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Covid inquiry: what stage is it at and what will it look at?

The Covid-19 Inquiry is a public inquiry to examine the UK’s response to the pandemic, as well as its wide-sweeping impact.

In the UK, at least 216,726 people have had Covid-19 mentioned on their death certificate since the start of the pandemic.

Multiple lockdowns, school closures and furloughs later, a public inquiry aims to gauge what lessons can be learned for the future.

Two preliminary hearings have already taken place on 28 February and 1 March. The next one will be on 21 March and will cover Scotland, including strategic issues, political governance, lockdowns and restrictions. The inquiry is chaired by Baroness Heather Hallett, a former Court of Appeal judge.

The inquiry has been split into three modules: resilience and preparedness, core UK-decision making; political governance, and the impact of Covid-19 on healthcare systems across the UK.

In Spring 2022, the inquiry held a public consultation on its draft terms of reference which allowed people to give their opinions on the topics the inquiry would cover.

The public inquiry has come under heavy criticism after it was announced that structural racism will not be explicitly considered.

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Source: The Independent, 2 March 2023

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Misplaced tube contributed to first UK child Covid death, coroner rules

A misplaced medical tube contributed to the death of the first child in the UK to die after contracting Covid, a coroner has found.

Ismail Mohamed Abdulwahab, 13, of Brixton, south London, died of acute respiratory distress syndrome, caused by Covid-19 pneumonia, on 30 March 2020, three days after testing positive for coronavirus. He had a cardiac arrest before he died.

Ismail’s death prompted widespread alarm about the potentially lethal impact of Covid on children.

Hours before Ismail died, an endotracheal tube (ET) used to help patients breathe was found to be in the wrong position. A consultant in paediatric intensive care decided to leave it and monitor him.

Giving his judgment on Thursday, senior coroner Andrew Harris said: “I am satisfied that he [Ismail] would not have died when he did were it not for the tube misplacement.”

On Wednesday, the inquest at London Inner South London coroner’s court heard evidence from Dr Tushar Vince, a consultant in paediatric intensive care at King’s College hospital who treated Ismail on 29 March after he had been intubated.

Asked by Harris if it would be reasonable to put the positioning of the ET on the death certificate as one of the causes, Dr Vince said: “I think it would be reasonable to consider it, yes.”

She said: “I was so focused on the lungs I just didn’t see how high this tube was and I’m so sorry that I didn’t see it.”

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Source: The Guardian, 2 March 2023

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‘Significant escalation’ in strike action, warns ambulance chief

Ambulance chiefs have warned of a ‘significant escalation’ in the strike action being planned by unions next week – saying the flexibilities that helped deal with previous walk-outs will no longer be available.

In a letter to local NHS leaders, seen by HSJ, North West Ambulance Service said unions are “becoming more stringent in their approach”, and the trust’s ability to respond to incidents will be severely weakened.

For the last day of strike action in February, the GMB union told NWAS it was abandoning exemptions (derogations) for category 2 calls, which include heart attacks and strokes.

The NWAS letter, sent yesterday, said the Unite union also now intends to take this approach on 6 March.

Last month the head of the London Ambulance Service said the reduced level of service in the capital “causes harm to our patients”

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Source: HSJ, 2 March 2023

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More than half of humans on track to be overweight or obese by 2035

More than half of the world’s population will be overweight or obese by 2035 unless governments take decisive action to curb the growing epidemic of excess weight, a report has warned.

About 2.6 billion people globally – 38% of the world population – are already overweight or obese. But on current trends that is expected to rise to more than 4 billion people (51%) in 12 years’ time, according to research by the World Obesity Federation.

Without widespread use of tactics such as taxes and limits on the promotion of unhealthy food, the number of people who are clinically obese will increase from one in seven today to one in four by 2035. If that happens, almost 2 billion people worldwide would be living with obesity. Evidence shows that obesity increases someone’s risk of cancer, heart disease and other diseases.

Prof Louise Baur, the federation’s president, said the stark findings were “a clear warning that by failing to address obesity today, we risk serious repercussions in the future.

“It is particularly worrying to see obesity rates rising fastest among children and adolescents.”

