public health – Page 37 – The NEN

COVID-19: New Omicron variant discovered in Scotland

Six cases of the COVID-19 omicron variant have been identified in Scotland.

Four cases are in the Lanarkshire area and two have been identified in the Greater Glasgow and Clyde area.

Public Health Scotland and local health protection teams are supporting and contact tracing is being undertaken to establish the origin of the virus and any individuals they have come into contact with in recent weeks.

Health Secretary Humza Yousaf said: “This will be a worrying time for the six people now identified as having the new variant. All will receive expert help and support and Public Health Scotland will undertake enhanced contact tracing in all cases. This will help establish the origin of the virus and any further individuals they have come into contact with in recent weeks.

“There is still much to learn about the Omicron variant. Questions remain about its severity, transmissibility and response to treatments or vaccines and scientists are working at pace to provide additional information. Until more is known we must be cautious and do everything we can to minimise the risk of spreading infection.

“We have already taken steps and are aligning with the new border restrictions being introduced by the UK Government which will require fully vaccinated arrivals to take a PCR test within two days of arrival and to self-isolate until a negative result is received.

“These measures will be introduced as soon as possible and kept under constant review. However, we reserve the right to go further if necessary. We are also adopting the expanded red list of countries identified by the UK Government. This will also be kept under review.

“We must now redouble our efforts to follow the basic rules that have served us well throughout the pandemic – wear a face covering on public transport and in all indoor settings for food and retail; open windows especially if you have people visiting at home; keep washing your hands regularly and thoroughly. Work from home where possible, take regular lateral flow tests – especially before mixing with others outside your household.

“If you have symptoms, self-isolate and take a test and if contacted by Test and Protect or public health teams please co-operate and follow their advice. All close contacts of suspected Omicron cases will be advised to self-isolate for 10 days, regardless of their vaccination status.

“And of course, if you are eligible for your booster, or are still to have any dose of the Covid-19 vaccine, please get vaccinated now.”

BREAKING: First Minister Nicola Sturgeon will be holding a Coronavirus briefing at 10.30 this morning.

Delayed hospital handovers: RCEM calls for system-wide action

The Association of Ambulance Chief Executives (AACE) has published a report following a structured clinical review of handover delays at hospital emergency departments across England.

This reveals for the first time the extent of potential harm that is being caused to patients when they must wait in the back of ambulances or in corridors before they are accepted into the care of their local hospital.

The review found that the proportion of patients who could be experiencing unacceptable levels of preventable harm is significant. Over eight in ten of those whose ‘handover’ (from ambulance clinician to hospital clinician) was delayed beyond 60 minutes were assessed as having potentially experienced some level of harm; 53% low harm, 23% moderate harm and 9% (one patient in ten) could have been said to have experienced severe harm.

The impact assessment was coordinated by AACE and was undertaken in all ten English NHS ambulance services who reviewed a sample of cases from one single day in January 2021, where handovers exceeded one hour.

Experienced clinicians assessed the range and severity of potential harm experienced by those patients who were already seriously ill, frail or elderly and who waited for sixty minutes or more before being accepted into the care of the hospital from the ambulance crews in attendance.

The nationally defined target for hospitals included in the NHS Standard Contract states that all handovers between ambulance and A&E must take place within 15 minutes, with none waiting more than 30 minutes.

Since April 2018, an average of 190,000 handovers have missed this target every month (accounting for around half of all handovers) while in September 2021 over 208,000 exceeded the 15-minute target.

You can read the report here.

Responding to the latest report ‘Delayed hospital handovers: Impact assessment of patient harm’ published yesterday by the Association of Ambulance Chief Executives, Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “This report makes for stark reading but will come as no surprise to Emergency Department staff.

“Patients should never be delayed in the backs of ambulances. Patient safety is being compromised. When there is simultaneously no space in the Emergency Department and ambulances queuing outside the Emergency Department, we are no longer delivering effective urgent and emergency care to the community.

“We support our paramedic colleagues and will continue to work with them to tackle these handover delays and keep patients safe. But these pressures must not be addressed in isolation. The answer does not lie with the ambulance services nor in the Emergency Department. This is a system-wide problem that requires system-wide action and solutions. In particular, the answer is not just to increase physical space in the Emergency department with no additional staff.

“Trusts and Boards must focus on increasing flow throughout the hospital to reduce exit block and ensure patients are moved through the system. In the immediate term, Trusts and Boards must safely expand capacity throughout the hospital where possible to stop patients being delayed in ambulances. Social care must be resourced to ensure patients can be discharged when they have completed their treatment to prevent long hospital stays.

