this week MISSING TESTS page 44 • BIRTHING PARTNERS page 47 • NHS NET ZERO EMISSIONS page 49 DAN KITWOOD/GETTYIMAGESDAN Patient safety at risk from staff shortages NHS trusts in England have reported and infrastructure, including the Queen Jonathan Ashworth, the various risks to the safety of patients linked Elizabeth Hospital King’s Lynn. It reported shadow health secretary, to staffi ng shortages, lack of funding, “a direct risk to life and safety of patients, said the risks were particularly or problems with buildings and failing visitors, and staff ” from the potential failure worrying for the NHS given the approaching winter and the equipment, shows an analysis of risk of a structurally defi cient roof. ongoing pandemic registers carried out by the Labour Party. Rob Harwood, BMA Consultants Labour says the documents show the NHS Committee chair, said, “This worrying entered the pandemic with major problems analysis illustrates the very real impact that and that urgent action is now needed for it understaffi ng and inadequate funding has to cope with a second wave of covid-19 on on the safety of our hospitals. It has never top of the usual winter pressures. been more essential that the NHS gets Jonathan Ashworth, shadow health everything it needs as the already exhausted secretary, said, “In a normal winter these and traumatised workforce look ahead to a risks would be worrying. In the coming winter where we face both a second wave of winter they take on a whole new meaning.” covid-19 and a massive backlog of care.” Labour analysed 114 risk registers, The analysis came as an NHS Providers LATEST ONLINE compiled after the onset of the pandemic, survey of 140 NHS trust leaders found that from non-specialist acute care NHS trusts in 99% were concerned about staff burnout, Confusion England and found over half reported risks while 94% were concerned about the eff ects continues over described as “signifi cant” or “extreme.” of winter pressures. Over half (56%) were Trump’s illness and treatment Ninety fi ve trusts (83%) reported a worried they did not receive the necessary workforce risk, including insuffi cient staff . support to deliver a sustainable service. Antibiotics are as For example, University Hospitals of Derby A Department of Health and Social Care good as surgery for appendicitis, and Burton warned it did not have enough spokesperson said, “On top of the record study reports clinical oncologists. And 75 trusts reported a investment already in place, the government fi nancial risk, including Liverpool Women’s, provided £31.9bn extra in July, with £3bn Anti-TNF drug adalimumab to which warned it was not fi nancially specifi cally to support the NHS during the be trialled for sustainable beyond this fi nancial year. winter and to update A&E facilities.” covid-19 patients The analysis also found that 69% of Jacqui Wise , London in the community trusts (77) reported risks linked to capital Cite this as: BMJ 2020;371:m3885 the bmj | 10 October 2020 43 SEVEN DAYS IN Only half of 16 000 patients missed from England’s covid fi gures have been traced Details of nearly 16 000 cases of covid-19 were not transferred to England’s NHS Test and Trace service and were missed from offi cial fi gures because of an updating error. The health and social care secretary, Matt Hancock, told MPs on Monday 5 October that the error was discovered on the Friday and 6500 hours of extra contact tracing had been carried out since. As he spoke only half (51%) of the contacts had been reached. In response, the shadow health secretary, Jonathan Ashworth, said, “Thousands of people are blissfully unaware they have been exposed to covid, potentially spreading this deadly virus at a time when hospital admissions are rising and we are in the second wave. This is not just a shambles, it is so much worse.” The missed cases were added to the weekend’s daily fi gures, meaning that 22 961 cases were reported on Sunday and 12 872 on Saturday. Reports indicated the problem may have been caused by the row limit on Microsoft ’s Excel soft ware, which caused numbers sent from one laboratory to be missed off . Hancock would not confi rm the cause but he told the House of Commons he had already decided in July to replace the system at fault. ALEX LENTATI/LNP/SHUTTERSTOCK Elisabeth Mahase , The BMJ Cite this as: BMJ 2020;371:m3891 Covid-19 not only reinforces inequitable 176 UK hospitals. Many clinical the Bill and Melinda Gates GPs need extra support power structures but undermines care guidelines that have Foundation and the World for second wave an effective covid-19 response— recommended the combination Health Organization. The move General practices will struggle to ultimately costing lives.” for patients admitted with covid- came after WHO approved the cope with a second wave of covid- 19 should now