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News Article
Largest ever daily fall in covid hospital patients
Patient Safety Learning posted a news article in News
The number of covid positive patients in English hospitals fell by 1,491 yesterday, by far the biggest decline recorded since the start of the pandemic. The previous record was set during the decline of the first wave, when numbers fell 1,055 on 17 April. The largest drop in the third wave before yesterday’s record was the 798 seen last Saturday. The national total of covid positive hospital patients now stands at 30,846, a drop of 9 per cent on the peak set on 18 January, but still 163 per cent of the mid-April peak. All seven English regions are now seeing a week-on-week decline in the number of their covid hospital patients for the first time. All have well established trends in falling admissions, with London and the south east seeing the running seven-day total fall by almost a third since a peak on 9 January. The east and south west have seen their admissions total decline by a fifth, while the midlands total has dropped 16 per cent in just five days and north east and Yorkshire nine in only four. Read full story (paywalled) Source: HSJ, 28 January 2021 -
News Article
Black over-80s 'half as likely' to have been vaccinated
Patient Safety Learning posted a news article in News
Black people over the age of 80 were half as likely as their white peers to have been vaccinated against Covid by 13 January, a large study suggests. This is despite the fact black people are four times more likely to die with COVID-19 than their white counterparts. People living in deprived areas or who have severe mental-health conditions or learning disabilities were also less likely to have received a vaccination. The study was based on more than 20 million patient records in England. The OpenSafely study, by the University of Oxford and the London School of Hygiene and Tropical Medicine, found of the million of those over 80 but not living in a care home: 43% of the white people had been given their first dose of the vaccine 30% of the Bangladeshi and Pakistani people had 21% of the black people had. Bangladeshi and Pakistani people are twice as likely to die with COVID-19 as white peple. Birmingham-based business owner Tru Powell told BBC Radio 5 Live of a "lack of trust between the government and people of colour". "People of colour have been subject to institutionalised racism within the healthcare system," she said. "We are five times more likely to be detained under the Mental Health Act and four times more likely to die in childbirth." Read full story Source: BBC News, 28 January 2021 -
News ArticleOnly a third of local authorities that are rolling out lateral flow testing have made the test’s limitations clear to the public—including that it does not pick up all cases and that people testing negative could still be infected, an investigation by The BMJ has found. A search of the websites of the 114 local authorities rolling out lateral flow testing found that 81 provided information for the public on rapid COVID-19 testing. Of these, nearly half (47%; 38) did not explain the limitations of the tests or make it clear that people needed to continue following the restrictions or safety measures even if they tested negative, as they could still be infected. Although 53% (43) did advise people to continue to follow the current measures after a negative result, only 32% (26) were clear about the test’s limitations or its potential for false negatives. The advice the websites gave to the public about a negative test result ranged from “A single negative test is not a passport to carrying on your daily life ‘virus-free’... don’t let a negative COVID-19 test give you a false sense of security” to “It is good news that you don’t have the coronavirus.” On 10 January England’s health secretary, Matt Hancock, launched the drive for local authorities to test asymptomatic people who cannot work from home, to try to halt the spread of the virus. But many public health experts are concerned about false reassurance from mass testing. Read full story Source: BMJ, 26 January 2021
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News ArticleNew advice on how to treat coronavirus has been issued by the World Health Organisation (WHO) as it also begins a wide-reaching study into the effects of so-called "long COVID". For COVID-19 patients at home, WHO is now suggesting the use of a pulse oximetry machine to measure oxygen levels in the blood - but warns that this should only be done after full patient education and with medical follow-up support if necessary. For hospitalised patients, WHO is recommending the use of low-dose anticoagulants to prevent clots forming in blood vessels, known as thrombosis. And for sufferers who are already using supplemental oxygen, the organisation is officially endorsing the positioning of patients on their stomachs to increase oxygen flow. This is known as "awake prone positioning". The new guidelines also include a recommendation that healthcare professionals favour "clinical judgement over models" in making decisions for individual patients. Read full story Source: Sky News, 26 January 2021
