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Psychological first aid in emergencies training for frontline staff and volunteers

Frontline staff and volunteers at the forefront of the national coronavirus response across England will be able to access a new Psychological First Aid (PFA) training course, the Minister for Mental Health Nadine Dorries has announced.

The course, which has been developed by Public Health England, will be available to frontline workers and volunteers dealing with the public during the coronavirus pandemic.

The free online course enables responders to develop their skills and confidence in providing key psychological support to people affected by coronavirus, including on issues such as job worries, bereavement or isolation as they carry out their vital work as part of the ongoing coronavirus response.

It will also help to develop understanding of how emergencies like the coronavirus pandemic can affect us all, how to recognise people who may be at increased risk of distress, and how to offer practical and emotional support.

Minister for Mental Health Nadine Dorries said:

“Supporting each other’s mental health and wellbeing is more important than ever during these challenging and uncertain times. Staff and volunteers in many different roles are working tirelessly to provide crucial support at this time and are often a critical touchpoint in identifying those who may be affected.

“This new training course will help to support the incredible work of frontline workers to support those most in need both through the coronavirus outbreak and beyond, equipping them with vital tools to deliver psychological first aid.”

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Source: GOV.UK, 15 June 2020

 

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Coronavirus: What is the true death toll of the pandemic?

At least another 130,000 people worldwide have died during the coronavirus pandemic on top of 440,000 officially recorded deaths from the virus, according to BBC research.

A review of preliminary mortality data from 27 countries shows that in many places the number of overall deaths during the pandemic has been higher than normal, even when accounting for the virus.

These so-called "excess deaths", the number of deaths above the average, suggest the human impact of the pandemic far exceeds the official figures reported by governments around the world.

Some will be unrecorded COVID-19 victims, but others may be the result of the strain on healthcare systems and a variety of other factors.

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Source: BBC News, 18 June 2020

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NHS contact-tracing app originally set for May launch is now planned 'for winter'

The NHS contact-tracing app will not be ready before winter, a health minister has said, despite initially being promised in mid-May.

Lord Bethell said the Department of Health was "seeking to get something going for the winter". But, he told a committee of MPs, the app wasn't "the priority at the moment".

Lord Bethell confirmed the government still planned to introduce a contact-tracing app, describing it as "a really important option for the future".

The app has been the subject of a trial on the Isle of Wight, where the Department of Health says it has been downloaded by 54,000 people.

Lord Bethell said the trial had been a success, but admitted that one of its principal lessons had been that greater emphasis needed to be placed on manual contact tracing.

Asked why the app had taken so long to release, Lord Bethell told the Science and Technology Committee the Isle of Wight trial had shown that people "weren't frightened of it, as we were worried that they might be" - and had also provided "concrete examples" of successes in breaking transmission chains. But he admitted there had been "technical challenges", as well as an "ongoing battle" to persuade people the system was safe and privacy-protecting.

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Source: Sky News, 18 June 2020

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A&E appointments should be introduced in response to coronavirus, says Royal College head

Appointments to be seen in A&E could be introduced permanently in response to coronavirus, the president of the Royal College of Emergency Medicine has said. 

Dr Katherine Henderson said it would cause "enormous harm" to patients if Britain returned to crowded casualty units with "elastic walls".

Instead, she said patients should be given a "contact point" such as the NHS 111 line to book a slot in an emergency department, or to be seen directly by a specialist or diverted to the care they need. 

"The old way of doing things involved emergency departments having elastic walls," Dr Henderson told MPs. "We were able to have an infinite number of patients. We were never able to say: 'We're full, we're at capacity.' We now need to recognise that we can't do that."

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Source: The Telegraph, 16 June 2020

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CQC plan to restart inspections needed like ‘hole in head’, says Confed

The Care Quality Commission (CQC) has issued a plan for re-starting routine inspections — but has been warned by the NHS Confederation that the health service needs this “like a hole in the head”.

The organisation said there would be a “managed return” of “routine inspections” in the autumn.

It also stated in a statement today: ”Inspectors are now scheduling inspections of higher risk services to take place over the summer.” But the CQC later insisted to HSJ that this was not a change to its current policy, in place since the beginning of the UK COVID-19 peak, as it would only be inspecting in response to information it receives which raises “serious concerns”.

The CQC suspended its routine inspections in March – and has instead been calling healthcare providers and only physically attending where there are serious concerns about harm, abuse or human rights breaches.