“We entered the pandemic with too few beds in the system and have continually struggled to manage with reduced capacity, now this is unsustainable. It is vital that the government restore bed capacity to pre-pandemic levels to achieve a desirable ratio of emergency admissions to beds. Currently 7,170 beds are required across UK Trusts and Boards.

“Patient safety is at risk and without urgent action avoidable harm will continue to fall upon patients while urgent and emergency care will fall deeper into crisis.”

£7 million to expand primary care

Funding of £7 million will improve GP surgeries, expanding the level of care to patients across Scotland.

Vacant high street units will be taken over by Integration Authorities to expand the primary care estate, with the funding also used to support GP practices, including digitising records to free up more space.

The Scottish Government has set aside £5 million from the Primary Care Fund in 2021/22 to make improvements to existing GP premises. An additional £2 million will obtain new sites to accommodate multi-disciplinary teams including those administering vaccines, mental health nurses and audiology specialists.

Health Secretary Humza Yousaf said: “GP surgeries provide a wide range of services, supporting both the physical and mental health of patients. So it’s vital they get the space they need to allow primary care multi-disciplinary teams to do their jobs.

“As we recover from the most challenging time in NHS history, our work is not only about providing access to services, but ensuring those services are high quality and inclusive for all of our communities. This funding will give GP practices the space they need to serve patients in the safest and most effective way.”

The £5 million from the Primary Care Fund will cover:

Premises Improvement Grants to GP contractors who own or lease from private landlords
digitisation of paper GP records to release space
improved ventilation
increased space in NHS-owned or leased premises to support multi-disciplinary teams

The Scottish Government will monitor how Health Boards spend the further £2 million to acquire vacant high street units to inform how the £10 billion available for capital investment in healthcare supports primary care.

Scottish hospitals roll out three-in-one winter virus tests

Hospitals in Scotland are rolling out new single tests to identify whether patients are infected with Covid-19, flu or RSV (respiratory syncytial virus).

The new three-in-one “multiplex tests” will be used when patients arrive showing respiratory symptoms at some emergency departments and assessment units.

They have been introduced with £5 million of Scottish Government investment.

They provide an advantage over “multi-target testing” which requires two or more tests to be carried out – one for Covid-19 and a second for other viruses such as flu A, flu B and RSV.

Health Secretary Humza Yousaf said: “The introduction of these new tests is an important step to help protect our NHS staff and patients, as services remobilise and we learn to live with the virus.

“The results will help hospital staff assess the treatment and placement of patients which should help accelerate patient flow through the system. It will also play a key role in avoiding healthcare associated infections and co-infection.

“It would be a mistake to think that the successful delivery of the vaccination programme means testing becomes less important.

“Testing will continue to play a vital role in our drive to bring down new cases of Covid-19 and break off future chains of transmission.”

The fastest multiplex tests will see results provided within two hours and will be prioritised for emergency admissions to assist with patient placement and treatment. Other laboratory-based tests may take between 90 minutes and eight hours for the results to come through.

All asymptomatic patients, staff and citizens will still be tested for SARS CoV-2 only and this will constitute the majority of testing in Scotland.

Covid: Book your Booster

Book a coronavirus vaccine booster and flu vaccine online from 15 November if you’re:

Aged 50 to 59

Aged 16 or over and an unpaid carer

Aged 16 or over and a household contact of an immunosuppressed person

Check your vaccine username http://bit.ly/NHSUserName

If you’re in one of the earlier priority groups and are waiting on an invite, you should:

Go to http://nhsinform.scot/covid19vaccinebooster

Call the helpline on 0800 030 8013

New drop-in vaccination clinic open at Ocean Terminal

A new vaccination clinic has opened this week in Ocean Terminal, making it even easier for you to get your first and second dose of the COVID vaccine.

The clinic is open seven days a week, from 11am to 7pm. You don’t need to make an appointment to attend, and you don’t need to be registered with a GP to get a jab.

Anyone over 12 can drop in, just make your way to the clinic which is on the first floor of the centre. If you’re coming to get your second jab, you must have had your first jab at least eight weeks ago.

To find out more about the COVID vaccine, visit NHS Inform.

‘Devastating’: Unite Scotland reveals Scottish Ambulance Service survey findings

Unite Scotland has today revealed the details of a ‘devastating’ survey conducted of nearly 300 Scottish Ambulance Service (SAS) workers.

The survey conducted over the last month by the trade union among its SAS members reveals a ‘horrifying’ picture of the nation’s ambulance service due to years of ‘chronic underfunding’.

The survey reveals that by huge majorities SAS workers feel under-valued, fatigued; that staff morale has collapsed, with the vast majority of workers stating the nation’s ambulance service is under-resourced and under-staffed.

