More than one in 10 hospital nurses are now off work in areas hard-hit by covid, according to internal data leaked to HSJ.
The data shows the toal absence rate among acute trust nurses has risen steadily over the last month.
Nationally the total absence rate among acute trust nurses was 9.7% as of Monday, up from around 7% at the start of December, pushed up by rapidly rising absences due to covid. These make up more than half of total absences, and have now hit rates last seen in early May.
Senior NHS sources said staff absences are severely compounding operational pressures in the hardest hit regions, limiting hospitals’ capacity to operate more than is suggested in official bed capacity figures.
The highest rate was in the East of England where 11.4% of nurses off work, with coronavirus accounting for 7.5%. This is likely to mask even higher rates in particular hospitals, services and wards.
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Source: HSJ, 14 January 2021
Younger people who think they are “invincible” need to be aware of the shocking life-changing reality of long Covid, according to health professionals who are living with the condition.
Long Covid, also known as post-Covid syndrome, is used to describe the effects of COVID-19 that continue for weeks or months beyond the initial illness.
Speaking at the All-Party Parliamentary Group (APPG) on Coronavirus, Dr Nathalie MacDermott, 38, said neurologists believe Covid has damaged her spinal cord and she can only walk about 200 metres without some form of assistance.
She said the damage has affected her bladder and bowel too, causing urinary tract infections, and she gets pain in her arms and has weakness in her grip.
Dr MacDermott, a clinical doctor sub-specialising in paediatric infectious diseases in the NHS, told MPs there needs to be “better recognition” from employers that long Covid is a “genuine condition” and that people may need to be off work for a significant period of time.
She added: “And I think we need better recognition in the public, particularly the younger public who think that they’re invincible.
“I’m 38 and I wonder if I’ll ever be able to walk properly without crutches again. Will this continue to get worse? Will I end up in a wheelchair?”
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Source: 12 January 2021, Lancashire Post
People who recover from coronavirus have a similar level of protection against future infection as those who receive a Covid vaccine – at least for the first five months, research suggests.
A Public Health England (PHE) study of more than 20,000 healthcare workers found that immunity acquired from an earlier Covid infection provided 83% protection against reinfection for at least 20 weeks.
The findings show that while people are unlikely to become reinfected soon after their first infection, it is possible to catch the virus again and potentially spread it to others.
“Overall I think this is good news,” said Prof Susan Hopkins, a senior medical adviser to PHE. “It allows people to feel that prior infection will protect them from future infections, but at the same time it is not complete protection, and therefore they still need to be careful when they are out and about.”
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Source: The Guardian, 14 January 2021
Public Health England press release
Patients are missing out on potentially life-saving organ transplant surgery because hospital intensive care beds are filled by coronavirus patients, The Independent has learnt.
Major organ transplant centres in London, as well as the Queen Elizabeth Hospital in Birmingham and Addenbrooke’s Hospital in Cambridge, have been forced to close their doors to transplant cases because of a lack of beds, the increased risk to patients, and the need to redeploy doctors and nurses to the coronavirus front line.
The impact on organ transplant services follows hundreds of urgent cancer operations being delayed in London and across the country, as NHS trusts run out of spare beds to treat non-Covid patients. Most routine operations have also been stopped in the hardest-hit areas.
Teacher Shona McFadyen was diagnosed with liver cancer in December 2018 and needs an urgent liver transplant at the Queen Elizabeth Hospital in Birmingham. She has already waited 22 months for her surgery.
She told The Independent: “It’s not the hospital’s fault. I get that. But it just adds to the feeling of hopelessness and it feels like as patients we have been forgotten about. It is life and death for us.”
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Source: The Independent, 13 January 2021
Some High Street pharmacies in England will start vaccinating people from priority groups on Thursday, with 200 providing jabs in the next two weeks.
Six chemists in Halifax, Macclesfield, Widnes, Guildford, Edgware and Telford are the first to offer appointments to those invited by letter. But pharmacists say many more sites should be allowed to give the jab, not just the largest ones.
More than 2.6 million people in the UK have now received their first dose.
Across the UK, the target is to vaccinate 15 million people in the top four priority groups - care home residents and workers, NHS frontline staff, the over-70s and the extremely clinically vulnerable - by mid-February.
