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1/19 What should happen on December 3? My new blog: https://nhsproviders.org/news-blogs/blogs/nhs-now-and-after-lockdown. Covered in today's Times: https://www.thetimes.co.uk/edition/news/make-tier-3-the-new-normal-to-avoid-disaster-say-hospital-chiefs-qkdh2qcf3. Tweet thread below sets out why the NHS is worried about the risk of trading looser restrictions for Xmas for a third phase of covid over winter.
2/19 Where are we now on infections rates and admissions levels? Welcome signs that rate of hospital admissions in Liverpool/Manchester finally starting to slow down. But this hasn’t yet happened consistently in rest of country. Worrying rates of increase in some places......
3/19 ...It’s therefore still too early to tell if our current national lockdown will have the consistent effect that’s needed. The working assumption is that it will do, but the next five to seven days will be crucial in confirming that.
4/19 Access to vaccines, therapeutic drugs & rapid turnaround testing offer a sustainable way to combat coronavirus in medium term. But, for now, restricting social contact remains only effective way to prevent the spread of the virus and the devastating impact it can have.
5/19 The key immediate issue confronting the NHS is how to navigate the hump of winter – late December to March – when the NHS is always at its busiest. It's vital that the NHS has sufficient capacity over the next three months to treat three groups of patients......
6/19 First, covid patients. Second, emergency cases, including large influx of emergencies NHS always sees over winter. Third, planned care where despite best NHS efforts over last few months, some patients still waiting for treatment from first phase delays & must be seen asap.
7/19 But NHS faces real constraints. 1. Capacity always most stretched at this time of year. 2. Significantly fewer beds available due to the need to separate coronavirus and non coronavirus patients, to keep them safe, with hospitals reporting between 10 and 20% lost capacity.
8/19 3. Staff are tired. 4. Sickness absence rates rising, particularly in areas with high rates of covid as NHS staff reflect infection rates in communities they serve. Trust leaders doing everything they can to maximise capacity but real risk of NHS overwhelm remains.
9/19 Worrying signs already emerging, well before the peak of the normal NHS winter surge. Demand for emergency care rising rapidly. Discharge flow slowing down. Bed occupancy rates rising. The number of 12 hour waits in hospital emergency departments is increasing quickly....
10/19 ...Ambulance trusts starting to report handover delays. Trusts report significantly higher levels of sickest patients than usual, often due to delays in coming forward for treatment. Many trusts already under degree of pressure normally only seen in depths of winter...
11/19 ... In the words of several trust leaders from across the country this week “it feels like we’ve hit winter six weeks early”. Worrying that trusts under significant pressure include many with currently low levels of covid patients. All before full winter has hit.
12/19 On Dec 2 we are likely to be in a covid halfway house. Infection rates and rates of hospital admissions will be coming down. But we won’t be properly on top of virus. It’ll be there waiting to flare up again if we let down our guard too much. Just as happened in 2nd wave.
13/19 Xmas is incredibly important to many of us. But, to covid, December 25 is no different to November 25 or January 25. There is a real risk that in our desire to celebrate Christmas, we swap a few days of celebration for the misery of a full third wave a few weeks later.
14/19 At this point, logic is inexorable & merciless. The more social contact, the higher the rate of deaths and long term ill health. Not just for covid patients. But for the emergency and delayed planned care patients NHS will be unable to treat if it's swamped by covid cases.
15/19 What should happen on Dec 3? NHS trust leaders are clear on three things. 1. We should only come out of national lockdown if we are certain that we are truly and fully past this second peak. We mustn't over-anticipate a drop in the R rate / falling hospital admissions.
16/19 2. We need to avoid a third phase in Jan by retaining appropriately tough restrictions. Second phase has shown that the restrictions in the old 1st/2nd tiers were insufficient and stronger regime than the old 3rd tier needed in areas of greatest spread.
17/19 3. Third, those tougher restrictions need to be adopted quickly and automatically wherever needed. We can’t afford the crucial lost days we saw in Liverpool and Manchester in the early part of the second phase as local and national leaders debated what to do.
18/19 Trust leaders recognise that it is difficult to ask politicians and a weary nation to continue tough restrictions. Particularly if the calculation involves an uncertain prediction of the likely forward pressure on the NHS between late December and February....
19/19 But there is a definite sense of “one more heave”. If we can surmount the hump of this winter, there is good reason to believe that next spring and summer we will be free.
