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News ArticleA trust has warned it may reach a ‘tipping point’ where it is ‘impossible’ to separate covid positive and negative patients. Surrey and Sussex Healthcare Trust also revealed in papers published ahead of its Thursday board meeting that it planned to distribute a “duty of candour” leaflet for patients, warning them of the risk of contracting covid in hospital. The papers noted covid patients at the trust increased from 80 pre-Christmas to 230 by January, filling half its beds. HSJ’s figures suggest covid patients at the trust continued to rise until around 14 January before dropping back slightly. The report from the trust’s safety and quality committee — which met on 7 January — said: “It is becoming more difficult to separate the covid+ and covid- patients. In an increasing number of instances, patients are admitted to cold areas for non-covid treatment and without symptoms but then test positive. These patients then need to be admitted to hot areas and any contacts (including patients from the same bay) isolated. “At some point a tipping point could be reached where it may be impossible to retain hot and cold areas.” Read full story (paywalled) Source: HSJ, 27 January 2021
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Content ArticleThe Faculty of Occupational Medicine (FOM) has published guidance for healthcare professionals to assist them in facilitating the return to work of people who are unable to work due to Long-COVID. Follow the link below or download the guidance as a pdf.
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News ArticleRotating clinicians and keeping ventilation running are among Public Health England’s (PHE) recommendations for how to avoid spreading covid while looking after patients in the back of ambulances outside emergency departments. The suggestions are made in unprecedented new guidance issued by PHE amid sky-high rates of very long ambulance handovers outside hospitals. This is because emergency departments (EDs) are struggling with attempts to maintain distancing for infection control, along with high occupancy and severe operational pressures elsewhere in hospitals. It has led over the past two months to large numbers of patients being looked after in ambulances for extended times while they wait for space in ED. The PHE guidance, added last week to existing covid guidance for ambulance services, says it should only happen in “exceptional circumstances”. But it says staff in this situation should adopt infection prevention and control procedures including: if more than one clinician is available, rotating them regularly, so allowing them time to change PPE and have a drink; keeping ventilation systems running which may require the engine to be kept running; ensuring patients and any essential escorts wear surgical masks, as long as patient care is not compromised; minimising the number of people within the patient compartment and avoiding sitting face-to-face with patients; and decontaminating contact surfaces more frequently and during the delay if possible. Read full story (paywalled) Source: HSJ, 25 January 2021
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News ArticleLondon’s largest acute trust has been accused of ‘emotional blackmail’ by suggesting junior doctors could do voluntary shifts in its ‘really short staffed’ critical care unit. In an email cascaded to all junior doctors at Whipps Cross Hospital, run by Barts Health Trust, hospital medical director Heather Noble said day and night shifts at another trust site, the Royal London Hospital, “really need cover”. She said doctors could work overtime through a “voluntary or paid shift”, and that if they made contact, should “state whether or not they want to be paid”. Doctors working at the trust who received the email, who wished to remain anonymous, described the email as “tone deaf” and “not the right way to incentivise anyone to do what they want”. One medic said: “There has been a lot of anger generated by this correspondence amongst junior doctors. People already working antisocial and demanding rotas are very unhappy about being asked to work more hours for free.” Read full story (paywalled) Source: HSJ, 26 January 2021
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News ArticleMen working in low-skilled jobs or care, leisure and service roles are more than three times as likely to die from Covid as professionals, according to new data. Office for National Statistics (ONS) figures show there were 7,961 coronavirus-related deaths registered among the working-age population (those aged 20 to 64 years) in England and Wales between 9 March and 28 December last year. Nearly two-thirds of those deaths were among men (5,128 fatalities). Analysis by the ONS shows men who worked in low-skilled occupations (699 deaths) or care, leisure and other service occupations (258 deaths) had the highest rates of death involving Covid-19, with 66.3 and 64.1 deaths per 100,000 males, respectively. Men working in process plants, as security guards or as chefs, had some of the highest COVID-19 death rates. Plant workers recorded a rate of 143.2 deaths per 100,000 males, while for security guards and related occupations, the figure stood at 100.7 deaths per 100,000 males. Ben Humberstone, ONS head of health analysis and life events, said: “Jobs with regular exposure to Covid-19 and those working in close proximity to others continue to have higher COVID-19 death rates when compared with the rest of the working-age population.” However, the figures do not prove that rates of death are caused directly by differences in employment. “There are a complex combination of factors that influence the risk of death, from your age and your ethnicity, where you live and who you live with, to pre-existing health conditions,” Mr Humberstone said. Read full story Source: The Independent, 25 January 2021
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Content ArticleThe Health Foundation policy tracker provides a description and timeline of national policy and health system responses to COVID-19 in England in 2020. The full tracker includes data on what changes have been introduced, when, why, and by whom – as well as how these changes have been communicated by policymakers. We track policy changes in five areas – from health and care system changes to wider social and economic policy.
