was taking its toll on staff. The leaders called for sustained local mental health support for the NHS workforce beyond the end of March and for a long term, fully funded plan to increase staffing numbers.
The government must also set out clear expectations for the public on when routine procedures and other treatments would be fully back on line, they added.
“With a workforce on its knees and many of the pre-pandemic challenges still very much at play they need your government both to acknowledge the consequences of the immense pressure their workers have been under so far, and to be realistic and honest with the public about what the NHS can safely deliver moving forward,” the letter said.
Layla McCay, director of policy at the NHS Confederation, said that while health leaders would continue to prioritise urgent care and patients with the greatest clinical need, the prime minister must “be upfront with the public about what the NHS can safely deliver in this next phase.”
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Source: The BMJ, 11 February 2021
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Community nursing faces ‘rehabilitation disaster’ as Covid leaves thousands in need

Tens of thousands of coronavirus survivors needing long-term care are heaping pressure on Britain’s stretched community services, threatening a crisis that experts warn could dwarf that seen in hospitals over the past 12 months.
As many as 100,000 intensive care patients, including up to 15,000 Covid-19 survivors, will need long-term community nursing care after being discharged from hospitals during the past 12 months, The Independent has been told.
This will be on top of an as yet unknown number of Covid patients from the 350,000 treated on general wards since the pandemic began, as well as tens of thousands of people who were sick without going to hospital but have been left with debilitating symptoms of long Covid.
Labour’s shadow health minister Liz Kendall warned: “There will be huge pressures on community services as people who need long-term support are discharged back into their own homes.
“Ministers have got to put in place a proper workforce strategy for the NHS and community care otherwise we will see people struggling to recover and the burden of care could also fall on their families."
“This is one of the long-term consequences of Covid that we haven’t begun to even think through yet.”
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Source: The Independent, 14 February 2021
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Oxford-AstraZeneca vaccine to be tested on children

A new trial is to test how well the Oxford-AstraZeneca coronavirus vaccine works in children.
Some 300 volunteers will take part, with the first vaccinations in the trial taking place later in February.
Researchers will assess whether the jab produces a strong immune response in children aged between six and 17.
The vaccine is one of two being used to protect against serious illness and death from Covid in the UK, along with the Pfizer-BioNTech jab.
As many as 240 children will receive the vaccine - and the others a control meningitis jab - when the trial gets under way.
Andrew Pollard, professor of paediatric infection and immunity, and chief investigator on the Oxford vaccine trial, noted that most children were relatively unaffected by Covid and were unlikely to become unwell with the virus.
But he said it was important to establish the safety and immune response to the vaccine in children and young people as some children might benefit from vaccination.
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Source: BBC News, 14 February 2021
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Fury at ‘do not resuscitate’ notices given to Covid patients with learning disabilities

People with learning disabilities have been given do not resuscitate orders during the second wave of the pandemic, in spite of widespread condemnation of the practice last year and an urgent investigation by the care watchdog.
Mencap said it had received reports in January from people with learning disabilities that they had been told they would not be resuscitated if they were taken ill with COVID-19.
The Care Quality Commission (CQC) said in December that inappropriate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) notices had caused potentially avoidable deaths last year.
DNACPRs are usually made for people who are too frail to benefit from CPR, but Mencap said some seem to have been issued for people simply because they had a learning disability. The CQC is due to publish a report on the practice within weeks.
The disclosure comes as campaigners put growing pressure on ministers to reconsider a decision not to give people with learning disabilities priority for vaccinations. There is growing evidence that even those with a mild disability are more likely to die if they contract the coronavirus.
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Source: The Guardian, 13 February 2021
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