Countries need to take “ambitious and coordinated action” as part of a “robust international response” to tackle the growing health and economic crisis that obesity involves, the federation believes.

“Governments and policymakers around the world need to do all they can to avoid passing health, social and economic costs on to the younger generation,” Baur added.

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Source: The Guardian, 2 March 2023

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Race and deprivation set back medical trainees, GMC analysis finds

New research shared with HSJ  has ‘laid bare’ the inequalities experienced by medical trainees, with black doctors more likely to perform worse in exams than any other ethnic group.

The report published by the General Medical Council (GMC) highlights that UK medical graduates of black or black British heritage have the lowest specialty exam pass rate of all ethnic groups at 62%, which is almost 20 percentage points lower than that of white doctors (79%). It is the first time the medical regulator has split this data by ethnicity, it said. 

The GMC has pledged to “eliminate discrimination, disadvantage and unfairness” in undergraduate and postgraduate medical education by 2031 and the disproportionate number of fitness to practise complaints received about ethnic minority doctors and doctors who gained their medical qualification outside of the UK by 2026.

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Source: HSJ, 2 March 2023

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Older and overweight patients ‘hampering efforts to clear NHS backlogs’

Older and overweight patients are making it harder to clear NHS surgery backlogs, anaesthetists have warned.

New data reveal an “extremely worrying picture” of increasing age, rates of obesity and complexity of surgical patients across the UK, the Royal College of Anaesthetists said.

The average age of patients requiring anaesthesia increased by 2.3 years, from 50.5 to 52.8, over the last decade, while their BMI also jumped from 24.9 (borderline normal/overweight) to 26.7 (overweight).

The proportion of patients who are complex or have other comorbidities has also significantly increased, the study found.

When patients are older, overweight and have other problems, this makes anaesthetic and surgical care more complicated and higher risk, the authors said. Managing these patients safely takes longer during surgery and can lead to slower recovery times, requiring more time in hospital.

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Source: The Telegraph, 2 March 2023

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Pharmacy leaders hit out at NHS England ads redirecting patients from GPs

Pharmacies do not have the capacity to absorb pressure from GPs unless it comes with additional funding, pharmacy leaders have warned.

A new NHS England ad campaign, announced earlier this week, aims to redirect patients from GP practices to local pharmacies for minor conditions such as coughs, aches, cystitis and colds.

But community pharmacy negotiating body PSNC has spoken out against the campaign calling it ‘deeply concerning’, ‘irresponsible, ‘extremely unhelpful’ and ‘irritating’.

Malcom Harrison, chief executive of the Company Chemists’ Association (CCA) said: ‘Community pharmacies are often the best place for patient to go for help with minor health concerns. 

‘However the current situation that many pharmacies find themselves, with a 30% cut in real term funding, the NHS recruiting their pharmacists and technicians to work in general practice and with the continuing increase in the number of medicines prescribed, will mean that there is now a very real risk that when patients visit a pharmacy, they will be faced by exhausted teams and longer than expected waiting times.

‘The NHS policy of moving asking patients to visit their local pharmacy does not address the problem of delays to access in primary care, it simply moves it from one pressurized location to another.  The NHS must address the chronic underfunding of primary care, and of pharmacy in particular, if patients are to be able to access the care they need and should rightly expect.’

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Source: Pulse, 28 February 2023

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Age discrimination leading to avoidable eating disorder deaths, government warned

The government must end “age discrimination” against eating disorder patients that is causing avoidable deaths, experts have warned.

A cross-party parliamentary group and the Royal College of Psychiatrists are calling for access targets to make sure adults with eating disorders get treated within a set time. The demands come after the healthcare watchdog said patients were dying while waiting to be seen.

Wera Hobhouse, chair of the All Party Parliamentary Group, and Agnes Ayton, chair of the Royal College of Psychiatrists’ eating disorder committee, said the targets must be equal to those for children, which were set in 2016.

According to the Health Service Journal, 19 patients under the care of inpatient and community eating disorder services have died since 2017.

A senior coroner in Norfolk also highlighted failings in 2019 and sent a warning to both NHS England and the Department for Health and Social Care, over the deaths of five young women.

