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Government advice on PSA was "confusing" and "invisible" during the height of the UK crisis


Public Health England (PHE) had to be persuaded to clarify its coronavirus guidelines following the death of a vulnerable Briton who was visited by caregivers who were not wearing PPE.

Official guidelines on wearing personal protective equipment (PPE) were "confusing" and "not visible" during the height of the outbreak in the UK, investigators say.

Independent watchdog The Healthcare Safety Investigation Branch released a report detailing how PHE has been asked to clarify its advice.

A member of the public complained to HSIB after seeing someone shield himself in April – during the depths of the UK crisis – after being visited by carers who were not wearing protective gear.

It emerged that carers had not been ordered to wear PPE and that the government was so unclear at the time that they had been told they did not have to.

The report implies that the patient received coronavirus from one of the caregivers, emphasizing that he was not sick before the visit, but says there is no way to know how the patient got Covid-19.

The HSIB said there were multiple versions of advice on PPE online at the same time and PHE had not made it clear enough which one to follow.

After being informed of the patient's death, PHE later changed his online advice to make it clearer which version was the latest.

Both the handling of the PSA and the PHE with the coronavirus crisis have been examined in detail in recent months. The government has been criticized for failing to target caregiver protective equipment and PHE in March to stop swab testing.

The Public Health England guidelines now make it clear that all caregivers should wear surgical masks, gloves and aprons every time they visit a screener. However, this was not clear, according to an investigation during the height of the UK coronavirus outbreak

"Guidelines to protect frontline workers and vulnerable patients need to be as clear and accessible as possible. This is even more important in times of crisis," said Dr. Kevin Stewart, medical director at HSIB.

"However, there are several guidelines for different care sectors and it is easy to see where confusion can arise when new updates overlap with older versions."

PHE was investigated in this study because it is not clear enough what protective equipment caregivers should wear around vulnerable people.

There is now a 28-page document on the gov.uk website outlining how caregivers can protect themselves and their patients from coronavirus.

Public Health England has a 28-page document on its website entitled "How to Work Safely in Home Care in England" informing caregivers about PPE to wear when visiting people's homes

Public Health England has a 28-page document on its website entitled "How to Work Safely in Home Care in England" informing caregivers about PPE to wear when visiting people's homes

But in April, when the virus was killing hundreds of people every day, there were two versions of the guidelines, the HSIB said.

And one of them, released on April 6th, failed to set out what protective equipment should be worn when treating extremely vulnerable people who shield themselves.

An April 27 update states that caregivers should wear "a liquid-repellent surgical mask, gloves and apron" in this scenario.

The previous version of the guide did not provide specific advice, and the caregivers visiting the patient in the report did not wear PPE because they did not know they should.

Both versions were online at the same time and the older version contained no indication that it had been updated.

CARE BOSSES BEAT & # 39; SHAMBOLIC & # 39; PPE ACCESSORIES IN LEAKED LETTER OFF

In a letter sent to the Ministry of Health by the Association of Directors of Adult Social Services (Adass) in April, nursing chiefs accused a senior person in the ministry of overseeing a "Shambolic response".

The BBC reported that there were concerns about testing in nursing homes, funding of the sector and insufficient amount of personal protective equipment (PPE) for staff.

Adass said it faced "confusion" and additional work because of the mixed news issued by the government.

The situation regarding PPE, which is now mandatory for all health workers, is "shambolic" and supplies have been "scanty" or "arbitrary".

The care sector, which looks after around 400,000 of the UK's most vulnerable people, has been overlooked while officials focused on the NHS, Adass said as they voiced concerns of a "significant imbalance".

The bosses added that they welcomed the testing of coronavirus swabs for people who work in social welfare, but said it looks like it will be "introduced without thinking about who will be tested and what we will do with it." Will make result ". .

The HSIB report states: “There was no easy way to navigate the gov.uk website. The instructions were not visible. & # 39;

As a result, according to the HSIB, health workers didn't know what to do.

"In the reported case," it said, "district nurses used PPE in the provision of home care."

“However, other caregivers did not use PPE and were told that it was not required.

The patient later died and his death was confirmed to be related to Covid-19. The care visits took place when the patient and another member of the household showed no Covid-19 symptoms. & # 39;

After HSIB Public Health England announced its guidelines were confusing, the government agency removed the link on April 6th.

Protective equipment for nurses has been a contentious issue for months at the beginning and during the height of the UK coronavirus crisis.