The new approach to regulation, which the CQC called its “emergency support framework”, was criticised by 11 older people’s and disabled groups, which said the decision not to carry out routine inspections broke human rights and equalities laws.

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Source: HSJ, 17 June 2020

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‘We need to act now’: Patient safety at risk as coronavirus set to compound NHS winter crisis, warns hospitals chief inspector

The chief inspector of hospitals has warned that patient safety is at risk if the NHS winter crisis is worsened by coronavirus – and ministers must act now in emergency departments to prevent a catastrophe.

Professor Ted Baker, speaking to The Independent in his first interview since the COVID-19 outbreak hit Britain, warned that the NHS could not carry on as before as hospitals across the country struggle to return to normal care while the crisis continues.

“If we are going to do something about it, we need to act now, not at the beginning of winter,” he warned, adding the Care Quality Commission (CQC) was also worried about patients being “forgotten” as NHS waiting lists surge to an expected 10 million later this year.

"We will be going into winter and all the difficulties of the winter viruses that we normally face, together with Covid. I think next winter is going to be very difficult, unless emergency departments and the whole system supporting emergency departments do things very differently.”

He warned providing care in the NHS under the shadow of coronavirus was “a formidable challenge … probably bigger than the challenge we faced at the height of the pandemic”.

Prof Baker also told The Independent that the CQC was investigating a number of reports that some hospital patients were discharged unsafely to care homes following a staggering 55% rise in whistleblowing complaints, particularly in care homes, with 2,612 calls between March and May.

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Source:  The Independent, 17 June 2020

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‘Independent review of NHS’ ahead of second wave

There should be independent reviews of the NHS’ readiness for a potential second major outbreak of coronavirus in the UK, senior doctors are arguing.

The Royal College of Anaesthetists said a series of reviews should be carried out, overseen by an independent group formed from clinical royal college representatives, independent scientists and academics.

It would encompass investigation of what happened to care quality during the peak of infection and demand through March, April and May — there are major concerns that harm and death was caused by knock of effects, with some health services closed and people being afraid to use others.

Hospitals were unable to provide many other services as staff, including most anaesthetists, were redeployed to help with critical care.

Ravi Mahajan, president of the Royal College of Anaesthetists, told HSJ areas such as capacity, workforce and protective equipment were key issues to be reviewed. He said: “We can’t wait for [the pandemic] to finish and then review. [The reviews] have to be dynamic, ongoing, and the sooner they start the better.

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Source: HSJ, 17 June 2020

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Coronavirus: NHS staff need tests 'twice a week'

A leading surgeon has said NHS staff must be routinely tested for coronavirus up to twice a week.

Prof Derek Alderson, president of the Royal College of Surgeons, said it was vital, to reassure patients staff were not unwittingly carrying the virus. 

But hospital trust bosses say they are still waiting for clarity on plans for regular testing. The Department for Health and Social Care (DHSC) said it was focusing on routine testing in care homes.

Prof Alderson was speaking at a Health Select Committee meeting about the necessary steps to get all NHS services back up and running. He said: "It's absolutely essential to regain public confidence that we are able to test our staff regularly."

It would be "pragmatic" for testing to take place "about twice weekly", he added, because it was known that the available tests were not perfect.

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Source: BBC News, 17 June 2020

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Isle of Wight patient sent home on first day of COVID-19 lockdown almost died

A patient almost died after being misdiagnosed and sent home from hospital on the first day of the lockdown as the NHS curtailed many normal services to focus on COVID-19.

The NHS trust involved has admitted that its failings led to the man suffering excruciating pain, developing life-threatening blood poisoning, and contracting the flesh-eating bug necrotising fasciitis. He needed eight operations to remedy the damage caused by his misdiagnosis.

The man, his wife and his GP spent three weeks after his discharge trying to get him urgent medical care. However, St Mary’s hospital on the Isle of Wight rejected repeated pleas by them for doctors to help him, even though his health was deteriorating sharply.

The man, who does not want to be named, said his experience of seeking NHS care for something other than COVID-19 during the pandemic had been “debilitating and exhausting” and that feeling the NHS “was not there” for him had been “very distressing” for him and his wife.

Mary Smith, of the solicitors Novum Law, who are representing the man in his complaint against the trust, said his plight highlighted the growing number of cases that were emerging of people whose health had suffered because they could not access normal NHS care in recent months.

