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We should all strive to keep antibiotics working for our NHS surgeons and future generations, by decreasing antibiotic use in medicine. It is mums themselves who could dramatically decrease antibiotic use, in the only medical specialty where this is possible - in obstetrics - by keeping skin intact; by being informed of the 10cm diameter that 'Aniball' and 'Epi-no Delphine Plus' birth facilitating devices, the mechanical version of Antenatal Perineal Massage, achieve by skin expansion (much like by 'earlobe skin expanders') prior to birth, for back of baby's head. This enables a normal birth for many more babies by shortening birth, with no cutting (episiotomies) or tearing, and much fewer Caesarean sections, as each Caesarean section requires antibiotics to be injected into mum, to kill any bacteria, which might have invaded a skin cell, from being implanted with that skin cell, deep into the wall of the uterus, by the surgeon's knife. There are around 750,000 births in the UK alone and three-quarters of mums are damaged during birth and at risk of developing infection; so a dramatic decrease in antibiotic use is possible. Empowering mums with knowledge; that both the skin and the coats of the pelvic floor muscles, which form the floor of the lower tummy, can be stretched painlessly, in preparation of birth, from the 26th week of pregnancy, so a gentler, kinder birth for both baby and mum becomes possible by decreasing risky obstetric interventions. Muscle can be stretched to 3 times its original length, if stretched painlessly over 6 or more occasions, and still retains its ability to recoil back, contracting to its original length. So there is no damage to mum. Baby's delicate head is not used to achieve this 'birth canal widening', because Antenatal Perineal Massage or Aniball or Epi-no Delphine Plus have already achieved this prior to the start of birth. In birth this stretching is rushed within the last 2 hours of birth, with risk of avulsion of pelvic floor muscle fibres from the pubic bone and risk of skin tearing or the need for episiotomy. The overlying skin will likewise stretch without tearing if done over 6 or more occasions. The maximal opening in the outlet or lower part of the pelvis is 10cm diameter, so 10cm diameter is the goal of the birth aiding devices and 'Antenatal Perineal Massage' or 'Birth Canal Widening' - opening doors for baby maximally. The mother reviews on 'Aniball' and 'Epi-no Delphine Plus' are impressive: Wanda Klaman, a first time mum, gives birth at nearly 42 weeks to a 4.4kg baby, with no need for episiotomy or forceps; Sophie of London, avoids episiotomy, when forceps are used to aid delivery for her baby who lays across her tummy - transverse lay, because the skin at this opening is so stretchy thanks to the birth facilitating devices. Cochrane Collaborate Report on Antenatal Massage https://pubmed.ncbi.nlm.nih.gov/23633325/ https://www.dailymail.co.uk/news/article-7450045/Fears-infections-pandemic-grow-NINETEEN-new-superbugs-discovered-UK.html https://www.mirror.co.uk/news/uk-news/mistakes-maternity-wards-setting-nhs-22702909

The NHS 111 service has permanently stopped nurses and other healthcare professionals in a clinical division handling calls with people suspected of having COVID-19 after an audit of recorded calls found more than 60% were not safe. The audit was triggered in July after many of the medical professionals recruited to work in that clinical division of the 111 service sounded the alarm, saying they did not feel “properly skilled and competent” to fulfil such a critical role. An investigation was launched into several individual cases after the initial review found that assurances could not be given “in regard to the safety of these calls”, according to an email, seen by the Guardian, from the clinical assurance director of the National Covid-19 Pandemic Response Service. In a further email on 14 August, she told staff that after listening to a “significant number” of calls “so far over 60% … have not passed the criteria demonstrating a safe call”. A number of “clinical incidents” were being investigated, she said, because some calls “may have resulted in harm”. One case had been “escalated as a serious untoward incident with potential harm to the patient”. NHS England declined to answer questions about any aspect of these apparent safety failings, saying it was the responsibility of the South Central ambulance service (SCAS), which set up a section of NHS 111 called the Covid-19 Clinical Assessment Service (CCAS). Read full story Source: The Guardian, 1 October 2020