The vaccines – made by either Oxford-AstraZeneca or Pfizer-BioNTech – are being administered at hospitals, care homes, GP surgeries and vaccination centres.
It comes as the UK saw its highest number of daily reported coronavirus deaths since the pandemic began, with the government announcing a further 1,564 deaths of people within 28 days of a positive Covid test.
On Wednesday evening, the Scottish government published its detailed 16-page plan for rolling out the vaccine, including details of how many vaccines it expects to receive every week until the end of May.
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Source: BBC News, 14 January 2021
NHS England has asked hospitals across the country to open hundreds more intensive care beds so they can take in patients from the hardest hit areas, to prevent those patches having to ration access.
A letter sent to dozens of acute trusts today by NHS England asks them to enact their “maximum surge” for critical care from tomorrow, opening up hundreds of beds, which will rely on them redeploying staff and cancelling more planned care.
The letter is to trusts in the Midlands but HSJ understands a similar approach is being taken in the other regions where critical care is not currently under as much pressure as London, the East of England and the South East.
The message to surge capacity to support a “national critical care service” was reinforced to trusts nationwide in a call with Keith Willett, NHS England covid incident director, also on Wednesday.
The letter, from the NHSE Midlands regional team, said there had been a national request for the region to surge beyond its own needs to support London and the East of England. “Significant” numbers are likely to be transferred, HSJ was told.
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Source: HSJ, 13 January 2021
COVID-19 patients in England's busiest intensive care units (ICUs) in 2020 were 20% more likely to die, University College London research has found.
The increased risk was equivalent to gaining a decade in age.
By the end of 2020, one in three hospital trusts in England was running at higher than 85% capacity. Eleven trusts were completely full on 30 December, and the total number of people in intensive care with Covid has continued to rise since then.
The link between full ICUs and higher death rates was already known, but this study is the first to measure its effect during the pandemic.
Tighter lockdown restrictions are needed to prevent hospitals from being overwhelmed, says study author Dr Bilal Mateen.
Researchers looked at more than 4,000 patients who were admitted to intensive care units in 114 hospital trusts in England between April and June last year. They found the risk of dying was almost a fifth higher in ICUs where more than 85% of beds were occupied, than in those running at between 45% and 85% capacity. That meant a 60-year-old being treated in one of these units had the same risk of dying as a 70-year-old on a quieter ward.
The Royal College of Emergency Medicine sets 85% as the maximum safe level of bed occupancy. However, the team found there was no tipping point after which deaths rose - instead, survival rates fell consistently as bed-occupancy increased.
This suggests "a lot of harm is occurring before you get to 85%".
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Source: BBC News, 14 January 2021
More than 1,000 people needing urgent cancer surgery in London have no date for their treatment, HSJ can reveal.
A document leaked to HSJ showed that, at the end of last week, more than 1,000 of London’s cancer surgery patients without an appointment date were defined as P2 (priority two), meaning they needed to be seen within four weeks or risk their condition worsening.
The report seen by HSJ also showed more than 300 P2 patients had their surgery postponed in the past week, a statistic NHS England London has so far refused to disclose.
Hospitals in the capital are facing their highest-ever COVID-19 occupancy rates, with surgical lists at many trusts being cancelled.
Meanwhile, a separate NHSE London document reported in the press this week revealed: “Most NHS Green sites [those cancer surgery sites intended to be covid-free to avoid risk to very frail patients] are now compromised with only a limited number of cases being undertaken in NHS sites this week”.
The papers also said the current plans to increase indepedent sector capacity usage were “insufficient to offset the NHS shortfall”, and noted there was a two week lead-in time to move patients into private hospitals “based on clinical rotas, theatre bookings, [and] patient isolation”.
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Source: HSJ, 12 January 2021
In July last year, the Independent Medicines and Medical Devices Safety Review – chaired by Baroness Cumberlege— published its landmark report, First Do No Harm. It followed a two-year review of harrowing patient testimony and a large volume of other evidence concerning three medical interventions: Primodos, sodium valproate and pelvic mesh.
Yesterday, in a written statement to Parliament, the Minister for Patient Safety, Suicide Prevention and Mental Health, Nadine Dorries, gave an update on the government’s response to the recommendations of the Cumberlege Review.