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Source: The Guardian, 16 June 2020

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DHSC tells care homes to destroy batch of COVID-19 tests over safety fears

Care homes have been ordered to destroy a batch of faulty COVID-19 test kits after it was discovered that the swabs could break off while being used to gather samples from residents’ tonsils and noses.

Care home managers were told on Sunday not to use the tests because they had “brittle stems at risk of snapping”. The kits were manufactured by Citotest, a company based in China, and were distributed by the government’s COVID-19 care home testing programme. It is tasked with providing tests for all staff and residents in care settings, not just people displaying symptoms.

The affected batch should be destroyed or kept in a safe area clearly marked with warnings not to use them, officials said, adding that the problem emerged on Saturday and they were working as quickly as possible to resolve it.

The Department of Health and Social Care (DHSC) said the batch could have contained tens of thousands of tests and that a complaint had been raised with the manufacturer, with whom discussions were ongoing.

“We are aware of an issue with one batch of swab sticks which are being replaced where needed but this does not affect any tests, or the results of tests, previously taken,” a DHSC spokesperson said. “Testing is unaffected and people should still arrive for their booked tests.”

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Source: The Guardian, 15 June 2020

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COVID-19: Woman whose father died in care home launches legal review over government’s “litany of failures”

A woman whose father died in a care home has launched a judicial review case in the High Court over the government’s “litany of failures” in protecting the vulnerable elderly residents who were most at risk from COVID-19.

Cathy Gardner accuses England’s health and social care secretary, Matt Hancock, NHS England, and Public Health England of acting unlawfully in breaching statutory duties to safeguard health and obligations under the European Convention on Human Rights, including the right to life.

Her father, Michael Gibson, who had Alzheimer’s disease, died aged 88 of probable COVID-19 related causes on 3 April at Cherwood House Care Centre, near Bicester, Oxfordshire. She claims that before his death the care home had been pressured into taking a hospital patient who had tested positive for the virus but had not had a raised temperature for about 72 hours.

“I am appalled that Matt Hancock can give the impression that the government has sought to cast a protective ring over elderly residents of care homes, and right from the start,” Gardner said. “The truth is that there has been at best a casual approach to protecting the residents of care homes. At worst the government has adopted a policy that has caused the death of the most vulnerable in our society.”

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Source: BMJ, 15 June 2020

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Coronavirus: Oxygen supplies will be stretched as patients recover at home, NHS warns

Demand for oxygen from COVID-19 patients recovering at home is set to place the NHS under strain, the health service has warned.

NHS England has issued guidance to out-of-hospital health providers on the extra demands likely to be placed on them given the number of people recovering after a hospital stay with the coronavirus. It warns that the provision from its home oxygen services and community respiratory teams across the NHS is expected to be an issue as the scale of demand increases.

Andrew Whittamore, a practising GP and clinical lead for the Asthma UK and British Lung Foundation partnership, said concerns about the potential for hospitals to be overwhelmed in the early part of the pandemic had led to community oxygen teams being primed to take on more patients – but he described that ramping up as “a short-term fix”.

“We don’t know how long people are going to need oxygen or other services for,” he said. “There are definitely going to be extra patients added on to our community teams’ workloads.”

The Taskforce for Lung Health – of which the British Lung Foundation is a member – has raised particular concerns about access to pulmonary rehabilitation. An education- and exercise-based treatment, which is proven to be more effective for lung patients than many drug-based treatments, and face-to-face classes have been suspended during the pandemic. It may be that such treatment would also be helpful for some patients recovering from COVID-19.

Jackie Eagleton, policy officer at the British Lung Foundation, said there had been issues with access to pulmonary rehabilitation for a long time, but the need to offer this form of support to people with lung conditions “has never been more pressing than it is now”.

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Source: The Independent, 16 June 2020

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New observatory will set out actions to tackle racism “within months,” say campaigners

The architects behind the new NHS Race and Health Observatory have vowed that it will deliver actionable recommendations within months to tackle the structural racism that exists throughout healthcare.

Victor Adebowale and Mala Rao called for an observatory to tackle the ethnic health inequalities in the UK in a special issue of The BMJ that they co-edited in February (bmj.com/racism-in-medicine) and NHS England confirmed at the end of the May that the centre would go ahead.