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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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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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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 -
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 -
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 -
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
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News Article
Trusts told to treat more COVID-19 patients at home
Patient Safety Learning posted a news article in News
Hospitals should ramp up their treatment of COVID-19 patients at home to free up more beds during the peak of the pandemic, under plans announced by NHS England/Improvement. All NHS trusts will receive up to 300 oximeters, which measure oxygen saturation levels and can be used to monitor COVID-19 patients in their own homes, rather than in hospital beds. NHSE has “recommended” that all areas of England “pursue immediate roll-out” given the “intense pressure on hospital beds right now”, according to a letter from medical director Steve Powis and two other national directors. Currently, nearly 60 trusts have COVID-19 patients in at least a third or more of their beds, and the total number of COVID-19 patients is peaking at around 37,000. There have been particular strains on hospital discharge, particularly of covid patients, whom many care homes are unable or unwilling to receive. The scheme, dubbed “covid virtual wards”, has been used at some trusts since the pandemic’s first wave. Read full story (paywalled) Source: HSJ, 19 January 2021 -
News Article
Covid: 'Sharp drop' in heart-attack hospital admissions
Patient Safety Learning posted a news article in News
There has been a sharp drop in the number of patients admitted to hospitals in England with heart attacks or heart failure in recent months, research reveals. Experts are worried that people who need urgent medical help are not seeking it. This was also the case during the first wave of the pandemic. The researchers included 66 hospitals in the study and compared daily admission rates in the year before the pandemic with those during the first and second waves in England, up to 17 November. During the first lockdown, daily admissions for heart attacks or heart failure decreased by more than 50%. They went up again in the summer, as coronavirus rates decreased in the UK and the NHS became less busy with the virus. From October, when coronavirus cases were rising again, heart admissions began to drop - by between 35% and 41% compared with pre-pandemic data, according to the study published in the Journal of the American College of Cardiology. Researcher Prof Chris Gale, from Leeds University, said: "Medical emergencies do not stop in a pandemic. I am afraid that we are seeing a re-run of one of the preventable tragedies of the first wave - people were either too afraid to go to hospital for fear of contracting COVIDd-19 or were not referred for treatment." "The message to patients needs to be clear. If they experience symptoms of a heart attack or acute heart failure, they need to attend hospital." Read full story Source: BBC News, 20 January 2021 -
News ArticleNearly a third of people who were discharged from hospitals in England after being treated for COVID-19 were readmitted within five months – and almost one in eight died, a study suggests. The research, which is still to be peer-reviewed, also found a higher risk of problems developing in a range of organs after hospital discharge in those younger than 70 and ethnic minority individuals. “There’s been so much talk about all these people dying from Covid … but death is not the only outcome that matters,” said Dr Charlotte Summers, a lecturer in intensive care medicine at the University of Cambridge who was not involved in this study. “The idea that we have that level of increased risk in people – particularly young people – it means we’ve got a lot of work to do.” There is no consensus on the scale and impact of “long Covid”, but scientists have described emerging evidence as concerning. According to recent figures provided by the Office for National Statistics (ONS), a fifth of people in England still have coronavirus symptoms five weeks after being infected, half of whom continue to experience problems for at least 12 weeks. Read full story Source: The Guardian, 18 January 2021
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News ArticleFor the last 10 months, everyone in healthcare has lived their lives as if they were trapped in a burning building without a fire escape. No matter how much water we throw on the fire or how many firefighters (healthcare providers in this instance) we send in, we cannot gain control of the flames. The catastrophic loss of life has been insurmountable, and we often haven’t had enough physicians to take care of everyone. This is not new for a healthcare system. For years prior to this pandemic, there has been a physician shortage in the United States that is expected to worsen over the coming years. The Association of Medical Colleges (AAMC) predicts that the US could see a shortage between 54,000 and 139,000 physicians in both primary and specialty care by 2033. Although