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Content ArticleThis report to Congress details a strategy to achieve the principal purpose and objective of Operation Warp Speed (OWS): ensuring that every American who wants to receive a COVID-19 vaccine can receive one, by delivering safe and effective vaccine doses to the American people beginning January 2021.
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Content ArticleSue Hignett and Paul Bowie propose taking a much-needed professional approach to patient safety through an accredited learning pathway to integrate safety into clinical systems and develop healthcare safety specialists and experts
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Content ArticleThis report summarises the impacts on babies of COVID-19 and the spring 2020 national lockdown. The report also explores how local systems responded to the challenges presented by COVID-19. It seeks to understand the factors that have shaped the response by services that support babies and their families. Most importantly, the report seeks to ensure that lessons are learnt for the future of service provision for this age group.
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News Article
Cancer operations down 800 in first two weeks of January
Patient Safety Learning posted a news article in News
There were 800 fewer cancer surgeries in the first two weeks of January than usually take place during the period, according to provisional data seen by HSJ. The bulk of this reduction came in London and the surrounding counties such as Essex, Bedfordshire, and Surrey. London and the south east have been severely hit by coronavirus pressures, causing widely reported mass cancellations of non-urgent elective surgery. However, the impact on cancer cases has, so far, been less clear. NHS England has insisted in the last week that urgent cancer cases should be given the same priority as coronavirus patients. Read full story (paywalled) Source: HSJ, 25 January 2021 -
News Article
Record ethnicity of those getting covid vaccine to fight stigma, NHSE told
Patient Safety Learning posted a news article in News
NHS England has been urged to introduce routine recording of race and ethnicity data when people are given their covid vaccination. Documents seen by HSJ show Pinnacle, the IT system being used by GPs and mass vaccination centres to record jabs, does not directly require ethnicity to be recorded. Jabeer Butt, chief executive of the Race Equality Foundation, which promotes race equality in public services, told HSJ that making it a requirement would help establish the facts on uptake among different groups, more quickly. It is understood the NHS is able to ascertain data on vaccine uptake by ethnicity by connecting it with GP records, through the national immunisation management service, and potentially with other healthcare data. However, Mr Butt said this would provide only limited insight and take more time. He believes the absence of data may allow ”misconceptions” to take hold about lower uptake among some minorities, which can lead to stigma, when in fact, he said, the trend may so far simply be due to there being fewer black and Asian people in the oldest age groups, who are the first eligible for vaccination. Read full story (paywalled) Source: HSJ, 24 January 2021 -
Content Article
Hidden wounds
Stephanie O'Donohue posted an article in Staff safety
In this short blog, Stephanie O'Donohue, Content and Engagement Manager for the hub, reflects on the inner turmoil many NHS staff are experiencing as they are having to spread themselves, and their care, thin. -
News Article
My ‘Long Covid’ nightmare: Still sick after 6 months
Patient Safety Learning posted a news article in News
A Times reporter caught the coronavirus during the New York City outbreak last April. But the acute phase of the illness was just the beginning. Laura recounts her experience of Covid nearly 3 months after first being diagnosed. "I remember the second time I thought I would die." Read full story Source: The New York Times, 21 January 2021 -
Content ArticleFrontline clinicians working with the National CLEAR Programme for ICU have published ten recommendations that can be adopted in ICU in 48 hours, to help manage the COVID surge. Click on the image or download the attachment as a PDF.
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Content ArticleRegina Hoffman, Executive director of Pennsylvania’s Patient Safety Authority and editor-in-chief of Patient Safety, discusses why we need to shift the focus from "whomever-care" to a "people's care" approach. She hopes after the pandemic that the next chapter brings radical change to how we approach patient safety and says we must start by making patient safety a national priority. This is part of a series of blogs from Regina 'The bigger picture'.
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Content Article'Covid Oximetry @home' describes an enhanced package of care for individuals with confirmed (or suspected) COVID-19 who are at risk for future deterioration. NHS England and Improvement wrote to all CCGs and trusts to encourage the development of local CO@H projects. The 'CO@h' package of care involves the remote monitoring of the patient's condition through providing regular contact with a local health care team who will reassess the individuals symptoms (including oxygen saturation levels). This close monitoring enables the individual to remain at their usual place of residence whilst allowing early signs of deterioration to be identified and escalated quickly and appropriately. This material has been designed primarily for use across the South East AHSN network by colleagues within the Wessex AHSN, Kent Surrey Sussex AHSN and Oxford AHSN regions. Colleagues from regions beyond the South East are also very welcome to make use of this toolkit in setting up their own local approaches to remote monitoring.
