NHS England is asking all organisations to conduct root cause analyses (RCAs) for every probable healthcare-associated COVID-19 inpatient infection (i.e. patients diagnosed more than seven days after admission).
In a letter sent to all NHS Trusts and Foundation Trusts on 24 June 2020, NHS England is asking all organisations to do root cause analyses (RCAs) for every probable healthcare associated COVID-19 inpatient infection (i.e. patients diagnosed more than seven days after admission) and such cases should be treated as "untoward incidents" (as referred to in the annex to the letter).
In the same letter, NHS England also directed that healthcare-associated COVID-19 infection rates at a local level must be analysed and reviewed on a daily basis to check case numbers and "particularly to note trends". NHS England expects these reviews to be led by executive directors.
For any organisations deemed to be 'outlier' Trusts, a further response will be required at a regional level. Trusts ought to take a full review of actions implemented locally and mobilise a regional infection prevention control support officer into the organisation. An 'outlier' is defined statistically according the national average number of cases aggregated over the preceding four weeks.
Another key point to note is that NHS England has reminded Trusts that as part of their responsibilities, all relevant staff, including Black, Asian and minority ethnic staff, should be offered a risk assessment. This is an important point to bear in mind as Coroners may consider what risk assessments were undertaken when reviewing COVID-19 related workplace deaths.
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