Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.
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COVID-19 guidance and policy
NHS Employers highlight the most recent updates to COVID-19 guidance for NHS workforce leaders. The updates include new information on registering staff for COVID-19 testing, FAQs on the extension to visas for international healthcare professionals, and details of the professions covered by the extension scheme.
A new framework produced by the Faculty of Occupational Medicine, and backed by NHS England, offers recommendations on how to reduce the risks of COVID-19 to healthcare staff. Based upon the current evidence available on the heightened risks linked with characteristics including age, gender, ethnicity and long term health conditions, the framework offers recommendations on how to approach risk assessments incorporating the workplace, workforce and the individual. One potential consideration is for the redeployment of staff to lower risk environments.
NHS England have produced guidance on supporting compassionate visiting arrangements for those receiving end of life care. The guidance highlights general practical considerations, and provides advice on how to facilitate visiting in inpatient, hospice, care home settings, as well as at home. All recommendations are consistent with the existing advice on suspension of visiting and palliative care in hospitals, and general advice from the government.
Health Education England (HEE) have produced a set of resources aimed at supporting staff to manage difficult conversations with patients and families during the Covid-19 outbreak. A series of films have been produced, alongside some print resources aimed to guide the process of communicating unwelcome news.
The Royal College of Nursing (RCN) has developed a learning resource to support the delivery of dignified end of life care. The programme is intended to equip staff with some of the resources necessary to support dying people and their family and carers, and to ensure the provision of dignified end of life care, and also offers support for the wellbeing and self-care of nursing and midwifery staff. The online programme has been designed to be flexible, allowing staff to access and revisit individual resources as necessary.
Multidisciplinary guidance published in the journal Anaesthesia, brings together the work of surgeons, anaesthetists, intensive care staff, nurses, physiotherapists, speech & language therapists and importantly, from patient groups, offering consensus on how to improve safety in tracheostomy of patients with Covid-19. Topics covered by the guidance include: the infectivity of patients with respect to tracheostomy indications and timing; aerosol‐generating procedures and risks to staff; insertion procedures; and management following tracheostomy.
Rehabilitation of Covid-19 patients
Two new sets of guidance provide recommendations for the rehabilitation needs of patients surviving COVID-19 related critical illness. The Faculty of Intensive Care Medicine (FICM) have produced provisional guidance on the recovery and rehabilitation of patients, considering the necessarily multidisciplinary nature of the services and professionals involved, and providing an example hospital care pathway.
Meanwhile, the Chartered Society of Physiotherapists (CSP) have launched a set of standards aimed at physiotherapists and service leads, and outlining the need for continuation of rehabilitation from critical and acute care through to hospital or community-based rehabilitation services.
Reintroducing healthcare services
A series of resources have been produced, outlining key principles for reintroducing routine aspects of the healthcare services in the UK that have taken a backseat during the first peak of COVID-19:
NHS England have produced a road map, noting the requirement for patients to isloate for 14 days prior to attending planned procedures, and to be symptom free in order to be admitted. It also mentions testing and social distancing requirements relating to both elective and emergency treatment.
NHS Providers have produced a briefing on balancing the needs of managing the ongoing demands and risks of COVID-19 treatment, alongside restarting care for other healthcare needs.
A joint piece from the Health Foundation, The King’s Fund and Nuffield Trust identifies five immediate challenges they believe the NHS face, including reassuring the public about using the services they need, looking after the workforce, and using the changes that have been made to services as the basis for future innovation and improvement.
The Academy of Medical Royal Colleges (AOMRC) have published principles for reintroducing healthcare services, again addressing the use of remote or virtual care where appropriate, the need for the public to seek necessary medical help, and staff support. Their guidance also provides further links to key specialty specific and individual College guidance.
Intercollegiate guidance on the pre-operative COVID-19 testing for elective cancer surgery has been updated. The guidance, from organisations including the Royal College of Surgeons of Edinburgh (RCSED), the Royal College of Surgeons of England (RCS) and the Royal College of Radiologists (RCR), clearly outlines the necessary process for screening before surgery.
The British Orthopaedic Association (BAO) have issued new guidance on restarting non-urgent trauma and orthopaedic care. The guidance comprises three sections: capacity issues for resuming surgery; infection prevention and control measures for planned surgery and prioritising patients for surgery.
A number of NHS unions have jointly produced a blueprint for return, focussed on keeping staff and patients safe.
COVID-19 related news
A new study will attempt to explore how genetics might influence individual reactions to COVID-19, offering explanations as to why some patients experience a mild infection, while others’ response of the virus is much more severe. In setting out to identify which genes cause particular people to be susceptible to specific infections, the study aims to determine which existing treatments may be effective, and to support the development of new treatments.