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News ArticleOne of the mysteries of COVID-19 is why oxygen levels in the blood can drop to dangerously low levels without the patient noticing. It is known as "silent hypoxia" and as a result, patients have been arriving in hospital in far worse health than they realised and, in some cases, too late to treat effectively. But a potentially life-saving solution, in the form of a pulse oximeter, allows patients to monitor their oxygen levels at home, and costs about £20. They are being rolled out for high-risk Covid patients in the UK, and the doctor leading the scheme thinks everyone should consider buying one. A normal oxygen level in the blood is between 95% and 100%. "With Covid, we were admitting patients with oxygen levels in the 70s or low-or-middle 80s," said Dr Matt Inada-Kim, a consultant in acute medicine at Hampshire Hospitals. He told BBC Radio 4's Inside Health: "It was a really curious and scary presentation and really made us rethink what we were doing." Read full story Source: BBC News, 21 January 2021 See hub resource on the 'Covid Oximetry @home' project
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News ArticleThe second wave of COVID-19 has put doctors under huge pressure, the Royal College of Physicians has warned, as two thirds of physicians report feeling tired or exhausted. A survey of 25 500 members of the college from across the UK, conducted on 2 November, received 1890 responses. It found that two thirds (64%, 931) felt tired or exhausted, 48% (687) felt worried, and just under a third (29%, 424) felt demoralised. Almost a fifth (19%, 280) said they have sought informal mental health support, such as speaking to colleagues or friends, during the pandemic. Just 10% (155) said they had sought formal mental health support from either their employer, GP, or external services. College president Andrew Goddard said he was concerned about the mental health of doctors, “There is no way to dress it up—it is pretty awful at the moment in the world of medicine. Hospital admissions are at the highest ever level, staff are exhausted, and although there is light at the end of the tunnel, it seems a long way away.” He said that before the pandemic, few physicians would have expected to need formal mental health support during their career. After the pandemic, staff will be in desperate need of a break, Goddard said, and will need specific time away if they’re to be at their best. “Doctors have demonstrated remarkable resilience throughout the pandemic, working under the most challenging conditions the NHS has ever faced, but they can’t continue working this way forever,” he said. Read full story Source: The BMJ, 21 January 2021
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News ArticleJust a third of people aged 80 and over have received the covid vaccine in one part of England, compared to four out of five in the area with the highest rate, new NHS England figures have revealed. Gloucestershire delivered at least one dose of the vaccine to 85% of its over 80s population between 8 December and 17 January. Three other STPs — Northamptonshire, Herefordshire and Worcestershire, and Lancashire and South Cumbria — have all delivered at least one dose to at least three-quarters of over 80s in the area. By contrast, Suffolk and North East Essex has vaccinated just 36% of its over 80s population. A further seven of England’s 42 STP/Integrated Care Systems had vaccinated under half of their over 80s population. The mixture of reasons for the differences are not known — it may be due to supply, delivery issues, the nature of the area, or the size of the over-80s population. NHS England has maintained that the vaccine is being used nearly as quickly as it is available each week, with supply the main constraint. NHSE decides when sites are able to open and when they have supply. Read full story (paywalled) Source: HSJ, 21 January 2021
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News Article
Ambulance service facing 'terrifying' levels of risk, says trust chief
Patient Safety Learning posted a news article in News
The chief executive of a small acute trust has described the “terrifying situation” faced by ambulance crews and hospital staff in trying to provide adequate emergency care as coronavirus threatens to overwhelm the local NHS services. Susan Gilby, of Countess of Chester Hospital Foundation Trust, told HSJ staff are seeing “tragic and potentially avoidable” instances where patients with COVID-19 have reached the emergency department too late. She suggested this is due to a combination of patients waiting too long to call 999, and then having to wait long periods for an ambulance to arrive. Cheshire has been among the hardest hit areas in England during this third wave of coronavirus, with all four of its acute hospitals having very high covid occupancy rates. Dr Gilby, a former critical care consultant, said her trust has been at around 60 per cent covid occupancy for the last fortnight, which has made her increasingly fearful of the difficulties in admitting patients through the emergency department due to a lack of beds. This can then cause knock-on delays for patients arriving in ambulances, and ties those ambulance crews up for long periods, preventing them from responding to further 999 calls. She said ambulance turnaround times had been relatively good at the Countess of Chester, but she had spoken to paramedics handing over patients who were “really struggling” to get to people quickly enough. Read full story (paywalled) Source: HSJ, 22 January 2021 -
News Article
More than 400 care homes investigated over deaths