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Source: The Independent, 1 March 2023

To support Eating Disorders Awareness Week, we have pulled together eight useful resources to help healthcare professionals, friends and family support people with eating disorders:

 

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Mental health of young adults severely impacted by pandemic

A new study has found that the pandemic has severely affected people’s mental health and relationships all over the world, particularly for young adults.

The third annual mental state of the world report (MSW) commissioned by Sapien Labs, a non-profit research organisation, conducted a global survey to better understand the state of mental health.

The research compiled responses from over 400,000 participants across 64 countries, asking respondents about their family relationships, friendships and overall mental wellbeing.

The survey found that there has been little recovery in declining mental health during the pandemic, which the group measures by a score called “mental health quotient”. It had found that average score had declined by 33 points – on a 300-point scale – over the past two years and still showed no signs of recovery, remaining at the same level as 2021.

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Source: The Guardian, 1 March 2023

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The mesh in my body is a 'ticking time bomb'

Sam Hindle has 23cm of polypropylene mesh in her body and lives in constant fear that it will become unstable and cause irreversible damage.

"You are in your own Battle Royale, strapped to a time bomb, and thinking when is it going to go off," she told the BBC.

Sam, 46, is one of hundreds of women in Scotland who have suffered life-changing symptoms since they had a transvaginal mesh implant.

After years of campaigning by the women, the Scottish government has promised it will cover the costs of mesh removal at private clinics in the UK and US.

But Sam has been waiting more than two years just for a referral to the Complex Mesh Surgical Service in Glasgow to start the process.

The Scottish government announced last year that it had signed a contract to allow NHS patients to visit a US expert for mesh removal surgery

The contract with Gynaecologic and Reconstructive Surgery of Missouri, where Dr Dionysios Veronikis operates, follows a similar contract agreed with Spire Healthcare in Bristol.

The cost of each removal procedure is estimated to be £16,000 to £23,000. But in order to access such treatment, women have to be assessed by the national service in Glasgow.

Women like Sam say there are waiting years to just get referred for assessment. With further delays for appointments and then waits for surgery.

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Source: BBC News, 2 March 2023

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£14bn plan to reduce NHS cancer backlogs in England is failing, MPs say

A £14bn plan to reduce NHS backlogs caused by Covid is failing to meet targets, with cancer waiting times at their worst-ever levels, parliament’s spending watchdog has said.

A report by the Commons’ public accounts committee said NHS England’s three-year recovery programme for elective and cancer care, agreed in 2022, was already “falling short” in its first year and expressed serious doubts that the wider plan would be achieved on time.

MPs found that although the first target was to eliminate two-year waits for elective care by July 2022, there were 2,600 patients who had been waiting more than two years in August 2022, and a record 7 million people on waiting lists in total.

The recovery programme was overoptimistic, the report said. “NHS England made unrealistic assumptions about the first year of recovery, including that there would be low levels of Covid-19 and minimal adverse effects from winter pressures.”

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Source: The Guardian, 1 March 2023

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AI could help NHS surgeons perform 300 more transplants every year, say UK surgeons

Artificial intelligence could help NHS surgeons perform 300 more transplant operations every year, according to British researchers who have designed a new tool to boost the quality of donor organs.

Currently, medical staff must rely on their own assessments of whether an organ may be suitable for transplanting into a patient. It means some organs are picked that ultimately do not prove successful, while others that might be useful can be disregarded.

Now experts have developed a pioneering method that uses AI to effectively score potential organs by comparing them to images of tens of thousands of other organs used in transplant operations.

The project is being backed by NHS Blood and Transplant (NHSBT), which has almost 7,000 people in the UK on its waiting list for a transplant.

“We at NHSBT are extremely committed to making this exciting venture a success,” said Prof Derek Manas, the organ donation and transplantation medical director of NHSBT.

“This is an exciting development in technological infrastructure that, once validated, will enable surgeons and transplant clinicians to make more informed decisions about organ usage and help to close the gap between those patients waiting for and those receiving lifesaving organs.”

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Source: The Guardian, 1 March 2023

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BMA ‘rate card’ wipes out elective recovery gains, claims trust

A struggling acute trust says its failure to hit its elective care targets is directly linked to doctors’ demanding overtime rates in line with the British Medical Association’s rate cards, as national tensions around the issue intensify.