Substantial majorities of SAS workers also state that they have considered leaving the ambulance service and reported that they have been abused at work in the last year.

The headline survey findings reveal the following:

98.2% believe that Scottish Government’s extra investment of £20m into the SAS and support from the armed services will ‘not be enough’ during the winter months;
88.2% do not feel valued by the Scottish Government and 84.6% do not feel valued by the SAS;
86.7% of SAS workers felt that staff morale was either poor (30.8%) or very poor (55.9%);
86.4% feel fatigued at work while 78.9% believe the SAS is under-staffed;
81.5% have suffered verbal or physical abuse, or both, while working at the SAS within the last year;
73.6% of respondents said they have considered leaving the SAS;
70% do not get the necessary break times during shifts;
53.8% stated that there were not enough ambulances at ‘station level’; and
44.3% stated that the longest shift they have worked was between 12-15 hours, 30%between 15-20 hours; 17.5% between 10-12 hours while 5.7% stated it was under 10 hours and 2.5% over 20 hours.

In a previous Daily Record Exclusive on 9 September, Unite called for a ‘major incident’ status to be declared at all hospitals with Accident and Emergency Units, where turnaround times exceed 30 minutes.

The demand was made by Unite to protect the public who have made 999 calls in the community, amid patient safety concerns due to 6 hours service running times.

On average, an ambulance response to a 999 call can take between 55 minutes, and 1 hour and 10 minutes, from call to completion. However, ambulances are now missing three 999 calls while located at a hospital waiting for patient handovers.

The survey findings shed new light on this depressing situation with nearly 71% of respondents declaring that the longest 999 call they have been involved in from call to completion exceeded six hours: (16.3% – over 20 hours), (11.7% between 15-20 hours), (6.3% between 12-15 hours), (4.6% between 10-12 hours), (5.4% between 8-10 hours), and (26.4% between 6-8 hours), with the remainder being under 6 hours.

Worryingly, 94.5% of survey respondents involved in ambulance 999 call-outs believed the clinical coding to ascertain the severity of the situation was wrong. In addition, 54.7% answered ‘yes’ to the question ‘due to longer service running times has your ‘call’ been involved in an adverse clinical event due to delays and hospital pressures?’

Unite Scotland has repeatedly warned the Health Secretary, Humza Yousaf, that the extra investment and resources for the SAS would ‘not be enough’ to deal with the crises affecting the nation’s health services, which the survey findings conclusively confirm.

Pat Rafferty, Unite Scottish Secretary, in response to the survey findings, said: “I don’t think I have ever seen such an utterly depressing and horrifying situation with massive implications for the nation.

“The workers at the Scottish Ambulance Service are sending out their own 999 call to the Scottish Government saying that they are undervalued, stressed, and exhausted. It is now beyond breaking point.

“The levels of abuse the workers are suffering is inexcusable. The vast majority of those responding to our survey are going as far as to say they are now considering leaving the ambulance service.

“Shockingly, the survey reveals a culture of extremely long hours, partially due to chronic underfunding over many years, and the overwhelming stresses being placed on the system. This situation is directly leading to paramedics and ambulance staff being increasingly involved in adverse clinical events, and dangerously long response times.

“It is a devasting indictment of the Scottish Government’s approach to the ambulance service. Urgent action is necessary because lives are at risk alongside the fundamental issue of how we value those trying to save those lives.”

Alex Cole-Hamilton: Getting serious about long Covid

Almost 100,000 people in Scotland have reported that they’re suffering with long Covid but it has taken until today (Tuesday 9 November) for the Scottish Parliament to debate this important issue.

I led this debate in Parliament yesterday because no matter how much campaigners and MSPs raise the issue, the SNP Health Secretary is just not listening.

It is shameful that it has taken an opposition party debate for the plight of long Covid sufferers to be heard in Parliament.

The SNP/Green Government’s action plan on long Covid is totally unfit for the scale of this challenge. Many Scots would be better off moving to England where there are well-established clinics and a care pathway.

We need to do much more to help long Covid sufferers. That is why I am calling on the SNP/Green Government to:

Have specialist long Covid clinics in every health board
Train more long Covid community nurses to offer in-home support
Give everyone who needs it access to physiotherapy and rehab treatment
Make sure long Covid sufferers are not penalised financially because they are absent from work for longer periods

You can join me in calling for action from the Scottish Government by signing up to my plan for long Covid here:

Covid-19 confirmed in pet dog in the UK

The UK’s Chief Veterinary Officer has confirmed that the virus responsible for Covid-19 has been detected in a pet dog in the UK.

The infection was confirmed following tests at the Animal and Plant Health Agency (APHA) laboratory in Weybridge on 3 November. The dog is now recovering at home.

