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The results found there were 129 unique mentions of barriers to patient safety; these barriers were categorised into five major themes. ‘Limited resources’ was the most prominent theme, followed by barriers related to health systems issues, the medical culture, provider training and patient education/awareness. Although inadequate resources are likely a substantial challenge to the improvement of patient safety in India, other patient safety barriers such as health systems changes, training, and education, could be addressed with fewer resources. While initial approaches to improving patient safety in India and other low- and middle-income countries have focused on implementing processes that represent best practices, this study suggests that multifaceted interventions to also address more structural problems (such as resource constraints, systems issues, and medical culture) may be important.

Birth choices Our pregnant women are still being offered good choices in their birth experience such as homebirth and water birth, so long as they are well. I did two lovely home births this week. We are definitely seeing a rise in people transferring to our homebirth service. I do think there is a concern nationally about high risk women choosing to homebirth unassisted, in areas where maternity services have suspended homebirth as an option. Because women in my area still have the option of a homebirth, it’s not something we’re experiencing. Birthing partners and limited visits Partners are allowed at births including cesarean sections. Also, we’ve had lots of very positive feedback from the women to say that not having their partners or visitors on the wards hadn’t been as bad as they thought, as they have talked and bonded more with other new mums and made new friends. It’s difficult for them without the support of family in the postnatal period but with encouragement they can usually see it as a positive, a time for them to bond as a family and get to know their little ones. Dads are actually very positive realising that it means they get to spend much more time with their partners and new baby. Appointments and new ways of working My Trust are doing just as many face to face antenatal visits. We do virtual appointments at booking and 16 weeks in the vast majority of cases but GPs locally are refusing to see women at 25 and 31 weeks, so we have changed the schedule to include these in midwifery care. We are using well midwives, who are isolating at home for whatever reason, to do phone clinics for booking and 16 week appointments which lifts the pressure off those of us working clinically. They also ring around all of the women due to be seen to make sure they’re well and understand that they need to attend appointments alone. I’m a case loading midwife so I know my mums to be/new mums well and do feel I’ve been able to support and reassure them effectively. I know that sadly not everyone is in this position though. Staff levels and wellbeing Annual leave has been cancelled. Nobody has complained about this though (or at least nobody that I’m aware of). We were expecting it and realise it’s vital. Lots of staff are also picking up extra shifts. If staffing levels drop though the pressure will be enormous. My trust have been very proactive regarding training and we are all being supported in terms of wellbeing. Accommodation has been provided for staff unable to go home and wellness packages and mental health support is in place. We’ve even been provided with a pop-up supermarket. Our local community are also amazing. Most staff could access a free hot meal most days if they chose to from various donations, school, restaurants and local sports teams. Hand cream, treats, snacks etc are always coming in. We feel so appreciated and loved One of our biggest issues is PPE Even for confirmed COVID-positive women we are given less protection than we are normally given when caring for women with flu. Working in community, this has its own issues. Statistically we know that the chances are that viral loads in homes are likely to be high due to the number of people present in small spaces, more soft furnishings, less stringent cleaning routines etc. The apron and mask we are given are unlikely to offer us any real protection. When we leave the houses we then have to transport the contaminated personal protective equipment (PPE) in our own vehicles, we’re wearing uniform that is likely to be contaminated and we are stood on pavements trying to clean the equipment we have used because that too will be contaminated. We’re not protected in the same way that hospital staff are. We are walking in to homes where there may be 4 or 5 people in the same room that we need to be in, as everyone is at home. We keep being told effective hand washing is key but we’re doing that in environments which are often less than clean, and in cases of COVID-confirmed women we can’t wash our hands at all as we’re unable to remove our PPE until we’ve left the house. It all feels very unsafe both in terms of staff contracting COVID-19 and cross contamination to other women, colleagues and our family. The support we are lacking comes from Public Health England and the Government. PPE guidance and availability is pitiful and dangerous and I believe is based on availability rather than need or any scientific basis. Do you work in maternity services? Or perhaps you are expecting a baby? Does this midwife's account reflect the maternity services in your area at the moment, or are you seeing different positives and challenges? We want to hear from patients and staff, so please sign up to comment below or contact us directly (content@pslhub.org) to share your story.

