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

HSJ’s story revealing reports of a spike in the use of restraint or seclusion across several mental health trusts will likely not have come as a surprise.

Ingredients of cancelled visits and patient leave, barriers to communicating through personal protective equipment, changes in regular staff due to sickness, blanket restrictions, predictably made for a recipe of increase frustration from patients.

These imposed restrictions, while they will have existed within the acute sector, take on a very different dimension if you are a patient under section, unable to leave of your free will.

All of this within an environment where some of usual techniques of de-escalation will not have been available to staff.

Reducing restrictive practices was a big focus for the mental health sector and considering many of the restrictions above will still be in place for the next few months, and through any second wave, it will be important for services to keep an extra eye on any incidents of restraint or seclusion.

It will also no doubt be on the minds of national leaders and care regulators, with high numbers of restrictive practices often serving as a barometer for poor care.

Breathing easier

New Public Health England data has shown emergency attendances for respiratory illnesses are continuing to fall, despite an increase in A&E numbers across England.

ED attendance for bronchitis, acute respiratory infections, respiratory, pneumonia, asthma are still far below their normal levels during lockdown; gastroenteritis figures have followed this trend too.

Patients with cardiac conditions, however, continue to return to levels seen before the lockdown.

The downfall could be in part due to effects of social distancing and isolation, vice president of the Royal College of Emergency Medicine, Dr Ian Higginson, has suggested to HSJ.

Patients avoiding hospital simply adds to this figure.

In any case, an uptick in cardiac patients indicates the pause in these specialisms is temporary. EDs are therefore likely to face familiar stretches in resources and staff alongside, now, pandemic management, sooner rather than later.

Dr Higginson said: “None of that has been fixed overnight so as patient numbers return to normal our members and fellows are still going to meet their needs in understaffed departments in outdated facilities.

“What we absolutely cannot see, what would be unthinkable or unconscionable, would be a return to the levels of crowding we were seeing before the lockdown, especially as we now have to think about keeping staff and patients safe from covid-19 through social distancing measures.”