PatientSafetyLearning Team

In a letter sent to Matt Hancock on 3 October, 66 GPs called for greater consideration to be given to the indirect harms (and deaths) caused by the COVID-19 pandemic. In their letter, they highlighted several concerns around the impact of lockdown measures on the health outcomes of patients - both young and old. 

Do you have concerns about the wider health impact of the pandemic?

Do any of the issues highlighted in the letter particularly resonate with you and your own experience as a patient or healthcare worker? 

You'll need to be a member of the hub to comment, it's quick and easy to do. You can sign up here.

@Birdy2020 thank you so much for taking the time to share your experience on the hub. Many women, like you, do not experience high levels of pain during hysteroscopy and it is wonderful to hear positive stories. The levels of pain differ so greatly and it can be difficult highlighting the trauma that has been felt by many, without causing anxiety for others, who may not have any difficulty with the procedure. It sounds like, importantly, you felt informed, able to speak up and in safe hands.  

COVID-19 has placed the health and social care system under enormous pressure. To meet the demand created by the pandemic, a range of non COVID care and treatment was postponed. 

Shared anonymously:

"Six years ago I underwent hysteroscopy. Due to very heavy periods they wanted to investigate. I had an LA and the pain was bearable for me. But what really shocked me was that, while I was still in position, with my legs in the air, they said they were just going to insert something that would help with my periods. It wasn't really a question. It was a Mirena implant. They passed me the form to sign while I was still reclined which I thought was odd at the time but I trusted them. It was only when I came home that I could actually research what I had agreed to, something I would have done beforehand usually. Thankfully the Mirena has worked well for me but I know that isn't the case for all women. I still can't believe the approach used to get my 'consent', it certainly didn't feel informed."

Thank you for sharing your insight @Sally A. I recently watched a webinar about the Your Covid Recovery portal and the lady presenting said that the assessments for post-covid clinic support would likely go via pulmonary clinicians. I am not sure if that is still the case but it sounds like it may be respiratory focused where you went. Which, like you said, may not be meeting everyone's needs as people have concerns and symptoms relating to different parts of the body. We hope the letter we have sent to Simon Stevens will prompt greater clarity so we can highlight any gaps like this. 

Today (Friday 11 September), Patient Safety Learning has written to Sir Simon Stevens, Chief Executive of the NHS, calling on him to take steps to publicise the locations and details of these clinics.

You can read the letter in the attached PDF below:

Letter_PSLtoSimonsStevens_110920_Issued.pdf

Thank you all for continuing to provide patient insight on this issue. 

Below are some more comments that have been shared with us by patients (with their permission) from a Facebook COVID research group. Some wished to remain anonymous. 

"Asked GP in Southampton...she has been supportive....knew of none." Anon. 

"I tried mid-August to pull together a list by asking the Long Covid support group and literally got only 1 answer. I was trying to get my MP to follow up on it.  it seems unfathomable to me that this doesn't exist already. FWIW, I asked my GP here in Bristol and he was unaware of any. I asked him to look at Southmead Hospital (have research underway) but there is nothing." Michelle Gates. 

"I have e-mailed a question re Covid Clinics (and where are they where I live) to my NHS Trust for their board of directors meeting and was told the question would be asked. I am waiting for a transcript/minutes of the meeting to see if the question was raised?" Anon. 

"This (the list) would be so helpful. My GP in the north east had never heard of any!" Anon.

"No clinics in Durham." Tracey Birch.

"I asked my GP a few weeks ago to refer me to such a clinic but she looked into it and said there was nothing for Bexley (just outside London) patients to be referred to." Karen Corbett-Smith.

"My GP looked into the post-Covid clinic at Adenbrookes in Cambridge and confirmed rumours that I’d heard that it is only for previously hospitalised and I think also ventilated patients. There seems to be nothing available in the county and precious little in the East of England. Apparently there’s a clinic in Stevenage (Herts) - somebody I chatted to has a phone appointment with them next week. Thanks for looking into this- so many promises, so little follow-through." Annette Shelford.

"I’m in East Berkshire and when I asked my GP a few weeks ago if there are any post Covid clinics in our area he said there is nothing he is aware of, that he’d ask around and get back to me if he found anything, but nothing." Anon. 

"I asked my gp multiple times and there is no covid hub in Bristol, despite Bristol-led long covid research study (that focus on hospitalised patients only) and other covid research. I did get sent to the respiratory hot clinic where the consultant  was very knowledgeable outside of discipline eg we discussed blood clotting, heart and nervous system effects. I Have separate referrals to ENT. Cardiology-Echocardiogram. I Will get a lung CT scan, but it would make sense if they looked at multiple organs, but because it was ordered by the respiratory team they will only look at lungs. Frustrating ! Really need a multidisciplinary team to coordinate tests, meds and rehab." Jo House.

@Raeven thank you for giving your insight. As you have highlighted, there are thousands of patients, who like you, are suffering chronic symptoms. Greater clarity around access to post-COVID support is really needed. 