the total physician supply is expected to grow, it won’t be at a fast enough rate to outpace demand. This is where physician assistants (PAs) and advanced practice nurses (APRNs) come in. Many people don’t realise that PAs and APRNs have been around for over 50 years. For 50 years, a plethora of research has shown that PAs and APRNs are safe, reliable, high quality healthcare providers and essential members of the healthcare team. But too often critics claim that because they have not gone through physician training, they cannot provide exceptional medical and surgical care. In fact, they already do. A recent comprehensive review of PA and APRN outcomes from 2008 to 2018 found that PAs and APRNs had similar outcomes compared to physicians including hospital length of stay, readmission rates, quality and safety and patient and staff satisfaction. Read full story Source: The Hill, 16 January 2021
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News ArticleNHS bosses have instructed hospitals to keep performing urgent cancer surgery despite Covid pressures, after a growing number cancelled procedures because they did not have enough intensive care beds or available staff. They have told England’s regional directors of cancer to ensure treatment of people who need cancer surgery within four weeks gets the same priority as care of patients who have Covid. The move was unveiled in a letter, obtained by HSJ, sent last Friday by Amanda Pritchard, the chief operating officer at NHS England and NHS Improvement. It was also signed by Cally Palmer, the NHS’s national cancer director, and Prof Peter Johnson, a highly respected specialist who is the NHS’s national clinical director for cancer. They have acted after unease among cancer specialists that growing numbers of hospitals, including all those in London, had cancelled urgent operations. Hospitals have felt obliged to do so either because they did not have enough intensive care beds for patients who might need one after their cancer procedure or because surgical staff had been repurposed to help care for Covid patients. Doctors voiced alarm at the scale of recent postponements of what the NHS classes as “priority two” operations. That means they should be done within 28 days to ensure that someone with cancer does not see their disease spread or become inoperable because it was delayed. More than 1,000 cancer patients in London are now waiting to have “priority two” or “P2” urgent surgery, but none have been given a new date for when it will happen, HSJ reported last week. Read full story Source: The Guardian, 18 January 2021
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News ArticlePeople in high-risk minority ethnic groups must be prioritised for Covid immunisations, alongside a targeted publicity campaign, experts and politicians have said amid growing concerns over vaccine scepticism. With figures on Monday recording more than 4m Covid vaccine doses now administered across the UK, and the rollout being expanded to all over-70s, public health experts and MPs called for black, Asian and minority ethnic (BAME) communities to be better protected. The Scientific Advisory Group for Emergencies (Sage) has also raised concerns after research showed up to 72% of black people said they were unlikely or very unlikely to have the jab. Prof Martin Marshall, chair of the Royal College of GPs, urged Whitehall to begin a public health campaign. “We are concerned that recent reports show that people within BAME communities are not only more likely to be adversely affected by the virus but also less likely to accept the Covid vaccine, when offered it,” he said. “As such, where appropriate, we’re calling for public health communications to be tailored to patients in BAME communities, to reassure them about the efficacy and safety of the vaccine and ultimately encourage them to come forward for their vaccination when they are invited for it.” His remarks came as the vaccines minister, Nadhim Zahawi, admitted he feared some BAME communities could remain exposed to coronavirus despite high expected uptake of the jabs. Read full story Source: The Guardian, 18 January 2021
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News Article
Patients ‘treated in ambulances as there was no space in A&E’
Patient Safety Learning posted a news article in News
A London hospital is being forced to send patients back to ambulances for treatment due to an ‘overwhelming’ number of Covid patients on ICU wards, according to a frontline doctor. The medic, who asked to remain anonymous, said A&E staff are "running" into waiting ambulances to treat patients there until space becomes available. He said: "It’s not the fault of the staff, but the sheer numbers are so unprecedented and being full like this means that you just have to do your best to adapt. But it’s not the standard (of care) I signed up to." "It’s extremely stressful for us to be doing our best but knowing that significant patient harm is happening because there isn’t space and the patient load is too high." He raised concerns that "significant patient harm" was occurring due to a lack of beds available and the emergency system means medics are limited in the care they can provide. Read full story Source: The Metro, 14 January 2021