Speaking at a meeting to discuss the aims of the observatory on 12 June, Adebowlae told more than 20 assembled stakeholders that he wanted the new centre “to fire on all cylinders,” making recommendations for changes to services that are likely to affect the health outcomes of people from black and ethnic minority backgrounds “within a couple of months.”

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Source: BMJ, 15 June 2020

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‘I had the coronavirus months ago but I’m still too ill to work... or even watch TV’

When Dan Scoble came down with the coronavirus in March, all the classic symptoms landed in one fell swoop. “I had everything under the sun: a fever, temperature, fatigue and chest pain,” he said. “My head felt like a balloon.”

The 22-year-old, a personal trainer from Oxford who normally breezed through 10-mile runs, suddenly found himself bed-bound. He presumed it would soon blow over, but 12 weeks after falling ill as the country went into lockdown, he is still not back to normal.

Dan has left his house just five times in three months — twice to see his GP and three times to hospital. He still suffers from crippling fatigue, recurrent migraines and a persistent sore throat, as well as abdominal and musculoskeletal pain.

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Source: The Times, 14 June 2020

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Unlawful do not resuscitate orders imposed on people with learning disabilities

Unlawful 'do not resuscitate' orders are being placed on patients with a learning disability during the coronavirus pandemic without families being consulted.

National charities have successfully challenged more than a dozen unlawful do not resuscitate orders (DNRs) that were put in place because of the patient’s disability rather than due to any serious underlying health risk.

Turning Point said it had learned of 19 inappropriate DNRs from families while Learning Disability England said almost one-fifth of its members had reported DNRs placed in people’s medical records without consultation during March and April.

In one example, a man in his fifties with sight loss was admitted to hospital after a choking episode and was incorrectly diagnosed with coronavirus. He was discharged the next day with a DNR form giving the reason as his “blindness and severe learning disabilities”.

Marie-Anne Peters, whose brother Alistair has epilepsy but no other health conditions, overturned a DNR on her brother which included instructions for him not to be taken to hospital.

Both charities fear other people with learning disabilities who are vulnerable could be wrongly denied life-saving treatment. They have now launched a new checklist for families and care workers to challenge illegal DNRs.

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Source: The Independent, 13 June 2020

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Six in 10 NHS doctors facing shortage of scrubs, shows UK survey

Dozens of hospitals are running short of scrubs in the latest problem to hit the NHS over the supply of personal protective equipment (PPE) during the coronavirus pandemic.

The shortages are revealed in a survey of UK doctors undertaken by the Doctors’ Association UK (DAUK), which found that 61% said that the hospital where they worked was facing a shortage of scrubs.

In recent months, many more NHS staff have begun wearing scrubs, which are usually used mainly by surgical staff, to protect themselves against COVID-19. The prevalence of coronavirus in hospitals has prompted many to switch from wearing their own clothes at work to using scrubs, and handing them in to be washed at the end of their shift. However, the big increase in demand for scrubs from doctors, nurses, physiotherapists and occupational therapists has left many hospitals unable to keep up and also put unprecedented pressure on hospital cleaning services.

Some staff have even worn pyjamas intended for patients when scrubs have run out.

“Protective clothing must be considered to be at a par with other PPE by Public Health England and must be provided to staff by the NHS," said said Dr Samantha Batt-Rawden, the president of the DAUK.

She added: “A failure to adequately supply scrubs to staff may risk further community spread of Covid-19.”

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Source: The Guardian, 15 June 2020

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Overdose calls may be getting too low priority for ambulances

Ambulance services have been urged to look at how suspected overdose and poisoning cases are prioritised after paramedics took 45 minutes to reach a woman with known mental health problems.

Helen Sheath, 33, had been discharged from a mental health unit in early July last year and was still waiting for an outpatient appointment with a psychological assessment and treatment service when she took a fatal dose of sodium nitrate on 20 August.

Her father called an ambulance at 6.20pm when she had locked herself in a bathroom and was threatening to take the sodium nitrate. But Bedfordshire and Luton senior coroner Emma Whitting said her father could not tell whether or not she had taken it, and that in view of her history of suicidal ideation, the call should have been treated as a category two – with an 18 minutes response target – rather than a category three incident.

The first ambulance which was sent to her was diverted on route and it was only after a second call to the East of England Ambulance Service at 6.48pm, that the call was upgraded to category two – when the call handler selected a different set of questions, after being told she had ingested the chemical. A rapid response vehicle arrived at 7.05pm and the mental health street triage team attended six minutes later. Shortly afterwards she became acutely unwell and was taken to Bedford Hospital, where she received treatment but died shortly afterwards.