Obsessed with protecting the NHS, government officials have been accused of overlooking and abandoning the care sector as the virus spread wildly in homes, killing thousands of vulnerable elderly people.

In a letter sent to the Ministry of Health by the Association of Directors of Adult Social Services (Adass) in April, nursing chiefs accused a senior person in the ministry of overseeing a "Shambolic response".

The BBC then reported concerns about testing in nursing homes, funding of the sector and insufficient amounts of personal protective equipment (PPE) for staff.

Adass said it was facing "confusion" and needed additional work due to the mixed news issued by the government.

It was said that the situation around PPE, which until then was mandatory for all healthcare workers, was "shambolic" and that the deliveries were "poor" or "arbitrary".

The care sector, which looks after around 400,000 of the UK's most vulnerable people, has been overlooked while officials focused on the NHS, Adass said.

They feared a “significant imbalance” between hospital patients and people who depend on care in nursing homes or in their own homes.

The bosses added that they welcomed the testing of coronavirus swabs for people who work in social welfare, but said it looks like it will be "introduced without thinking about who will be tested and what we will do with it." Will make result ". .

Dr. Eamonn O’Moore, Head of Adult Care at Public Health England said: “We were very sorry to hear what happened and what lessons were learned.

& # 39; We updated the links to the guidelines to clarify the correct one.

"We continue to update and revise the UK guidelines based on evolving evidence and listen to feedback from the health and care sectors on their adequacy and accessibility."

PUBLIC HEALTH ENGLAND CORONAVIRUS ERROR

Public Health England has come under fire for a number of its responses to the Covid-19 crisis.

Directors have tried to divert the blame, claiming that important decisions were made by government ministers at the Ministry of Health, but the agency has been accused of being in control.

These are some of the mistakes PHE has been blamed for:

Stopping mass testing and tracking

On March 12, the government announced it would stop testing anyone suspected of having coronavirus and stop tracking the contacts of most cases in an attempt to stop the spread of the disease.

As a result, the UK effectively stopped tracking the virus and allowed it to spiral out of control.

Conservative MP David Davis said that was "just the wrong thing".

Professor Yvonne Doyle, PHE's medical director, told MPs in May: "It was a decision made because of the sheer scale of the cases in the UK."

She added, "We knew we would certainly need more capacity if this epidemic continued to grow."

PHE said, "Widespread contact tracing stopped because increased community broadcast meant it was no longer the most useful strategy."

Count deaths inaccurately

Last month it was found that Public Health England had counted coronavirus deaths by reviewing a list of people who had ever tested positive to see if they were still alive.

The cause of death or the time since the test was positive were not taken into account and the agency was accused of "exaggerating" the number of people who died each day.

A health department investigation into the method removed 5,000 deaths from the UK's official list.

The statistical error was reported by Professor Carl Heneghan of Oxford University and Dr. Yoon Loke from the University of East Anglia revealed.

Since then, Matt Hancock has aligned the numbers with Scotland and Northern Ireland, which attribute Covid-19 deaths only if they occur within a month of their diagnosis.

Lack of contact tracking capacity

Articles published by government scientists on SAGE showed PHE was only able to handle five new cases per week on February 18.

At this point, only nine cases had been diagnosed.

PHE experts said the modeling suggested increasing the capacity tenfold to 50 new cases a week, contacting 8,000 people a day.

SAGE said, "If there is sustained transmission in the UK, contact tracing is no longer useful."

In early March, cases in the UK rose by 50 every day.

Antibody tests pawned in March

PHE professor Sharon Peacock said on March 25 that the UK is well on its way to making antibody tests available to the public this month.

It confirmed that the government had bought 3.5 million of the tests and assessed their quality.

They could be available to the public "within a few days," she said at a briefing on Downing Street.

However, three months later, they are still not a reality. Officials have since decided that there are no tests available that are good enough and there is no evidence that the results will be of any use to the public.

Testing efforts have been slowed by the "centralized" laboratory approach

Scientists at private laboratories, universities and research institutes across the country said in April that their offers to assist with coronavirus testing had fallen on deaf ears.

Only eight PHE laboratories and some in NHS hospitals were used to analyze tests at the beginning of the crisis.

Little ship laboratories had tools to run tests and could have quickly increased testing capacity if officials had agreed to work with them.

However, it took the UK by the end of April to run more than 100,000 tests a day. Germany had mastered the feat for weeks with private laboratories.

PHE says it has not prevented or controlled any public, university or commercial laboratory from running tests for Covid-19.

She claimed she asked officials to change testing methods in January so that any testing facility could run diagnostic tests.

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