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Thousands missing out on cancer diagnosis

Delays in diagnosing and treating people with cancer could lead to more years of lost life than with COVID-19, according to a leading cancer expert.

A drop-off in screening and referrals means roughly 2,700 fewer people are being diagnosed every week, Cancer Research UK says.

Cancer screening has paused in Wales, Scotland and Northern Ireland, with few invitations sent out in England.

People are still advised to contact their GP with worrying symptoms.

But Richard Sullivan, professor of cancer and global health at King's College London, said there was more fear of Covid-19 than of having cancer at the moment. With GPs more difficult to contact than normal, this was resulting in a "dramatic drop-off" in referrals to specialists, he said.

"Most modellers in the UK estimate excess of deaths is going to be way greater than we are going to see with Covid-19," he said.

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Source: 22 April 2020, BBC News

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Military appalled by planning fiasco over NHS protective kit

Military personnel have criticised the NHS for its “appalling” handling of distributing personal protective equipment. The armed forces are helping with the distribution of equipment and staff have been seconded to help planning across seven hubs.

A senior army source lambasted the health service for its logistics for PPE, alleging that masks, aprons, gloves and other items were being assigned to hospitals without regard to relative need, leading to oversupply in some areas and shortages in others.

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Source: The Times, 22 April 2020

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Coronavirus death toll in UK twice as high as official figure

The coronavirus pandemic has already caused as many as 41,000 deaths in the UK, according to a Financial Times analysis of the latest data from the Office for National Statistics.

The estimate is more than double the official figure of 17,337 released by ministers on Tuesday, which is updated daily and only counts those who have died in hospitals after testing positive for the virus. The FT extrapolation, based on figures from the ONS that were also published on Tuesday, includes deaths that occurred outside hospitals updated to reflect recent mortality trends.

The ONS data also showed that deaths at home and in care homes had also jumped sharply during the pandemic. In the week ending 10 April, deaths in care homes reached 4,927, almost double the figure of 2,471 a month earlier.

The ONS said on Tuesday it had asked Public Health England to investigate why care home deaths were rising so sharply.

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Source: The Financial Times, 22 April 2020

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NHS data sharing failure ‘exasperating and could cause error’

Significant concerns about the NHS’ refusal to share data with councils have emerged in a letter from a leading council chief executive and clinical commissioning group accountable officer. 

Steven Pleasant, chief executive of Tameside Metropolitan Borough Council and accountable officer of Tameside and Glossop CCG, said the failures are “becoming increasingly exasperating”, in a letter intended for the Ministry of Housing, Communities and Local Government’s shielding sounding board.

Steven said he understands NHS Digital has decided the most recent version of the list cannot be shared with councils even though it is being shared with police, fire, voluntary organisations and companies offering logistical support.

“I am sure that you will appreciate that this is counterproductive and frustrating given that local authorities are leading and coordinating the response to the most vulnerable in communities,” he wrote.

He also raised concerns about how the NHS’ shielded patients team is passing on to councils information about people needing additional support — for instance, if the recipient’s food parcel stock is running low, requiring the council to step in. Welfare concerns and medication information could also need to be passed on. Mr Pleasant said although his council had asked for this information to be provided via email, staff “have been told by the NHS shielding team that they do not have permission to do this and that details can only be provided verbally over the phone”.

“We believe this significantly increases the chances of error and presents significant risk… around incorrect information being captured,” he wrote.

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Source: HSJ, 21 April 2020

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Nurse shortage causes Nightingale hospital to turn away patients

Dozens of patients with Covid-19 have been turned away from the NHS Nightingale hospital in London because it has too few nurses to treat them, the Guardian can reveal.

The hospital has been unable to admit about 50 people with the disease and needing “life or death” care since its first patient arrived at the site, in the ExCeL exhibition centre, in London’s Docklands, on 7 April. Thirty of these people were rejected because of a lack of staff.

The planned transfer of more than 30 patients from established London hospitals to the Nightingale was “cancelled due to staffing issues”, according to NHS documents seen by the Guardian.

The revelation raises questions about the role and future of the hospital, which up until Monday had only treated 41 patients, despite being designed to include almost 4,000 beds.

One member of staff said: “There are plenty of people working here, including plenty of doctors. But there aren’t enough critical care nurses. They’re already working in other hospitals and being run ragged there. There aren’t spare people [specialist nurses] around to do this. That’s the problem. That leads to patients having to be rejected, because there aren’t enough critical care nurses.”

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Source: The Guardian. 21 April 2020

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Shrewsbury maternity scandal: Hundreds of families sent letters as inquiry cases near 1,200

An independent investigation into one of the worst maternity safety scandals in NHS history has written to 400 families today as the number of cases under investigation swell to almost 1,200.