"In one of the most vivid scenes in the Home Box Office (HBO) miniseries 'Chernobyl' (among many vivid scenes), soldiers dressed in leather smocks ran out into radioactive areas to literally shovel radioactive material out of harm's way. Horrifically under-protected, they suited up anyway. In another scene, soldiers fashioned genital protection from scrap metal out of desperation while being sent to other hazardous areas. Please don't tell me that in the richest country in the world in the 21st century, I'm supposed to work in a fictionalized Soviet-era disaster zone and fashion my own face mask out of cloth because other Americans hoard supplies for personal use and so-called leaders sit around in meetings hearing themselves talk. I ran to a bedside the other day to intubate a crashing, likely COVID, patient. Two respiratory therapists and two nurses were already at the bedside. That's 5 N95s masks, 5 gowns, 5 face shields and 10 gloves for one patient at one time. I saw probably 15-20 patients that shift, if we are going to start rationing supplies, what percentage should I wear precautions for? Make no mistake, the CDC (Centers for Disease Control and Prevention) is loosening these guidelines because our country is not prepared. Loosening guidelines increases healthcare workers' risk but the decision is done to allow us to keep working, not to keep us safe. It is done for the public benefit – so I can continue to work no matter the personal cost to me or my family (and my healthcare family). Sending healthcare workers to the front line asking them to cover their face with a bandana is akin to sending a soldier to the front line in a t-shirt and flip flops. I don't want talk. I don't want assurances. I want action. I want boxes of N95s piling up, donated from the people who hoarded them. I want non-clinical administrators in the hospital lining up in the ER asking if they can stock shelves to make sure that when I need to rush into a room, the drawer of Personal Protective Equipment (PPE) I open isn't empty. I want them showing up in the ER asking 'how can I help' instead of offering shallow 'plans' conceived by someone who has spent far too long in an ivory tower and not long enough in the trenches. Maybe they should actually step foot in the trenches. I want billion-dollar companies like 3M halting all production of any product that isn't PPE to focus on PPE manufacturing. I want a company like Amazon, with its logistics mastery (it can drop a package to your door less than 24 hours after ordering it), halting its 2-day delivery of 12 reams of toilet paper to whoever is willing to pay the most in order to help get the available PPE supply distributed fast and efficiently in a manner that gets the necessary materials to my brothers and sisters in arms who need them. I want Proctor and Gamble, and the makers of other soaps and detergents, stepping up too. We need detergent to clean scrubs, hospital linens and gowns. We need disinfecting wipes to clean desk and computer surfaces. What about plastics manufacturers? Plastic gowns aren't some high-tech device, they are long shirts/smocks... made out of plastic. Get on it. Face shields are just clear plastic. Nitrile gloves? Yeah, they are pretty much just gloves... made from something that isn't apparently Latex. Let's go. Money talks in this country. Executive millionaires, why don't you spend a few bucks to buy back some of these masks from the hoarders, and drop them off at the nearest hospital. I love biotechnology and research but we need to divert viral culture media for COVID testing and research. We need biotechnology manufacturing ready and able to ramp up if and when treatments or vaccines are developed. Our Botox supply isn't critical, but our antibiotic supply is. We need to be able to make more plastic Endotracheal tubes, not more silicon breast implants. Let's see all that. Then we can all talk about how we played our part in this fight. Netflix and chill is not enough while my family, friends and colleagues are out there fighting. Our country won two world wars because the entire country mobilised. We out-produced and we out-manufactured while our soldiers out-fought the enemy. We need to do that again because make no mistake, we are at war, healthcare worker s are your soldiers, and the war has just begun." First published on www.telegram.com/news

Although participants tended to feel a general obligation to work during an influenza pandemic, there are barriers to working, which, if generalisable, may significantly reduce the NHS workforce during a pandemic. The barriers identified are both barriers to willingness and to ability. This suggests that pandemic planning needs to take into account the possibility that staff may be absent for reasons beyond those currently anticipated in UK planning documents. In particular, staff who are physically able to attend work may nonetheless be unwilling to do so. Although there are some barriers that cannot be mitigated by employers (such as illness, transport infrastructure etc.), there are a number of remedial steps that can be taken to lesson the impact of others (providing accommodation, building reciprocity, provision of information and guidance etc). The authors suggest that barriers to working lie along an ability/willingness continuum, and that absenteeism may be reduced by taking steps to prevent barriers to willingness becoming perceived barriers to ability.