In a prevention of future deaths report Ms Whitting said: “If the first call had been coded as a category two, it seems likely that the rapid response vehicle, mental health street triage team (and even possibly the double staffed ambulance) would have arrived on scene much earlier (potentially just before or just after Helen had ingested the sodium nitrate) which could potentially have altered the outcome.” 

The case comes just months after two other ambulance trusts were criticised in cases involving suspected or threatened overdoses.

The prevention of future deaths report was sent to the Association of Ambulance Chief Executives and the emergency call prioritisation advisory group, which is run by NHS England. Neither would comment other than saying they would respond to the coroner.

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Source: HSJ, 15 June 2020

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Endoscopy shortfall is here to stay, NHS warned

A leading doctor has warned that trusts will struggle to get back to anything like pre-covid levels of endoscopy services and will need to prioritise which patients are diagnosed.

Endoscopy procedures are part of the diagnostic and treatment pathway for many conditions, including bowel cancer and stomach ulcers. Most hospitals have not done any non-emergency procedures since the middle of March because they are aerosol generating — meaning a greater covid infection risk and need for major protective equipment.

Although some areas are now starting to do more urgent and routine work, capacity is severely limited.

Kevin Monahan, a consultant gastroenterologist at St Marks’s Hospital, part of London North West Healthcare Trust, and a member of the medical advisory board for Bowel Cancer UK, said the time taken for droplets to settle in rooms after a procedure can be up to an hour and three quarters, depending on how areas are ventilated. Only then can the room be cleaned and another patient seen.

Dr Monahan said his trust had restarted some endoscopy work and was currently doing around 17 per cent of its pre-covid activity. “We can provide a maximum of about 20 per cent of normal activity — and that is using private facilities for NHS patients,” he said. “I am not at all confident we will be able to double what we are doing now, even in three to four months’ time."

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Source: HSJ, 12 June 2020

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Racism 'could play a part in BAME covid deaths'

Factors such as racism and social inequality may have contributed to increased risks of black, Asian and minority communities catching and dying from COVID-19, a leaked report says.

Historic racism may mean that people are less likely to seek care or to demand better personal protective equipment, says the Public Health England (PHE) draft, seen by the BBC. Other possible factors include risks linked to occupation and inequalities in conditions such as diabetes may increase disease severity.

The report, the second by PHE on the subject, pointed to racism and discrimination as a root cause affecting health and the risk of both exposure to the virus and becoming seriously ill.

It said stakeholders expressed "deep dismay, anger, loss and fear in their communities" as data emerged suggesting COVID-19 was "exacerbating existing inequalities".

And it found "historic racism and poorer experiences of healthcare or at work" meant individuals in BAME groups were less likely to seek care when needed or to speak up when they had concerns about personal protective equipment or risk.

The report concluded: "The unequal impact of COVID-19 on BAME communities may be explained by a number of factors ranging from social and economic inequalities, racism, discrimination and stigma, occupational risk, inequalities in the prevalence of conditions that increase the severity of disease including obesity, diabetes, hypertension and asthma."

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Source: BBC News, 13 June 2020

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BAME safety plan not published

A report containing measures to protect ethnic minority groups from coronavirus has been drawn up for government, BBC News has learned.

Public Health England (PHE) published a review last week confirming coronavirus kills people from ethnic minorities at disproportionately high rates. But a senior academic told BBC News a second report, containing safeguarding proposals to tackle this, also existed.

And PHE now says this report will be published next week.

Labour described the decision not to immediately publish the second report as "scandalous and a tragedy".

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Source: BBC News, 11 June 2020

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Children 'self-harming in hospital' after family visits banned

Young people with learning disabilities are being driven to self-harm after being prevented from seeing their families during the coronavirus lockdown in breach of their human rights, a new report finds.

The Joint Committee on Human Rights warned that the situation for children and young people in mental health hospitals had reached the point of “severe crisis” during the pandemic due to unlawful blanket bans on visits, the suspension of routine inspections and the increased use of restraint and solitary confinement.

The report concluded that while young inpatients' human rights were already being breached before the pandemic, the coronavirus lockdown has put them at greater risk – and called on the NHS to instruct mental health hospitals to resume visits.

It highlighted cases in which young people had been driven to self-harm, including Eddie, a young man with a learning disability whose mother, Adele Green, had not been able to visit him since 14 March.