In an article in The Times today, Baroness Cumberlege welcomes that the government has now accepted the need for a patient safety commissioner for England and the amendment to the Medicines and Medical Devices Bill, which is being considered in the House of Lords today, which she hopes "will swiftly become law".
However, she also states that "... a full response to the review's is still outstanding 6 months after publication. Action is urgently needed to ensure we help those who have already suffered and reduce the risk of harm to patients in future".
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Source: The Times, 12 January 2021
The Becker's Clinical Leadership & Infection Control editorial team chose the top 10 patient safety issues for healthcare leaders to prioritise in 2021, presented below in no particular order, based on news, study findings and trends reported in the past year.
COVID-19
Healthcare staffing shortages
Missed and delayed diagnoses
Drug and medicine supply shortages
Low vaccination coverage and disease resurgance
Clinical burnout
Health equity
Healthcare-associated infections
Surgical mistakes
Standardising safety efforts.
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Source: Becker's Healthcare, 30 December 2020
Hospital chiefs in the South West have warned the region will not avoid the extreme pressures felt by other parts of the NHS amid rapidly rising numbers of COVID-19 inpatients.
The region was the least affected area of England during the pandemic’s first wave, but the medical director of two acute trusts yesterday predicted a “tidal wave” of COVID-19 coming to the West Country.
Adrian Harris, medical director at Royal Devon and Exeter Foundation Trust and Northern Devon Healthcare Trust (NDHT), said the region faced an “absolute crisis” and individual trusts would be “hanging on by their fingernails”.
His comments, made at NDHT’s board meeting, came on the same day HSJ revealed the South West region now has the fastest growth in COVID-19 inpatients. Although the region is England’s least densely populated, it also has the lowest hospital capacity per capita in the country.
Dr Harris said: “We hope and we pray that the lockdown has come in time for Devon. My personal view — and of my colleagues around the country — is that there’s a tidal wave of COVID-19 coming to the West Country."
“We are preparing to be hit as hard as the East of England. If we are hit as hard, we will be hanging on by our fingernails and we are planning accordingly.”
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Source: HSJ, 8 January 2021
The Pfizer/BioNTech vaccine can still target a key mutation that has emerged in two new variants of coronavirus, laboratory studies show.
However, this is only one of many mutations that are found in the new forms of the virus. So while the study has been welcomed, it is not being seen as definitive scientific evidence about how the vaccine will perform.
New variants have been detected in the UK and South Africa. Both forms of the virus are spreading more quickly and this has raised questions over what level of protection vaccines can offer against them.
The widely held view is that vaccines will still work, but researchers are on the hunt for proof.
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Source: BBC News, 8 January 2021
Patients calling NHS 111 in London could face a 30-hour wait before being admitted to a hospital bed, the capital’s ambulance service has warned.
Slides presented by London Ambulance Service Trust at a webinar with NHS London this week showed “category three” patients faced long delays at all stages of the process.
The length of each stage was said to be as follows: having calls answered at 111 centres (20 mins); the “revalidation” of the call before it is passed to 999 (two hours); 10 to 12 hour waits for an ambulance; and similar waits in emergency departments before being admitted to a bed.
Category three calls are considered urgent, but not immediately life-threatening. The calls could involve abdominal pain, uncomplicated diabetic issues and some falls. Category three patients are among those the NHS is encouraging to call first, rather than going straight to accident and emergency, as part of the flagship “111 first” drive designed to produce pressure on emergency care.
Normally, the pathway from a 111 call being made to a patient being admitted to a bed would take nine hours with a faster response at all stages, the slides suggest. But the pressure across the NHS from covid cases is leading to much longer waits.
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Source: HSJ, 8 January 2021
The Moderna COVID-19 vaccine has become the third to be approved by the UK.
The US pharmaceutical company’s jab was given the green light by Britain’s regulator and doses will be available in the spring.
The announcement comes as the rollout of the Pfizer and Oxford vaccines is scaled up to meet Boris Johnson’s target of immunising all care-home patients by the end of the month, with 1,000 vaccination centres expected to be operational by Sunday.
The government has also purchased an additional 10 million doses of the Moderna vaccine on top of its previous order of 7 million, taking the total to 17 million.
Supplies will begin to be delivered to the UK once Moderna expands its production capability, the Department of Health and Social Care said.