All available evidence suggests that the dog contracted the coronavirus from its owners who had previously tested positive for Covid-19. There is no evidence to suggest that the animal was involved in the transmission of the disease to its owners or that pets or other domestic animals are able to transmit the virus to people.

The advice from UK Health Security Agency (UKHSA) is for people to wash their hands regularly, including before and after contact with animals.

Chief Veterinary Officer Christine Middlemiss said: “Tests conducted by the Animal and Plant Health Agency have confirmed that the virus responsible for Covid-19 has been detected in a pet dog in the UK. The infected dog was undergoing treatment for another unrelated condition and is now recovering.

It is very rare for dogs to be infected and they will usually only show mild clinical signs and recover within a few days.

There is no clear evidence to suggest that pets directly transmit the virus to humans. We will continue to monitor this situation closely and will update our guidance to pet owners should the situation change.

Dr Katherine Russell, Consultant Medical Epidemiologist at UKHSA, said: “COVID-19 is predominantly spread from person to person but in some situations the virus can spread from people to animals.

“In line with general public health guidance, you should wash your hands regularly, including before and after contact with animals.”

Pet owners can access the latest government guidance on how to continue to care for their animals during the Covid-19 pandemic.

The case has been reported to the World Organisation for Animal Health in line with international commitments. There have been a very small number of confirmed cases in pets in other countries in Europe, North America and Asia.

New drug delivery could significantly improve treatment outcomes for prostate cancer

Researchers at Queen’s University Belfast have developed a new treatment to be used in combination with radiotherapy that could significantly improve treatment outcomes for men with locally advanced prostate cancer.

The treatment can make cancerous cells up to 30% more receptive to radiotherapy while simultaneously reducing adverse side effects that limit quality of life.

Radiotherapy is extensively used to treat various localised cancers including prostate cancer, offering the best chance for curative intervention. However, approximately 30% of prostate cancer patients experience treatment failure leading to disease progression.

The research team at Queen’s have developed a new nanomedicine comprised of tiny gold particles, coated in a small peptide called RALA. If these nanoparticles are present in tumour cells when treated with radiotherapy, they increase the cell killing potential of this conventional treatment, helping to reduce the risk of disease relapse. In the absence of radiation, the gold nanoparticles are not directly toxic, meaning that risk of treatment related toxicity is low.

Various groups around the world have reported that gold nanoparticles, or other high-atomic number elements, hold the potential to sensitise tumour cells to radiation treatment, but one key challenge has been delivering these particles in sufficient levels to the right regions within the tumour cells.

Combining the gold particles with RALA increases the efficiency of nanoparticle uptake, while also enabling the gold particles to be delivered to regions within the cells which are more sensitive to the effects of radiation damage.

The study, published in Nanobiotechnology, shows that through the new formulation, prostate cancer cells were rendered up to 30% more sensitive to the cell killing effects of the same radiotherapy used to treat patients.

Furthermore, in experiments investigating the magnitude of effect in small 3-dimentional models of prostate tumors called tumourspheres, the combination of radiation and RALA-gold nanoparticles completely suppressed tumoursphere growth.

Professor Helen McCarthy, from the School of Pharmacy at Queen’s University Belfast, explains: “The peptide enables the gold nanoparticles to be delivered more efficiently to the tumour cells. The gold then interacts with the radiotherapy, increasing the cell killing effect in a highly localised manner.”

The gold particles are up to three times more visible on standard medical imaging equipment. This means that if the nanoparticles are located within the tumour, they should help to improve the accuracy of radiotherapy delivery, reducing the risk of off-target damage to neighboring normal tissue such as the bladder or bowel.

The multi-disciplinary team have recently been awarded £376,000 from Prostate Cancer UK to evaluate the effectiveness of these implants at increasing the sensitivity of prostate cancer cells to radiotherapy.

Dr Jonathan Coulter (top), from the School of Pharmacy at Queen’s University Belfast, explains: “Our research has shown that ultra-low concentrations of the RALA-gold nanoparticles effectively sensitise prostate tumour cells to radiotherapy.

“Now we want to build on this work, to address the second major challenge, consistently delivering sufficient nanoparticles to the tumour throughout a patients’ radiotherapy. We are delighted that Prostate Cancer UK are supporting our proposal to develop a biodegradable implant designed to provide sustained release of the gold nanoparticles.”

“Following insertion into the main tumour lesion, the biodegradable implant will consistently release the nanoparticles over time. This is opposed to current approaches that involve daily injections. Following consultation with a local prostate cancer patient focus groups, we learned that a one off implant would be better tolerated by patients than regular injections to the tumour.”