“When the lockdown came, it was quite quick in the sense that the hospital placed a blanket ban on anybody going in and anybody going out,” said Ms Green. “Within a week, with the fear and anxiety, he tried to take his own life, which really blew us away. We were mortified.”

The Committee is urging NHS England to write to all hospitals, including private ones, stating they must allow visits unless there is a specific reason relating to an individual case why it would not be safe, and said the Care Quality Commission (CQC) should be responsible for ensuring national guidance is followed.

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Source: The Independent, 12 June 2020

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Cancer patients missed out on tests during lockdown, NHS England figures show

Huge numbers of people with suspected cancer were not referred to hospital for urgent checks or did not have a test during the first month of the lockdown, prompting fears that late diagnosis of the disease will reduce some patients’ chances of survival.

Unprecedented numbers of cancer patients missed out on vital treatments, diagnostic tests and outpatient appointments as the pandemic unfolded, NHS England data shows.

Macmillan Cancer Support estimates that 210,000 people should have entered the system this month. That means roughly 130,000 people who would ordinarily be referred to a consultant have not been. About 7% of these patients would usually require cancer treatment, meaning approximately 9,000 people might not have had their cancer diagnosed in April. 

The organisation said that around 2,500 people who should have been referred for their first treatment after a cancer diagnosis will not have received that treatment.

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Source: The Guardian, 11 June 2020

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Coronavirus: 'Start public inquiry now to prevent more deaths'

Relatives of 450 people who have died in the coronavirus pandemic are demanding an immediate public inquiry. The families want an urgent review of "life and death" steps needed to minimise the continuing effects of the virus and a guarantee that documents relating to the crisis will be kept.

A full inquiry would take place later, says lawyer, Elkan Abrahamson, who is representing the families.

The government has said its current focus is on dealing with the pandemic.

But the COVID-19 Bereaved Families for Justice UK group say immediate lessons need to be learned to prevent more deaths, and that waiting for ministers to launch an inquiry will cost lives.

The call for an inquiry comes as a report from the National Audit Office - assessing the readiness of the NHS and social care in England for the pandemic - has shown it is not known how many of the 25,000 people discharged from hospitals into care homes at the peak of the outbreak were infected with coronavirus.

Health and Social Care Select Committee chairman Jeremy Hunt said it seemed "extraordinary that no one appeared to consider" the risk.

The Department of Health says it took the "right decisions at the right time".

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Source: BBC News, 12 June 2020

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English care bosses say lack of resources cost thousands of lives

Thousands of people lost their lives “prematurely” because care homes in England lacked the protective equipment and financial resources to cope with the coronavirus outbreak, according to council care bosses.

In a highly critical report, social care directors say decisions to rapidly discharge many vulnerable patients from NHS hospitals to care homes without first testing them for COVID-19 had “tragic consequences” for residents and staff.

In many places, vulnerable people were discharged into care facilities where there was a shortage of personal protective equipment (PPE) or where it was impossible to isolate them safely, sometimes when they could have returned home, the report says.

“Ultimately, thousands have lost their lives prematurely in social care and were not sufficiently considered as part of wider health and community systems. And normality has not yet returned,” James Bullion, the president of the Association of Directors of Adult Social Services (Adass), said in a foreword to the report.

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Source: The Guardian, 11 June 2020

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Patients received ‘derogatory’ treatment at women’s unit

Inspectors have placed a women’s mental health service into special measures after patients were said to have been subjected to “inappropriate” and “derogatory” treatment by staff.

St Andrew’s Healthcare, which runs the women’s inpatient facility in Northampton, has received a series of damning reports among its services over the past two years.

The inspectors noted during visits between February and March that staff reportedly used language to describe patients on a medium secure ward such as “self-harmers”, “attention seeking”, and “kicking off”.

Patients said staff used “inappropriate restraint techniques that caused pain” with reports they “bent the patient’s wrist and arm behind their back.”

They also said staff spoke to them in a “derogatory manner, for example telling them to sort themselves out when engaging in self harm behaviour.”

Inspectors rated the service “inadequate” overall, noting concerns elsewhere including “forensic failure incidents due to staff shortages”, that staff were not reporting all safeguarding concerns and that “managers did not ensure safe and clean environments in the long stay rehabilitation service and learning disability service.”

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Source: HSJ, 10 June 2020

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