A Cochrane Rapid Review published yesterday, examines the evidence for convalescent plasma in the treatment of patients with COVID-19. While the existing evidence consists of 8 very small studies, meaning the effectiveness and safety of this treatment is uncertain, the authors identified 48 ongoing studies into the use of convalescent plasms in COVID-19 patients. The review will be updated based on monthly searches.
The Royal College of Nursing (RCN) has called for the collection of accurate data on health and care staff who contract COVID-19 in an open letter sent to the UK’s health secretaries and ministers. The letter states that a failure to properly collect data on workers testing positive, those admitted to hospital or having died as a result of the virus, means that decisions are being made without sufficient information.
Trainee rotations in August will take place as planned, Health Education England (HEE) have announced, following the cancellation of all planned rotations in May, June and July. Trainees in Foundation and Core posts will rotate at the beginning of August, though these will take account of local requirements and COVID-19 pressures. A webinar for trainees will take place at 7pm on Tuesday 26 May, and further information and up to date guidance for trainees can be found on the HEE website.
The Royal College of Physicians (RCP) has called on the government to make changes for international health and social care staff, in recognition of their vital frontline role, which has been highlighted during the management of the current pandemic. Changes proposed by the RCP would see staff exempted from the International Health Surcharge, extension of the proposed NHS Visa to social care staff, and indefinite leave to remain offered to all NHS and social care staff who have worked during the pandemic, along with their spouses and dependents.
The Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives (RCM) have published a joint statement in response to a study on the outcomes of pregnant women and their babies during the pandemic. Findings from the UK study support the existing clinical guidance that pregnant women are at no greater risk of severe illness, but did show that older pregnant women, or those who were obese or overweight, had pre-existing conditions including diabetes, or were of BAME background were more likely to be hospitalised if infected. In addition, the majority of women hospitalised were in the third trimester of their pregnancy.
The Parliamentary Office of Science and Technology (POST) have produced a series of briefings based on the concerns that experts have relating to COVID-19 and various aspects of short, medium and long-term management and treatment. The briefings address concerns about the health and social care system, future preparedness for public health crises, research into testing, treatment and therapies, and the virology, immunology and epidemiology of COVID-19.
The Centre for Mental Health has used international evidence from previous epidemics and the aftermath of the 2008 banking crisis, to estimate the potential effects of COVID-19 on the mental health of the UK population. The briefing highlights groups who are at especially high risk of mental health difficulties, and offers recommendations for action that the government and the NHS can take in order to protect and support the mental health of the population.
International Nurses Day took place on the 12 May, and while planned celebrations had to be put on hold, or much adapted in light of the current pandemic, the always vital contribution of nursing staff to the healthcare system was still marked, locally, nationally and internationally. The RCN created a video to mark the day, and also urged nursing staff to ensure their own self-care and wellbeing.
Medtech innovation briefing
- COVID-19 infection survey, England: provisional results
- COVID-19 related deaths by occupation, England and Wales: deaths registered up to and including 20th April 2020
- Deaths involving COVID-19, England and Wales: deaths occurring in April 2020
- Potential Coronavirus (COVID-19) symptoms reported through NHS Pathways and 111 online
- Potential Coronavirus (COVID-19) symptoms reported through NHS Pathways and 111 online, Week Ending 10th May 2020
- Weekly all-cause mortality surveillance: 2019 to 2020
- Weekly national flu reports: 2019 to 2020 season
- Waiting times for suspected and diagnosed cancer patients, Q4 2019/20 (Provider based)
- Waiting times for suspected and diagnosed cancer patients for March 2020
- Monthly hospital activity data for March 2020
- Referral to treatment waiting times statistics for consultant-led elective care for March 2020
- Diagnostic waiting times and activity for March 2020
- A&E attendances and emergency admissions for April 2020
- Provisional Accident and Emergency Quality Indicators for England – March 2020, by provider
- Provisional Monthly Hospital Episode Statistics for Admitted Patient Care, Outpatient and Accident and Emergency data – April 2019 – March 2020
- Summary Hospital-level Mortality Indicator (SHMI) – Deaths associated with hospitalisation, England, January 2019 – December 2019
- Deaths registered weekly in England and Wales, provisional: week ending 1 May 2020
- NHS Continuing Healthcare and NHS-funded Nursing Care for Q4 2019/20
- Recorded Dementia Diagnoses – April 2020
- Psychological Therapies: reports on the use of IAPT services, England – February 2020 Final including reports on the IAPT pilots
- Physical Health Checks for People with Serious Mental Illness, Q4 2019/20
- Mental Health Services Monthly Statistics – Final February, Provisional March 2020
- Out of Area Placements in Mental Health Services – February 2020
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