Despite the coronavirus crisis the review, chaired by midwifery expert Donna Ockenden, is continuing its work investigating poor maternity care at the Shrewsbury and Telford Hospitals Trust where dozens of babies died or suffered brain damage as a result of poor care over several decades.

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Source: The Independent, 21 April 2020

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Hancock: Staff should be free to speak out over coronavirus concerns

NHS staff should “feel free” to speak out about problems like protective equipment shortages, Matt Hancock has said, despite many having been warned not to do so.

The health and social care secretary told the daily coronavirus briefing on 21 April that it’s “totally normal” for NHS staff to raise concerns about personal protective equipment shortages in their areas and said “transparency is important”.

HSJ has heard from multiple senior local NHS leaders that they have been given strong warnings not to communicate externally about the COVID-19 response, with national officials seeking to closely grip information given to the media.

There have been several reports of healthcare professionals having been “gagged” by hospitals and NHS bodies, with some reports of threats of disciplinary action if they raise concerns on social media or speak to journalists. 

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Source: HSJ, 21 April 2020

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NHS staff given flawed coronavirus tests

Coronavirus tests given to thousands of NHS staff so they could return to work have been found to be flawed and should no longer be relied on, a leaked document reveals. 

The memo from Public Health England (PHE), sent earlier this month, warns of "degraded" performance, meaning the results are less reliable than first thought. 

Almost 100,000 NHS and social care workers and their relatives have now undergone tests in an effort to get as many staff back to the frontline as possible. 

But the memo, dated April 11, reveals that "discordant results" have been identified in the tests, run by PHE and NHS laboratories, requiring ambiguous samples to be re-checked.

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Source: The Telegraph, 22 April 2020

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COVID-19: increasing demand for dialysis sparks fears of supply shortage

More than a quarter of patients with COVID-19 on ventilators also need renal support in the form of dialysis, raising concerns that there could be significant supply problems as countries attempt to stock up on the required fluid and plastic consumables.

Nephrology consultant Graham Lipkin told The BMJ, “This is an under-recognised challenge. While the original focus has been on whether we have enough ventilators and intensive care beds, it has become apparent that there is a high incidence of acute kidney injury (AKI) requiring some form of renal replacement therapy (RRT) through dialysis. With the volume of people coming into intensive care, there are increasing challenges to capacity across the system.”

Lipkin, who is president of the Renal Association, has been working with NHS England to develop new clinical guidelines for the prevention and optimal management of AKI in hospital. The guidance aims to reduce the incidence of AKI and therefore the demand for dialysis.

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Source: BMJ, 21 April 2020

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COVID-19: ibuprofen can be used for symptoms, says UK agency, but reasons for change in advice are unclear

UK medicines agencies have changed their advice on ibuprofen to say that the drug can be used to treat patients with symptoms of COVID-19, although the evidence that prompted the revision has not been made public.

The change follows a review by the Commission on Human Medicines’ expert working group on COVID-19 which, along with previous reviews of evidence, concluded that there is currently insufficient evidence to establish a link between use of ibuprofen, or other non-steroidal anti-inflammatory drugs (NSAIDs), and contracting or worsening of COVID-19.

The group’s review has not been published, but prompted the Medicines and Healthcare Products Regulatory Agency (MHRA), NHS England, and the National Institute for Health and Care Excellence (NICE) to update their advice to say that patients can take paracetamol or ibuprofen for symptoms of COVID-19, such as fever and headache.

This is a change to NICE’s recommendation on 3 April that paracetamol should be used in preference to NSAIDs for managing fever in patients with suspected COVID-19 until more evidence is available.

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Source: BMJ, 17 April 2020

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Coronavirus disproportionately affecting BAME communities in UK, new figures show

More than 16% of people who had tested positive for coronavirus when they died were from black, Asian and minority ethnic (BAME) communities, new data shows.

On Monday, NHS England released data showing the ethnic breakdown of people who have died with coronavirus for the first time.

The statistics come days after a review was announced to examine what appears to be a disproportionate number of BAME people who have been affected by Covid-19.

Last week Downing Street confirmed the NHS and Public Health England will lead the review of evidence, following pressure on ministers to launch an investigation.

Discussing the review, Professor Chris Whitty, the chief medical officer for England, said ethnicity is "less clear" than three others factors in determining who is most at risk from coronavirus.

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Source: The Independent, 21 April 2020

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Masks for public 'could put NHS supplies at risk'

NHS supplies of face masks could be put at risk if the government starts advising the public to wear them, hospital bosses have warned.

The government's scientific advisers are to meet later to discuss whether the public should be urged to wear masks in a bid to combat coronavirus, but Chris Hopson, chief executive of NHS Providers, warned there should be "clear evidence" to justify their use.

He said securing supplies for NHS staff amid huge global demand was "crucial".