Yesterday Matt Hancock, Secretary of State for Health and Social Care said:

"The NHS set up Long Covid clinics and announced them in July and I'm concerned by reports this morning from the Royal College of GPs that not all GPs know how to ensure people can get into those services."[1]

Many patients are having to find out about Long Covid clinics through word of mouth or their own research, as Barbara Melville explains:

"I admin the Long Covid Support Group on Facebook, which has over 20, 000 members. We're hearing of 'Covid Clinics', but we still don't know where they are, how we access them, or what support we can expect. I learned of Edinburgh’s Covid service on Facebook, when a friend photographed a poster on a GP surgery door – the absolute last place I would have gone.

But it wasn’t plain sailing once I knew. I managed to access physio, but it is still light, and mostly phone based. One friend, who was hospitalised, was sent leaflets through the post – he had to push hard for physio. Neither of us were able to access investigations to determine if exercise is really safe, which is worrying given emerging evidence of multi-system complications."

Where is the list of these clinics?

Has it been widely shared with GPs and patients so those suffering symptoms of Covid-19 months later can access help? 

How many clinics are able to help patients access clinical investigations as well as rehabilitation?

What about those who did not get a positive test result? Or were not hospitalised? Are they able to access these services? 

Do you know of a central list or of services near you? Please comment below to #share4safety.

Nb: You'll need to sign in to the hub to comment (click on the icon in the top right of your screen). If you're not a member yet, you can sign up here for free. 

Reference 1. Matt Hancock, 8 September 2020, Health and Social Care Select Committee (00:01:35 of attached video). 

Dumfries and Galloway Royal Infirmary have installed a new poster explaining the practical workings of the Critical Care Unit in clear language for visitors and relatives. The funding was received from generous donations.

Have you used visual communications to improve patient safety and to engage more effectively with staff, visitors or patients? What has worked well? 

You'll need to be a hub member to comment, it's quick and easy to do. You can sign up here.

Additional reading:

• Patient safety concerns for Long COVID patients (6 July 2020)
• Press release: Patient Safety Learning calls for urgent action to ensure Long COVID patients are heard and supported (6 July 2020)
• My experience of suspected 'Long COVID'

@Claire Cox @Kirsty Wood @Alex Entwisle @Phil Gurnett is anyone able to help Shabnum? 

A significant number of people (who may or may not have been acutely unwell with COVID-19) are experiencing a prolonged and debilitating recovery at home. In this interview, a patient called Barbara, speaks of her personal experience of safe and unsafe care and highlights the dangers of ‘catch-all’ diagnoses. 

The interview highlights the important question..."are the COVID-19 'long-haulers' receiving the right support and care?"

Please join the conversation by sharing your thoughts and experiences below. If you are not already a member, you'll need to sign up first here. It's quick and easy to do. 

The next big push is on community rehab but how will commissioners support community equipment providers who will play a crucial role in this?

We (equipment provider) usually have 70 referrals per week - this is down to five at present. How will services catch up as well as providing support for those accessing community rehab? When will community health practitioners expect to be back in their usual roles following redeployment?

These concerns were raised by a participant at our recent webinar. Join the conversation by adding your thoughts below.  If you are not yet a member, you'll need to sign up here. It's quick and easy to do. 

Some more resources that may be useful...

NHS Employers: Risk assessments for staff – COVID-19

NHS: Supporting our BAME NHS people and communities during and beyond COVID-19 (May 2020)

Are some ethnic groups more vulnerable to COVID-19 than others?

This topic has been created to provide our members with a space to share COVID-19 risk assessments for BAME staff. You can share your risk assessment resources by commenting below and adding an attachment. We've kicked things off by sharing an example below. If you are not yet a member of the hub, you'll need to sign up here first - it's quick and easy to do.  

By collaborating and sharing learning, we hope to reduce risk. 

Risk ax form .doc

The Paediatric Intensive Care Society recently shared an alert on Twitter (referenced to NHS England), highlighting concerns that a coronavirus-related condition may be emerging in children.

This has been widely reported on by the media:

HSJ: National alert as ‘coronavirus-related condition may be emerging in children’

Do you work in paediatrics? Have you seen similar trends emerging? What are your thoughts on the concerns raised?

 A few more resources added to the hub that may be of interest...

CARDMEDIC – Flashcards for communicating with patients in the ICU during the COVID-19 pandemic

Advice for staff on preventing pressure ulcers while wearing PPE (BTHFT Tissue Viability Team)
PPE guidance and how to keep your skin safe (DBTH, April 2020)

Sarah-Jane Marsh is the CEO for the Birmingham Women's and Children's NHS Foundation Trust.

Matt Butler, resident Pharmacist at St Geroges Hospital was recently interviewed and talked about how they are having to adapt...

Full article 

Dr Anne Connolly, Chair of Primary Care Women's Health Forum (PCWHF), provided Patient Safety Learning with the following comment:

"There are concerns that women’s health will suffer - as usual women will tolerate their problems without seeking help or prioritising their needs.

One concern is the lack of access to contraception with Sexual health clinics becoming harder to access and not prioritising contraception and routine GP clinics/practice nurse clinics becoming hard to get appointments at - or being dealt with over the phone.

We have issued a guidance for our members on managing contraception remotely.  We are developing an HRT version too and will share other resources as we find them or feel that we can make a difference.  Rock my Menopause is a patient facing campaign and we have the support network through the Facebook page but also all the other resources for patients and clinicians to use."

PCWHF Resources 

How to manage contraceptive provision without face to face consultations

Recently created by the Palliative Care Team at West Middlesex Hospital...

Available to download here