The Medicines and Healthcare products Regulatory Agency (MHRA) accepted the recommendation of the Commission on Human Medicines and authorised the Moderna vaccine following months of rigorous clinical trials and extensive analysis of the vaccine’s safety, quality and effectiveness.
The jab is 94% effective in preventing disease, including in the elderly.
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Source: The Independent, 8 January 2021
Two more life-saving drugs have been found that can cut deaths by a quarter in patients who are sickest with Covid.
The anti-inflammatory medications, given via a drip, save an extra life for every 12 treated, say researchers who have carried out a trial in NHS intensive care units.
Supplies are already available across the UK so they can be used immediately to save hundreds of lives, say experts. The UK government is working closely with the manufacturer, to ensure the drugs - tocilizumab and sarilumab - continue to be available to UK patients.
As well as saving more lives, the treatments speed up patients' recovery and reduce the length of time that critically-ill patients need to spend in intensive care by about a week.
Both appear to work equally well and add to the benefit already found with a cheap steroid drug called dexamethasone.
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Source: BBC News, 7 January 2021
The chief inspector of hospitals has called for honesty about the impact of the coronavirus pandemic on patients warning poor care could become normalised.
Professor Ted Baker told The Independent it was vital staff continued to report incidents and revealed the Care Quality Commission had seen a 60% rise in whistleblowing concerns during the last national lockdown in November.
He said staff must report incidents and be free to speak up about any concerns as well as being transparent with families where things have gone wrong.
He emphasised that where a patient was unable to get the care they clinically needed because of the demand on services, this would amount to a notifiable patient safety incident.
Professor Baker’s comments follow multiple anonymous leaks from NHS staff to The Independent in recent weeks, showing how bad the situation has become in some hospitals. Many staff have only spoken out on condition of anonymity.
Many hospitals have declared major incidents, cancelled operations and been forced to stretch staffing ratios to unsafe levels to cope with the increasing numbers of COVID-19 patients.
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Source: The Independent, 7 January 2021
A hospital in the South East today declared a level of critical care alert meaning that it may be forced into ‘refusal or withdrawal of critical care due to resource limitation’ because it has been ‘overwhelmed’ — but later claimed it was an ”administrative error”.
Data from an internal NHS dashboard for critical care, seen by HSJ, showed today Darent Valley Hospital, near Dartford in Kent, declared it was at “CRITCON level four”.
CRITCON level four declarations are extremely rare. In guidance they are known as “Triage - emergency” and defined as: “Resources overwhelmed. Possibility of triage by resource (non-clinical refusal or withdrawal of critical care due to resource limitation).”
The definition continues: “This must only be implemented on national directive from [NHS England] and in accordance with national guidance.”
Dartford and Gravesham Trust, which runs the hospital, replied to HSJ more than five hours after it was contacted, and after publication of the story, to say: “This was a purely administrative error which was quickly rectified.” The level has not however been changed so far on the live dashboard, HSJ has confirmed.
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Source: HSJ, 7 January 2021
"There can be no debate: this is now much, much worse than the first wave", says a NHS consultant.
"Truly, I never imagined it would be this bad.
Once again Covid has spread out along the hospital, the disease greedily taking over ward after ward. Surgical, paediatric, obstetric, orthopaedic; this virus does not discriminate between specialities. Outbreaks bloom even in our “clean” areas and the disease is even more ferociously infectious. Although our local tests do not differentiate strains, I presume this is the new variant.
The patients are younger this time around too, and there are so many of them. They are sick. We are full."
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Source: The Guardian, 7 January 2020
In a Letter to the Editor published in The Times yesterday, the All Party Parliamentary Group on First Do No Harm Co-Chair Baroness Julia Cumberlege argues in favour of the work of the Independent Medicines and Medical Devices Safety (IMMDS) Review and its report 'First Do No Harm'.
"Inquiries are only as good as the change for the better that results from their work."
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Source: The Times, 5 January 2021
An experimental treatment involving stem cells from umbilical cords could significantly reduce deaths and quicken recovery time for patients suffering the most severe form of COVID-19, a study suggests.
US researchers reported a 91% survival rate in seriously ill patients given the stem cell infusion, compared to 42% in a second group who did not receive the treatment.
Researchers said the treatment also appeared to be safe, with no serious adverse reactions reported.