The World Health Organization (WHO) has said there is no evidence to support the use of face masks by the general population. It says people who are not in health and care facilities should only wear masks if they are sick or caring for those who are ill.

But the debate around their use in the UK has been gaining momentum in recent weeks, with proponents arguing they can help reduce the risk of people with the virus passing it on to others.

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Source: BBC News, 21 April 2020

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Ventilator manufacturers form ventilator training alliance, create App to help front-line medical workers during COVID-19 pandemic

According to an Allego press release, several of the world’s ventilator manufacturers have formed a Ventilator Training Alliance (VTA) and partnered with Allego to create a mobile app that front-line medical providers can use to access a centralised repository of ventilator training resources.

Dräger, GE Healthcare, Getinge, Hamilton Medical, Medtronic, Nihon Kohden, and Philips have joined this humanitarian training coalition.

The VTA app – powered by learning and readiness platform provider Allego – connects respiratory therapists, nurses and other medical professionals with ventilator training resources from alliance member companies, including instructional how-to videos, manuals, troubleshooting guides, and other ventilator-operation expertise critical to helping responders treat patients suffering from COVID-19-related respiratory distress.

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Source: American Association for Respiratory Care, 16 April 2020

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NHS told to expect ‘huge number’ of legal challenges after pandemic

The NHS should expect a “huge number” of legal challenges relating to decisions made during the coronavirus pandemic, healthcare lawyers have warned.

The specialists said legal challenges against clinical commissioning groups and NHS providers would be inevitable, around issues such as breaches of human rights and clinical negligence claims.

Francesca Burfield, a barrister specialising in children’s health and social care, told HSJ’s Healthcheck podcast: “I think there is going to be huge number of challenges. If and when we move through this there will not only be a public enquiry, [but] I anticipate judicial reviews, civil actions in relation to negligence claims and breach[es] of human rights….”

She said criminal proceedings by the Care Quality Commission or Crown Prosecution Service would also be a possibility, around issues such as deprivation of liberty, neglect, safeguarding, and potential gross negligence manslaughter.

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Source: HSJ, 20 April 2020

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Hospitals washing gowns at 60C to re-use PPE as stocks run low

Some hospitals are washing single-use protective gowns at 60C so they can be used several times by frontline staff because of the ongoing shortage, according to a senior NHS official.

Chris Hopson, the chief executive of NHS Providers, also said hospitals could not rely on government promises that more personal protective equipment (PPE) was on the way – saying there was “relatively low confidence” a shipment of 400,000 gowns would arrive from Turkey on Monday.

The head of the membership organisation for NHS trusts in England said some trusts had taken to “hand-to mouth” arrangements, with one discovering that some types of gowns remained fluid-repellent if washed at high temperatures.

“There is no doubt that at the moment, we have now got trusts who have definitely got shortages of gowns,” Mr Hopson told BBC Radio 4’s Today programme. “Trust leaders are doing absolutely everything they can to try and address that problem.”

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Source: The Independent, 20 April 2020

 

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Don’t bank on a coronavirus vaccine, says Sir Patrick Vallance

The government’s chief scientific adviser has cautioned against banking on a OVID-19 jab, warning that new vaccines are “long shots”.

Oxford University researchers are planning to begin human trials of a vaccine this week and believe that they could have results showing whether it works as early as September.

However, Sir Patrick Vallance, the chief scientific adviser, has cautioned that even if a vaccine shows signs of protecting against the virus, ensuring that it is safe could take much longer.

“All new vaccines that come into development are long shots. Only some end up being successful,” he said yesterday. “Coronavirus will be no different and presents new challenges for vaccine development. This will take time.”

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Source: The Times, 20 April 2020

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Coronavirus: 'I'm the nurse who switches off the ventilator'

Having access to a ventilator can mean the difference between life and death for patients who are seriously ill with COVID-19, but sometimes even these breathing machines cannot save someone's life.

Juanita Nittla is a chief nurse in the intensive care unit (ICU) at London's Royal Free Hospital, and has been working for the NHS as an intensive care specialist nurse for the past 16 years. Switching off ventilators is part of Juanita's job.

The work is traumatic and painful, the 42-year-old says. "Sometimes I feel like I am somewhat responsible for someone's death."

Medical teams face tough decisions about when to stop treatment for patients who aren't getting better. The decision is made after careful consideration, analysing factors such as the age of the patient, underlying health conditions, their response to the virus and likelihood of recovery.

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Source: BBC News, 20 April 2020

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Coronavirus: Plasma treatment to be trialled

The UK is gearing up to use the blood of coronavirus survivors to treat hospital patients ill with the disease.

NHS Blood and Transplant is asking some people who recovered from COVID-19 to donate blood so they can potentially assess the therapy in trials. The hope is that the antibodies they have built up will help to clear the virus in others.

