The must-read stories and debate in health policy and leadership.

When the covid pandemic took hold last spring, strict restrictions on visiting patients were quickly ushered in. The aim of the new guidance was to curb the spread of the virus across NHS settings, protecting the lives of patients and those who care for them

But of course it also brought heartache and made unpleasant experiences much much worse for many inpatients. Now HSJ has discovered multiple coroners reports which highlight visiting restrictions and the very real impact they can have both on overall standards of care and wellbeing, and very likely on clinical outcomes. In particular, they raised the issue that families of vulnerable patients may be unable to pass on relevant information.

One report was for 40-year-old Azra Hussain who died by suicide within a psychiatric intensive care unit. The coroner said her family was unable to participate in a multidisciplinary team meeting, which took place shortly before Ms Hussain’s death, to raise concerns about a recent suicide attempt.

Ms Hussain’s daughter Mari told HSJ: “People need to see their families. We need to see them because that makes the difference between life and death. If mum saw us, even at social distance, she would still be alive.”

The issue of whether to allow visitors is a fine-tuned balancing act. As NHS Providers chief executive Chris Hopson said: “No trust makes the decision to suspend or restrict visiting lightly.”

Many staff and services went to great lengths to try to keep patients in touch with family and friends, but the comments for our piece, and from readers underneath it, speak of the times this was not achieved.

More in the pipeline?

It is now four weeks since medical technology company Becton Dickinson wrote to trusts and GPs warning of “intermittent supply challenges” for blood collection devices.

The firm said supplies of four kinds of blood collection tubes, used extensively across the NHS, would be impacted, with the issue stemming from increased demand, ongoing logistic challenges, including “UK border challenges”, and with supplies of raw materials and components.

Less than a week later, NHS Supply Chain announced it was implementing “demand smoothing” measures, including making trusts order supplies of tubes daily to meet “immediate clinical need”.

Since then, trusts have taken steps to limit the amount of blood tubes they use and the NHS has issued guidance on which tests should be prioritised, and which deferred, to preserve stocks.

But, at the end of last week, online meetings between health system leaders and NHS England spelled out the extent of the shortages.

Notes from a meeting chaired by Barts Health Trust deputy chief medical officer said supply problems could last until the end of the year with the trust “currently only receiving 20 per cent of [its] usual supply”. There was an “urgent need to reduce clinical demand on blood bottles”. The trust told staff it was taking “interim steps” to “manage supplies,” which would start on 16 August.

Other trusts’ supplies of these ubiquitous, fundamental products are also falling short of normal volumes, though not to the same extent as Barts.

The questions remain: How long will the supply disruption last, and how long will measures promulgated by NHSE and those adopted by individual trusts mean blood tube stocks hold out?