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Source: The Independent, 5 January 2021
Hundreds of people a day across London are waiting hours for an emergency ambulance to get to them, as paramedics warn that patients are dying as a result of delays.
Patients in emergency calls classified as category two, such as those involving a suspected stroke or chest pains, should be seen by paramedics within an average of 18 minutes but are being forced in some cases to wait up to 10 hours.
Even life-threatening calls where patients are in cardiac arrest and should be reached within seven minutes have experienced delays, with data suggesting one such call was waiting 20 minutes on Monday.
Internal data shared with The Independent shows that London Ambulance Service is holding hundreds of open 999 calls for hours at a time with the service’s boss acknowledging in an email to staff that the service is struggling to maintain standards. Experts warned that the problems in the capital were reflected in ambulance services across the country.
One paramedic told The Independent: “Patients desperately requiring ambulances aren’t getting them and, anecdotally, people are deteriorating and dying whilst waiting. Our poor dispatchers have to stare at screens of held calls, working out who gets the next available resource and who waits, suffers or dies.”
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Source: The Independent, 5 January 2021
Overseas-trained nurses have been told they can join the temporary coronavirus register without undertaking a formal “clinical assessment” in an attempt to bolster the NHS workforce as the third covid wave surges.
The Nursing and Midwifery Council confirmed on Tuesday that it has invited the additional nurses in a bid to “strengthen workforce capacity in the immediate period and coming weeks”.
It comes as the number of covid inpatient admissions rises sharply across the country, with London and the South East of England badly hit. At the start of the pandemic last year, the NMC asked former nurses who had left within the last three years to join the emergency covid register as cases grew.
Unison union’s national nursing officer Stuart Tuckwood believed the move will help deal with “severe” staffing shortages, but warned they must be “supported and supervised” by fully registered nurses to ensure patient safety.
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Source: HSJ, 6 January 2021
Potentially life-saving cancer operations have been put on hold at a major London NHS trust because of the number of beds taken by Covid patients.
King's College Hospital Trust has cancelled all "Priority 2" operations - those doctors judge need to be carried out within 28 days.
Cancer Research UK said such cancellations did not appear to be widespread across the country.
And surgery has not been stopped on the same scale as during the first wave.
Rebecca Thomas, who has had her bowel cancer surgery at King's College Hospital "cancelled indefinitely", told the BBC she felt like she had been left "in limbo".
Until she has surgery her tumour cannot be studied to see how aggressive it is, and so she won't know until then how significant this wait will turn out to be.
A spokesperson for the Trust, which mainly serves patients in south London, said: "Due to the large increase in patients being admitted with COVID-19, including those requiring intensive care, we have taken the difficult decision to postpone all elective procedures, with the exception of cases where a delay would cause immediate harm.
"A small number of cancer patients due to be operated on this week have had their surgery postponed, with patients being kept under close review by senior doctors."
Twenty-three hospital trusts had more than a third of their core bedbase occupied by COVID-19 patients on Tuesday, and occupancy is still rising at all but one.
Three trusts (North Middlesex in north London, as well as Medway and Dartford and Gravesham in Kent) had more than half of general and acute beds occupied by patients who had the virus, and others were not far behind.
Several trusts saw their covid occupancy share up by more than 10 percentage points in a week — a rate of growth which would soon see them entirely filled by covid patients, a situation with radical consequences for emergency hospital care in those areas.
London as a whole had a third of these beds occupied by patients with COVID-19.
HSJ has analysed data published for the first time by NHS England last night. The data concerns the status of adult general and acute beds, which make up the large majority of the acute bedbase. They do not include intensive care, which is also now under huge pressure in London, the south east and the east of England. Most hospitals in these areas are stretching IC capacity above normal levels.
Such high covid occupancy in both intensive care and the core bedbase is putting severe strain on hospitals’ ability to treat other patients. Most or all of the trusts under the greatest pressure have now cancelled routine planned surgery, and many are struggling with crowding, delays getting patients into and out of emergency departments due to the space available, and a lack of staff.
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Source: HSJ, 1 January 2021
Elderly people who suffer falls are having to wait up to six hours for an ambulance because of rising Covid pressures, a medical body has warned.
The delays are due to paramedics having to prioritise 999 calls from people suffering from coronavirus related breathing difficulties.
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Source: The Telegraph, 1 January 2021