Hundreds of people believe the 111 helpline failed their relatives. Now the Guardian reports that they are demanding a full inquiry into the service. When the coronavirus outbreak hit in March, the NHS feared hospitals could be overwhelmed and so patients with suspected symptoms were directed to call the designated 111 helpline. Call volumes were massive and waiting times were often over an hour. The Guardian’s David Conn has spent months talking to bereaved relatives about that difficult time and during his conversations he found many were deeply unhappy about the service they felt had been provided by the 111 helpline. Lena Vincent’s partner Patrick McManus died from the virus in April following a short period in hospital. He had called 111 three times and had not been advised to seek further medical help. Lena tells Anushka she wants to know who is accountable for the service. Listen to the podcast Source: The Guardian, 28 September 2020

Nurses and non-medical staff have been stopped from taking patient calls to the NHS coronavirus helpline amid concerns over the safety of their advice. An audit of calls to the telephone assessment service found more than half were potentially unsafe for patients, according to a leaked email shared with The Independent. At least one patient may have come to harm as a result of the way their assessment was handled. The COVID-19 Clinical Assessment Service (CCAS) is a branch of the NHS 111 phone line and is designed to assess patients showing signs of coronavirus to determine whether they need to be taken to hospital or seen by a GP. The helpline was set up at the start of the pandemic to divert patients with symptoms to a phone-based triage to relieve pressure on GPs and prevent them from turning up at surgeries and spreading the virus. GPs, nurses and allied health professionals (AHPs) such as paramedics and physiotherapists were recruited to speak to patients after they were flagged by NHS 111 call handlers. The use of non-medical staff was first paused in July amid concerns about the quality of call handling. Now it has emerged much wider safety issues have surfaced. Read full story Source: The Independent, 18 August 2020

A key element in the new covid-19 response service run by NHS 111 urgently needs more doctors, NHS England has said. The national covid-19 clinical assessment service, or CCAS, serves a cohort of patients with coronavirus symptoms deemed by 111 as needing a clinical assessment over the phone or online. An email to GPs from NHSE’s primary care directors on Friday evening said: “We urgently need more GPs help to staff this service, especially as covid-19 cases increase over coming days, because of your expertise and experience.” Read full story Source: HSJ, 6 April 2020

The rapid spread of coronavirus has given the NHS a “kick forward” in the need to accelerate technology and ensure staff are digitally prepared, a GP has said. Neil Paul, a Digital Health columnist and GP in Ashfields, said the need to reduce face-to-face appointments to prevent the potential transmission of Covid-19 has forced the NHS, particularly in primary care, to adopt already available technologies. He said practices “still in the stone ages” and “technophobes” were less prepared for the current situation, but that it would force them to move into the digital age. “It’s absolutely made my surgery go ‘right, how do we do online consults’. I think it actually has given people a real kick forward,” he told Digital Health News. “I think in six months’ time my surgery might be very different in that actually we will be doing a lot of online and telephone consults where previously we may have been a bit reluctant." GP practices across the country have been advised to assess patients online or via telephone and video appointments to mitigate the potential spread of coronavirus. In a letter to GPs last week, NHS England urged Britain’s 7,000 GP surgeries to reduce face-to-face appoints for patients displaying symptoms of Covid-19. The preemptive move means millions of patients will now be triaged online, via telephone or video and contacted via text messaging services. Read full story Source: Digital Health News, 13 March 2020

Regional NHS leaders in England have been ordered to immediately organise a primary care management service to care for covid-19 patients who “do not require immediate admission” to hospital. In a letter sent on 8 March, seen by The BMJ, NHS England and NHS Improvement’s strategic incident director for coronavirus, Keith Willett, has ordered regional primary care and public health directors to set up a 24 hour, seven day a week service to manage patients in the community. This service should be delivered by an out-of-hours provider, and every part of England must be covered by Tuesday 10 March, the letter said. The service will be used to manage patients who are deemed well enough to be isolated at home, with active monitoring for people who are at high risk of developing severe illness, and advice to those not deemed high risk on what to do if their illness deteriorates. The letter advises that patients “remain in isolation until 5 days after resolution of symptoms, unless [they are a] healthcare worker or work with high risk groups, in which case require one negative sample 5 days after resolution of symptoms before return to work.” People with mild illness and not in a high risk group will be told to isolate themselves at home and will be given health advice on how to identify deterioration. All patients managed at home will be given a phone number to call if they feel more unwell. The letter said that the community service should be provided by a nurse and GP team and that all clinical information should be recorded and transferred to the patient’s general practice. Providers must also provide regular situation reports, including confirmed numbers of patients cared for under the service, numbers of patients who deteriorate, and numbers of patients admitted to and discharged from the service. Read full story Source: BMJ, 9 March 2020