The US has already started a major project to study this, involving more than 1,500 hospitals.

A statement from the organisation said: "We envisage that this will be initially used in trials as a possible treatment for Covid-19. If fully approved, the trials will investigate whether convalescent plasma transfusions could improve a Covid-19 patient's speed of recovery and chances of survival."

"All clinical trials have to follow a rigorous approval process to protect patients and to ensure robust results are generated. We are working closely with the government and all relevant bodies to move through the approvals process as quickly as possible."

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Source: BBC News, 20 April 2020

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Coronavirus: Concern over protective kit guidance change

Concerns have been raised that updated government guidance on personal protective equipment (PPE) could put hospital staff and patients at risk.

Healthcare workers have been advised to reuse gowns or wear different kit if stocks in England run low.

Unions representing doctors and nurses have expressed concerns about the updated Public Health England guidance.

Healthcare staff treating patients with Covid-19 have previously been advised to wear long-sleeved disposable fluid-repellent gowns.

But Public Health England changed its guidance on Friday, outlining three options if the gowns are not available as "some compromise is needed to optimise the supply of PPE in times of extreme shortages".

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Source: BBC News, 18 April 2020

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‘Unprecedented’ plan to prevent suicides during covid-19 crisis

An “unprecedented” national suicide prevention plan has been launched by a government advisory group amid concerns suicides could increase during the covid-19 pandemic, HSJ can reveal.

The government’s national suicide prevention advisory group has developed the plan to address risks covid-19 could present to vulnerable people.

Chair of the group and the national adviser to the government on suicide prevention, Louis Appleby, told HSJ the plan was centred on getting far quicker access to data on suicides and self-harm episodes, which is the strongest indicator of suicide risk.

He said: “We are in unprecedented times, we haven’t got a lot of evidence on what happens to suicides rates during pandemics, so we’re having to infer from what we know generally to see where the risk might lie.

“This is a serious attempt, in some senses an unprecedented attempt to prevent a [physical health] crisis turning into a mental health crisis."

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Source: HSJ, 17 April 2020

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Dozens of trusts on course to run out of gowns as PPE crisis escalates

Dozens of NHS trusts fear running out of disposable gowns this weekend if they do not receive more supplies, while national officials have issued guidance on alternatives to use in extreme circumstances, HSJ has learned. 

Several well-placed sources in procurement reported widespread concerns, more severe than so far in the COVID-19 outbreak. One had information that at least 60 trusts would run out this weekend without supplies, and that it was likely the large majority of NHS providers were affected.

One well-placed source told HSJ the situation today was “not normal even during this pandemic”. Another described the “critical” shortage as “a dire situation for everyone”.

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Source: HSJ, 17 April 2020

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Three-year-old child dies from cardiac arrest after its mother was kept on hold to NHS 111 for an hour

A three-year-old child died after its desperate mother spent more than an hour on hold to the NHS 111 helpline.

The ill child suffered a cardiac arrest at its home and died in hospital, according to details of critical incidents affecting children in London amid the coronavirus crisis. 

Another case saw a six-month-old die from sepsis and liver failure because the parents feared the child could catch Covid-19 in hospital, the Evening Standard reports. 

Doctors have raised concerns that parents are not seeking treatment for their children amid the outbreak.

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Source: 16 April 2020, Mail Online

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Disastrous results’ feared from COVID-19 home tests

Experts have warned giving the public coronavirus antibody tests to be carried out at home could lead to “disastrous results”.

A testing manager at an NHS trust told HSJ they feared the public may take the tests too soon for antibodies to appear, which could produce misleading results, while a leading virologist at the British Society for Immunology called for antibody tests to be carried out in GP surgeries.

Public Health England has previously said it wants to distribute antibody tests via Amazon and Boots and make them available to the general public. Health secretary Matt Hancock has also promised increased antibody tests will form part of 100,000 of all types of daily COVID-19 tests by the end of April.

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Source: HSJ, 17 April 2020

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NHS England accused of ‘dragging its feet’ on dental care

The British Dental Association (BDA) has criticised NHS England for “dragging its feet” in setting up an urgent care system for dental patients, putting further strain on already overstretched GPs.

At the end of March, dental practices were ordered to suspend all routine treatment, as part of plans to prevent the spread of coronavirus. NHS regions were instructed to set up local urgent dental care centres.

However, GPs have told HSJ they have been experiencing a rise in calls from patients with dental problems, but when they direct them to the urgent care centres, appointments appear to be limited. The BDA has said, in some regions, there is “nowhere” to send patients in need of urgent dental care.

Sources working in primary care and tech said GPs were dealing with a spike in demand from dental patients who did not know where to go.

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Source: HSJ, 17 April 2020

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