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During the initial impact of the COVID-19 pandemic, the Government recognised that a key enabler would be to increase capacity within the NHS, ensuring that enough acute beds were available to cope with the rising tide of patients. An important policy priority has been to ensure the safe discharge of patients back into their home or, where appropriate, into a placement with a community provider. While there were already pathways in place to accelerate this process, responding to the pandemic required a significant acceleration of hospital discharges. Hospital discharges are complex. To enable a safe and timely transfer of care, they require good co-ordination between hospital and community staff to arrange clinical assessments and to equip the home or community setting with the appropriate equipment and care plans. In this submission to the Inquiry, Patient Safety Learning and CECOPS focus on: Rapid hospital discharge - considering the challenges to this caused by the pandemic, the importance of interoperability in overcoming these, preventing care homes and nursing homes becoming vectors of transmission and harnessing digital technologies, such as an app, to assist hospital discharges. Community support - as the rate of hospital discharges significantly increases, the need to consider the availability of Personal Protective Equipment supplies, access to and guidance on supportive equipment and technologies and other pressures that will need to be met by community support services. In the concluding comments the submission sets out an eight-point action plan required to tackle this issue: A model of demand to inform hospital discharge and planning of community and care services New agile ways of working using digital technologies. An improved cross health and social care information system is imperative to ensure safe transfers of care Strengthened cross-sector leadership and communication with clinical teams and patients and families The provision of equipment services addressed urgently - to support hospital discharge and prevent admissions i.e. wheelchair, prosthetic, orthotic and equipment services Integration of planning and service delivery across sectors with the right leadership, the ability and capacity at a local level to streamline services and procurement to the needs of patients, families, and care providers Innovation in the development of safe transfers of care. We must adapt the traditional bureaucratic processes and regulatory framework to ensure that the needs of patients are met speedily Financial support to ensure that there is capacity to provide community-based care The safety of patients at the core of all plans and service delivery. All plans should include how the safety of patients is being prioritised. References [1] UK Parliament, Delivering Core NHS and Care Services during the Pandemic and Beyond, Last Accessed 7 May 2020. https://committees.parliament.uk/work/277/delivering-core-nhs-and-care-services-during-the-pandemic-and-beyond/ [2] UK Parliament, Call for evidence: Delivering Core NHS and Care Services during the Pandemic and Beyond, Last Accessed 29 April 2020. https://committees.parliament.uk/call-for-evidence/131/delivering-core-nhs-and-care-services-during-the-pandemic-and-beyond/

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The Health and Social Care Select Committee is currently holding an inquiry to consider the preparedness of the UK to deal with the coronavirus pandemic. MPs will focus their discussion on measures to safeguard public health, options for containing the virus and how well prepared the NHS is to deal with a major outbreak. At Patient Safety Learning we are gathering #safetystories from both staff and patients to highlight the challenges for safety in healthcare that are resulting from the pandemic. Ahead of the Committee’s next oral evidence session we have raised several urgent safety issues with the Chair, Jeremy Hunt MP. The Committee should seek answers and actions from NHS leaders and politicians on the issues identified to ensure the safety of staff and patients. Below is a summary of our submission to the Committee, a full copy of which can be found here. Personal Protective Equipment (PPE) for staff There has been an increasing number of concerns raised by staff through the media over the past week around problems accessing appropriate PPE. While at a senior level there has been assurances about the availability of appropriate PPE for NHS staff, we are concerned that this is not being borne out by their experiences on the front-line, undermining trust and confidence that staff safety is being treated as a priority. In our submission we’ve cited several issues raised by healthcare workers in this regard, such as discrepancies in the amount of PPE available to staff in some roles (e.g. ambulances) as opposed to others (e.g. emergency departments). There have also been concerns about the guidance provided on what PPE is required. We’ve been advised of incidents where this has been downgraded to reflect the availability of supplies; this is clearly highly risky and does not reflect a science-based response to the pandemic. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What is being done to ensure all ‘at risk’ staff have access to PPE, not only in the Intensive Treatment Units (ITUs) but Emergency Departments, Wards, Ambulances, in the community, everywhere? Who is in charge in every organisation to ensure that PPE is available and in use, according to robust guidelines? How do staff report concerns and to whom? What assurances are there that the safety of staff is paramount and that the cost of PPE is not preventing staff from having access to life-saving protection? How is the NHS supply chain communicating with trusts over likely lead times for PPE and availability of supplies? Is there transparency in this so that trusts can plan effectively how to use the stocks they have left? Testing There has been a number of reports about how the UK’s approach to testing differs from World Health Organization guidance and we’ve had concerns raised directly with us by staff who are genuinely fearful that they are infected and spreading the virus to their friends, family and the general public without knowing. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What is the policy for testing and tracing patients for Covid-19 in the UK? What are the requirements for test production and testing capacity in this country? What are the plans and timescales to deliver this? We think that the scale of testing is compromising our ability to track the spread of the virus and isolate those that are infected. Non Covid-19 care Understandably the healthcare system is focusing its attention on the deadly effects of the coronavirus and we believe that we need to pay attention to patient safety now more important than ever. We are hearing stories of patients whose planned tests, elective operations, diagnostic procedures are being postponed or delayed while the health care system focuses on responding to the pandemic. It is important to assess the impact the coronavirus will have on other areas of care and ensure it does not magnify or exacerbate existing patient safety issues. We’re asking patients to share their safety stories with us to highlight weaknesses or safety issues that need to be addressed and share solutions that are working, so we can seek to close the close the gaps that might emerge as a result of the pandemic. We’re asking the Committee to bring the following questions to the meeting, and to seek answers and action from NHS leaders and politicians: What arrangements are being put in place to inform patients and families of any changes in non Covid-19 care during the pandemic? How are UK patients and families being informed about any such changes in their care? What should patients do if they notice new signs and symptoms? References [1] UK Parliament, Health and Social Care Committee: Preparations for Coronavirus, Last Accessed 25 March 2020. [2] HSJ, Staff in ‘near revolt’ over protective gear crisis, Last Accessed 25 March 2020.

The programme includes key materials to help the health and care workforce respond to Coronavirus. Initially, the Coronavirus programme will include limited resources, but more content will be added in the coming days and weeks. The additional content will include new content and content curated from different sources such as existing HEE e-LfH sessions and other resources from organisations such as NHS England and NHS Improvement or the World Health Organization (WHO). Courses in the Coronavirus programme currently include: Essential Guidance from the NHS and Government Infection Prevention and Control Public Health England – Personal Protective Equipment Critical Care Resources.

Background and scope of guidanceWhat do we mean by extremely vulnerable?What you need to knowSymptomsWhat is shielding?What should you do if you have someone else living with you?Handwashing and respiratory hygieneWhat should you do if you develop symptoms of coronavirus (COVID-19)?How can you get assistance with foods and medicines if you are shielding?What should you do if you have hospital and GP appointments during this period?What is the advice for visitors, including those who are providing care for you?What is the advice for informal carers who provide care for someone who is extremely vulnerable?How do you look after your mental well-being?What steps can you take to stay connected with family and friends during this time?What is the advice for people living in long-term care facilities, either for the elderly or persons with special needs?What is the advice for parents and schools with extremely vulnerable children?

"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