Increase availability of testing for NHS staff, says report

A new report by the Healthcare Safety Investigation Branch has recommended that NHS England and NHS Improvement better support additional capacity for testing for NHS patients and staff.

The report charts a four-month patient safety investigation that was launched following concern that patients were contracting coronavirus after being admitted to hospital. It concludes with short, medium and long term measures that support both immediate and future responses as the NHS continues to tackle the virus.

The measures include eight national safety recommendations, safety observations and a tool that trusts can use straight away to review their approach. Chief among these are recommendations that NHS England and NHS Improvement supports additional capacity for testing for NHS patients and staff (known as Pillar 1 testing), and also facilitates the accessibility of rapid testing for NHS trusts, as soon as an increase in rapid testing supplies becomes available.

The report also recommends that the Department of Health and Social Care, working with NHS England and NHS Improvement, Public Health England, and other partners as appropriate, develops a transparent process to co-ordinate the development, dissemination and implementation of national guidance across the healthcare system to minimise the risk of nosocomial transmission of coronavirus.

NHS England and NHS Improvement are also encouraged to develop a national intensive infection prevention and control (IPC) safety support programme for coronavirus which focuses on leadership, IPC technical support, education, practice, guidance and assurance, as well as develop a national IPC strategy which focuses on developing IPC capacity, capability and sustainability across the NHS in England.

HSIB also suggests that NHS England and NHS Improvement investigates and evaluates the risks associated with the potential impact of staff fatigue and emotional distress on nosocomial transmission of the virus.

Kathryn Whitehill, HSIB Principal National Investigator, said: “We were moved by stories shared and grateful for the input from families, staff and system leaders. We know the profound personal and organisational impact this virus has had; our intention is not to criticise the NHS response rather set out a prospective view of safety that supports their efforts as cases rise and we head into winter.

“The spread of coronavirus in hospitals presents a risk to patient safety. It also puts enormous strain on the workforce and the fear of contracting Covid-19 in hospital can deter patients from attending hospital who may need urgent treatment for other conditions.

“Our investigation sought to understand factors that helped or hindered efforts to manage the risk of transmission on hospital wards. We also examined the NHS response in the context of the ‘hierarchy of controls’ – a widely used approach that sets out measures to mitigate risk ranked by their effectiveness. Our report sets out 39 key findings that cover everything from hospital design and guidance to PPE and testing capacity. This detailed insight enabled us to develop safety recommendations that would aid short and long-term planning and ensure that NHS trusts had measures they could implement immediately.”

Justin Madders MP, Labour’s Shadow Health Minister, responded: “This is an important report highlighting the challenges the NHS has faced in understanding how Covid-19 was transmitted in hospitals and the significant effort that has gone in to limiting that transmission.

“There are a number of important recommendations in the report that ministers must rapidly implement – not least the need to increase the availability and speed of testing for patients and NHS staff, something Labour has been calling for many months now. The NHS workforce were placed under immense pressure during the first Covid-19 wave and so there must be a workforce plan in place for the second wave with a guarantee that all staff will receive the support they need to keep themselves and patients safe.”

Miriam Deakin, director of policy and strategy at NHS Providers, said: “Throughout the pandemic trust leaders have demonstrated their willingness to learn and adapt as our knowledge and understanding of the virus has developed. This report from HSIB draws on the experiences of trusts, staff and patients with a welcome focus on learning, to try to reduce the risk of Covid-19 transmission on hospital wards.

“We agree about the need for greater clarity on the development and communication of guidance. HSIB is also right to emphasise the importance of improved testing capacity for staff, and to point out the challenges that additional infection control requirements place on the NHS estate. Unfortunately this has highlighted yet again the impact of years of inadequate capital investment.

“The report also rightly highlights the potential consequences of staff fatigue and emotional distress. In our recent survey of trust leaders 99 per cent said they were concerned about current levels of burnout across the workforce.”