be updated, first rapid point-of-care test 19 without urgent measures Politicians must be honest researchers wrote in the Lancet . for emergency use, from SD to support them, the BMA about NHS delivery Biosensor, on 22 September. warned. In a report published NHS leaders called for an honest Testing Several other tests that do not on 30 September its General assessment of what the service Test staff weekly to keep require laboratory processing are Practitioners Committee called for can deliver as it grapples with a NHS running, say MPs being assessed, including one occupational health services to “triple whammy” of rising covid- The government should ensure from US company Abbott, which be made available to all practice 19 infections, a major backlog that all NHS staff are routinely is in the final stages of approval. staff, alongside free supplies of of treatment, tested for covid-19 this winter to personal protective equipment, and reduced enable services to continue, MPs GMC cases suspension of routine capacity owing to urged. In its inquiry report the Consultant is re-registered inspections by the Care Quality infection control Health and Social Care Committee after “deep remorse” Commission, and suspension measures. A said urgent action was needed to Pandeshwar Gururaj, a of the Quality and Outcomes report by the NHS tackle a treatment backlog and an consultant anaesthetist who Framework, as part of efforts to Confederation said the service unknown level of demand for all was suspended from the reduce bureaucracy. was at “a critical crossroads” as health services. The MPs said that medical register for 12 months winter approached. Niall Dickson they had accepted advice from for adding his name to theatre Men dominate decision (above), the confederation’s scientists about a “significant sheets at the private Albyn making groups outgoing chief executive, said risk that not testing NHS staff Hospital in Aberdeen when An analysis of 115 covid-19 that, while the NHS had made routinely could lead to higher he was not present, has been decision making task forces “fantastic strides” towards levels of nosocomial infections in allowed back on the register from 87 countries published in resuming routine services, any second spike.” after telling a tribunal of his BMJ Global Health found that covid’s impact on capacity was “deep shame and remorse.” A men predominated in over 85% “likely to go on for several years.” Poorer countries to get medical practitioners tribunal of these groups, while women 120 million rapid tests heard he had repaid the predominated in just 11.5%, Antiviral combination does Low and middle income money he was paid, worked with gender parity in 3.5%. not help severe illness countries were promised as a volunteer at a British “Men dominating leadership The drug combination lopinavir- 120 million covid-19 Red Cross store, and positions in global health has ritonavir is not an effective diagnostic tests, which undertaken educational long been the default mode of treatment for patients admitted can provide results in courses. Insight into governing,” excluding those to hospital with covid-19, showed 15-30 minutes, his behaviour was “who offer unique perspectives, results from the Randomised by a group of “substantial and expertise and lived realities,” Evaluation of COVid-19 thERapY organisations comprehensive,” the authors concluded. “This (RECOVERY) trial, under way at including it said. 44 10 October 2020 | the bmj SIXTY SECONDS MEDICINE ON . VITAMIN D Maternity care New royal college Communication campaign guidance aims to aims to tackle disparities improve communication THE SUNSHINE ONE? The Royal College of Obstetrics with pregnant women Indeed, as we enter the season of mists and and Gynaecology and the mellow fruitfulness, thoughts have been campaigning group Five X More turning to the sunshine vitamin and its potential role in beating covid-19. published guidance to help improve communication between CAN YOU SHED MORE LIGHT ON THAT? healthcare professionals and England’s health secretary, Matt Hancock, pregnant women to try to drive put his foot in it when he told MPs last week down maternal health disparities that he had ordered a trial to see if vitamin D in the UK. The five actions include reduced the incidence or eff ects of covid-19 listening to women’s concerns, the Democratic Republic of the and that “the results were that it does not anxieties, and responses to Congo. WHO stated, “The betrayal MENTAL appear to have any impact.” It turns out that pain and removing barriers to of people in the communities we there have been no government trials. communication by using lay serve is reprehensible. We do not HEALTH DID THAT RAYS SOME QUESTIONS? terms and translation services tolerate such behaviour in any of Hancock appears to have been confused.