“Major problem” with testing meant likely covid deaths went unrecorded

Martin Marshall told the health select committee the lack of coronavirus testing to date had meant GPs were sometimes unable to accurately complete death certificates.

He said: “[With] certificates, we always try to put the most likely diagnosis. If it’s likely to be covid we want to put covid. The major problem here has been the lack of testing which has meant that we haven’t always been able to put covid when we think it might be likely or maybe we’ve just had to suggest it’s most likely to be covid.

“When more testing takes place I think it’ll be much easier for us to be able to fill out death certificates in an accurate way and that of course is extremely important for us all.”

He added that “death certification” had been a “fast-moving field because we’re all dealing with more deaths, we’re preparing for a larger number of deaths, particularly in the community”.

The comments follow hospital chiefs warning this week that a drive to restart elective procedures would be hampered by the lack of rapid testing and tracking of covid-patients and urging a cautious return to elective work.

Professor Marshall also told MPs there had been a reduction in the number of face-to-face GP consultations, from 70 to 23 per cent. He estimated that in future this would increase to “maybe 50 per cent”. He also suggested many GPs still lacked the support, training or equipment to carry out virtual consultations.

The MPs’ evidence session had been convened to examine the challenges facing NHS leaders in their bid to restore the provision of non-coronavirus services.

NHS England national cancer director Cally Palmer said that as of the week starting 20 April, urgent two-week wait cancer referrals had reduced by 62 per cent on pre-pandemic levels, with just under 15,000 people booked for an appointment.

She however denied a suggestion by chair Jeremy Hunt that this meant two thirds of cancers were being missed.

She said: “No, I don’t think that’s the case because there’s roughly an 8 per cent conversion rate for urgent referrals. I know some modelling has been done by Cancer Research UK but it’s really important to state that urgent referrals and urgent cancer treatment is continuing.

“Obviously we need to tailor that to patients’ individual risk but I think it would be wrong to make a mathematical calculation on that basis. It’s very important that we get people coming forward but I think to translate that into misdiagnosis and poor survival would not be a responsible position at this point.”

She also stated that chemotherapy appointments were running at about 70 per cent of normal levels but thought they could be “stepped back very quickly”.

NHSE national mental health director Claire Murdoch told the committee that children and adolescent mental health services referrals had reduced by a “ballpark” estimate of between 30 and 40 per cent.

She added: “We’re trying to understand whether there’s been a correlation between a drop-off in referrals and the intensity of the virus as it’s moved to different parts of the country because certainly one of the things we’ve been hearing is that there’s been a change in behaviour of parents; everybody is hunkering down, home feels safer, not wanting to go through usual referral routes or perhaps thinking we won’t be there.”

Meanwhile Gill Walton, chief executive of the Royal College of Midwives, also agreed with Mr Hunt that there was an increased risk of still births and problematic pregnancies during the pandemic and that pregnant women from BAME backgrounds were more vulnerable than the general population.

Ms Walton also stated that domestic abuse, which she said increases during pregnancy, had increased during lockdown, with an increase in referrals to perinatal mental health services as well.