University Hospitals of Morecambe Bay Foundation Trust’s January performance report said its elective activity was down by around 1,000 cases over a two-month period, due to the issue.

Last summer, the BMA published a “rate card” outlining the “minimum” hourly pay consultants should receive for additional work, such as waiting list initiatives and weekend shifts. Some accused the union of “acting like football agents” by trying to inflate their members’ pay.

NHS chiefs have long been warning of the risk the rate card poses to elective recovery. But there are few examples of a trust making such an explicit link between their struggle to staff overtime shifts because of the rate card and subsequent failure to hit their elective targets, and placing a number on how many patients they were forced to add to the list because of the issue.

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Source: HSJ, 1 March 2023

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‘Toxic working environment’ exposed at troubled unit

Staff endured a “toxic and difficult working environment” at a maternity unit an employment tribunal has found.

The tribunal panel said that the case of a black midwife, Kemi Akinmaji, who partially won her case against East Kent Hospitals University Foundation Trust for racial discrimination showed “there were wider issues beyond the specific allegations before us and which were possibly related to race”.

The tribunal judgment said: “The evidence we heard reflected a toxic and difficult working environment generally where the claimant and colleagues were shouted and sworn at over differences of professional opinion. There was some evidence before us that there were wider issues beyond the specific allegations before us and which were possibly related to race…

“There is evidence of wider bullying of the claimant in the way the group of colleagues treated the claimant… We’ve also heard that the previous grievance had highlighted risks in respect of unconscious bias and identified recommendations which were not actioned.

“The race champion was not appointed and the unconscious bias training not sufficiently followed through. We also heard evidence of staff being wary of further such complaints. These matters were all concerning but we had to limit ourselves to the specific allegations brought by the claimant and which the respondent had been given an opportunity to address.”

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Source: HSJ, 1 March 2023

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Inquiry exaggerated trust death toll, claims CEO

A trust chief executive has suggested an inquiry team looking at 2,000 deaths is lacking in “expertise” and has created a “disproportionate impression” of the problems at his trust.

Essex Partnership University Trust is at the centre of a high-profile inquiry into the deaths of patients over a 20-year period, which was sparked after serious concerns were raised over specific cases.

The inquiry, led by Geraldine Strathdee, a former national clinical director for mental health, is reviewing the cases of 2,000 people who died while they were patients on a mental health ward in Essex or within three months of being discharged.

In a letter to the inquiry, obtained by HSJ through a freedom of information request, trust chief executive officer Paul Scott wrote: “The headline number of c.1,500 or c.2,000 deaths used in publicity by the inquiry is, in my opinion, not a fair reflection of the deaths that would be of interest to the inquiry.”

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Source: HSJ, 1 March 2023

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Doctors pressured not to make a fuss over Lucy Letby, trial told

A consultant has said that doctors were put under pressure by hospital management not to make a fuss when they raised concerns about nurse Lucy Letby.

Dr Ravi Jayaram said his team first raised concerns about unusual episodes involving babies in October 2015 but nothing was done

Ms Letby, 33, is accused of murdering seven babies and attempting to murder 10 others at the Countess of Chester Hospital between 2015 and 2016.

He told the court the matter was raised again in February 2016 and the hospital's medical director was told at this point.

The consultants asked for a meeting but did not hear back for another three months, the court heard.

Ms Letby was not removed from front-line nursing until summer 2016.

Dr Jayaram told jurors that he wished he had bypassed hospital management and gone to the police.

He said: "We were getting a reasonable amount of pressure from senior management at the hospital not to make a fuss."

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Source: BBC News, 28 February 2023

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Medical body NICE backs online mental health treatments

The National Institute for Health and Care Excellence (NICE) has recommended eight online therapies for anxiety and depression.

NICE says the therapies have the potential to help more than 40,000 people in the UK.

Each therapy must come with a formal assessment from an NHS therapist in order for it to be recommended.

According to NHS Digital, there is a six-week waiting list for patients who need mental health support in England. There are hopes that introducing online digital therapies could ease pressure on the NHS.

The treatments can help those with depression, anxiety, PTSD and body dysmorphia and are centred on the use of cognitive behavioural therapy (CBT) - a talking therapy which can help a patient manage their problems by suggesting alterations to their thought process and behaviour.