Patient Safety Learning posted a news article in News
A special Crown Office unit set up to probe Covid-linked deaths is investigating cases at 474 care homes in Scotland, the BBC can reveal. The unit was set up in May to gather information on the circumstances of all deaths in care homes. Prosecutors will eventually decide if the deaths should be the subject of a fatal accident inquiry or prosecution. Care homes say the investigation is "disproportionate" and placing a huge burden on overstretched staff. The COVID-19 Deaths Investigation Team (CDIT) had received 3,385 death reports as of Thursday. The majority of them relate to people who lived in care homes. Behind the Crown Office statistics are hundreds of families grieving for loved ones who died in Scotland's care homes. Alan Wightman's 88-year-old mother Helen died in May last year during a Covid outbreak at Scoonie House in Fife Helen's death is part of the Crown Office probe and Mr Wightman's hopes for the investigation are that it looks "at the bigger picture and appreciates that on the ground people were doing the best they could". He added: "I thought that Scoonie House did the best they could in a very difficult situation, sourcing their own PPE and stopping people coming from hospital." "My own view is that care homes were put in an impossible situation because we had successive governments which did not properly prepare for a pandemic, you only have to look at the lack of PPE at the beginning of the pandemic to see that." Read full story Source: BBC News, 22 January 2021 -
Event
The NHS ICU Virtual Summit: Future-proofing critical care
Sam posted an event in Community Calendar
The countries focus on critical care services in England has increased because of COVID-19. A significant proportion of hospitalised patients with COVID-19 require help with breathing, including mechanical ventilation and other services critical care staff and units provide. Delivering sufficient critical care capacity goes beyond physical infrastructures – such as having more beds and equipment – and requires sufficient numbers of trained and available staff. The NHS ICU Virtual Summit: Future-Proofing Critical Care conference aims to celebrate the current efforts of ICU staff, in this time of unprecedented strain, via best practice and practical insight. We will also take a look at some key areas of potential improvement including: Understanding intensive care staffing, occupancy and capacity. Infection control. Crisis management and emergency preparedness. Clinical Information Systems. NHS staff and services will continue to be tested to their limits over the coming months, this short but high-value session aims to bring peers together from across the UK to share best practice and outcomes. Register -
EventOn November 29, 1999, the Institute of Medicine released a report called To Err is Human: Building a Safer Health System, the report reviewed the status of patient safety in the US and UK, 20 years on and the NHS have released The NHS Patient Safety Strategy. Within the newly developed strategy, the NHS has three strategic aims that will support the development of patient safety culture & a patient safety system. This virtual conference will discuss the 2020, COVID-19 response best practice, along with some national policy insights and international trends. Register
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News ArticleOnly a little over half of British Indians say they would get a coronavirus vaccine, according to research. Some 56% of British Indians said they would take up a vaccine when asked by the 1928 Institute, a new think tank led by academics from the University of Oxford. However, 31% per cent were unsure, while 13% said they would decline a jab, the online poll of 510 respondents found. The think tank said much of this stemmed from people feeling they were not informed enough about the vaccines, while a significant proportion felt other people deserved to receive a vaccine more. The researchers are calling for an urgent public health campaign and funding, with messaging in different languages and co-produced with community leaders to assuage doubts. The government should also widely share information on how it is helping poorer countries distribute vaccines, given that several participants said vulnerable people and those in poorer countries should take priority, they said in their report. Read full story Source: The Independent, 21 January 2021
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News Article‘Surge’ clauses allowing the NHS to again take over private hospitals — as it did in the spring — have been triggered in some areas, HSJ has learned. An email from NHS England to private hospitals in London, seen by HSJ, was sent last week, triggered a seven-day notice period under NHSE’ covid contracts with the providers. The letter said the London region had requested the move after taking into account “critical care capacity, the doubling rate [and the] forecast acute admission rate related to local prevalence.” The letter refers to the north central London health system, but HSJ understands similar arrangements have been triggered for north east London. The two areas have a combined population of 3.9m people and have been some of the hardest hit by covid admissions. The clause is also thought to have been triggered in other parts of south east England, but it is not known which ones. The letter listed six hospitals, five owned by BMI Healthcare and one by Aspen Healthcare, which would, from Friday, commit “100 per cent” of their capacity to NHS use. Read full story (paywalled) Source: HSJ, 20 January 2021