The therapies have been conditionally recommended by NICE - meaning early assessments have taken place to identify promising medical technology but more evidence needs to be gathered.

However, Professor Dame Til Wykes, of the School of Mental Health and Psychological Sciences at London's King's College, cautioned "we don't know enough" about the effectiveness of online therapies and whether the therapies will offer sufficient support for mental health patients.

Her view was echoed by mental health charity Mind, with content manager Jessica D'Cruz asserting "the majority" of people needing support "will struggle to benefit from this".

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Source: BBC News, 1 March 2023

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Woman died after breathing tube put in food pipe

A mother-of-one died after a breathing tube was put into her food pipe, despite staff raising concerns it was inserted incorrectly, an inquest heard.

Emma Currell, 32, had just received dialysis and was heading home to Hatfield, Hertfordshire, in an ambulance when she had a seizure. 

An anaesthetic team was called to sedate her as her tongue had swelled and she was bleeding from the mouth.

Dr Sabu Syed, who was a trainee anaesthetist, told the hearing: "I used suction to remove blood and I was able to push the tongue to the side and got a partial view."

She said she believed she inserted the tube into the trachea - the windpipe - and had asked her senior colleague Dr Prasun Mukherjee to check the position of the tube.

"Dr Mukherjee was busy doing other tasks," she added.

Technician Nicholas Healey said he flagged his concerns when there was no carbon dioxide reading on the ventilator, which was not faulty.

He said that both he and Dr Syed had raised concerns about the tube being in the wrong place.

The court heard the hospital had drawn up a guideline checklist for trachea procedures since Ms Currell's death and staff were due to have "no trace = wrong place" training on the warning signs of incorrect insertion.

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Source: BBC News, 27 February 2023

 

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Cybersecurity strategy among dozens of tech promises missed by government

The government has failed to meet most of its own deadlines for commitments to improve how the NHS uses data, including developing a cybersecurity strategy, HSJ can reveal.

The delays include work to store and analyse patient data more securely, building public trust in the NHS’ use of patient data, and agreeing national strategies on cybersecurity and cloud technology.

The strategy and its commitments were published following the Goldacre Review, which called for an overhaul of how NHS patient data is collected, stored and used.

It came after the government was forced to indefinitely halt a controversial plan to collect all GP-held patient data in 2021, which resembled the fate of a similar data scheme in 2016.

Several data projects have also come under scrutiny from doctors and campaigners in recent years, such as NHS England’s procurement of a new Federated Data Platform and a much-criticised trust’s data-sharing scheme with a credit rating company.

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Source: HSJ, 28 February 2023

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Half of men with eating disorders don’t get any help: 8 warning signs somebody needs support

Over half of men with an eating disorder have never had any treatment, according to new research.

Despite typically being linked with females, males account for a quarter of all eating disorder cases – and many are not getting any support, the eating disorder charity Beat is highlighting

“Eating disorders affect 1.25 million people in the UK, and we estimate one in four of those are men,” says Tom Quinn, Beat’s director of external affairs – speaking to mark this year’s Eating Disorders Awareness Week (February 27 – March 5).

“We surveyed men across the UK about their experiences of an eating disorder and, alarmingly, we discovered over half have never had treatment for their eating disorder, and one in three have never tried to get treatment in the first place.

“There’s a harmful misconception that eating disorders are female illnesses, which creates a great deal of shame and can entrench harmful behaviours for men who are unwell,” Quinn adds.

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Source: The Independent, 27 February 2023

Further reading on the hub: Top picks: Eight resources on eating disorders

 

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Patients losing out amid slump in NHS clinical trials, warn top clinicians

The state of clinical trials in the NHS is “much worse than it has been in years” with patients losing access to cutting-edge cancer and dementia treatments, one of the UK’s most senior clinicians has warned.

Sir John Bell, the regius professor of medicine at the University of Oxford and a government life sciences adviser, said the UK’s approach needed “a full overhaul, top to bottom” to prevent a collapse in the number of clinical trials being conducted in the NHS.

“I don’t think there’s any doubt that companies are choosing not to evaluate their drugs in the UK,” he said. “The risks [to patients] are much bigger than have been alluded to.”

The intervention comes after the government launched an independent review led by the former health minister James O’Shaughnessy into why the NHS had seen a 44% drop in participants recruited to commercial clinical trials in the past five years. The UK is rapidly losing ground to countries such as Spain, Poland and Australia, falling from fourth to 10th internationally for phase III trials.

Reduced access to trials is particularly concerning for patients with limited routine treatment options, such as the roughly 3.5 million people living with rare diseases and patients with dementia and advanced cancer.

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Source: The Guardian, 27 February 2023

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Covid inquiry: Race should be at its core, say campaigners

Race should be made a central part of the UK's independent public inquiry into the pandemic, campaigners say.

A letter seen by BBC News, sent to the chairwoman of the Covid-19 inquiry, calls for it to look at "racism as a key issue" at every stage.

Ethnic minorities were significantly more likely to die with Covid-19, according to official figures.

An inquiry spokesperson said the unequal impacts of the pandemic would be at the forefront of its work.

People from ethnic minority backgrounds who lost loved-ones during the pandemic also told BBC News they felt "sidelined" by the process so far.

The letter to Baroness Hallett, who is chairing the inquiry, has been co-ordinated by the group Covid-19 Bereaved Families for Justice and race equality think tank Runnymede. It calls for ethnic minority communities to be "placed firmly at the centre" of the inquiry.

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Source: BBC News, 28 February 2023

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CCTV to be used ‘pro-actively’ by trusts to combat abuse

Mental health trusts are exploring wider use of CCTV to review incidents of seclusion or restraint in response to high-profile abuse scandals, HSJ  has learned.

All providers of mental health, learning disability and autism services were ordered to review safety and asked to feed back to NHS England’s national team. The request was made in a letter from national director Claire Murdoch  sent in response to abuse allegations aired by BBC Panorama and Channel 4’s Dispatches.

The review is taking place alongside NHSE’s launch of a £36m three-year quality programme. This aims to identify providers and systems needing support, commission a culture and leadership development programme for all trusts, and produce a new model for safe inpatient care.

Results of trust-level reviews, seen by HSJ, show at least five providers aim to use CCTV more “pro-actively”, as a tool for boosting safety. 

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Source: HSJ, 27 February 2023

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One patient dies every 23 minutes in England after long delay in A&E

One patient is dying every 23 minutes in England after they endured a long delay in an A&E unit, according to analysis of NHS figures by emergency care doctors.

In all, 23,003 people died during 2022 after spending at least 12 hours in an A&E waiting for care or to be admitted to a bed, according to the Royal College of Emergency Medicine (RCEM).

That equates to roughly 1 every 23 minutes, 63 every day, 442 a week or 1,917 each month.

The college said its findings, while “shocking”, were also “unsurprising” and reflected the fact that emergency departments are often overwhelmed and unable to find patients a bed in the hospital.

Rosie Cooper, the Liberal Democrats’ health spokesperson, said “patients are now dying in their droves” due to successive Conservative governments neglecting the NHS, and added that the lives lost due to A&E snarl-ups constituted a “national disaster”.

“Long waiting times are associated with serious patient harm and patient deaths,” said Dr Adrian Boyle, RCEM’s president. “The scale shown here is deeply distressing.”

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Source: The Guardian, 28 February 2023

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Northampton: Maternity unit needs 37 more midwives

A criticised maternity service needs 37 more midwives, about a fifth of its total midwifery workforce.

The Care Quality Commission has said Northampton General Hospital did not always have enough qualified and experienced staff to keep women safe from avoidable harm.

Figures obtained by the BBC show that 49 serious incidents have occurred in its maternity services in four years.

The hospital said it had undertaken "a lot of work" in the past 18 months and a recruitment process was under way.

According to a Freedom of Information Act response, between November 2018 and November 2022, the hospital had 278 serious incidents, with the highest level coming across maternity services, including gynaecology and obstetrics.

There are currently 37 vacancies for midwives but the trust said it manages staffing levels "closely and ensure that all shifts are covered by bank or midwives working altered shift patterns, to ensure that we are able to provide a safe maternity experience".

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Source: BBC News, 27 February 2023

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