1/14 Important new blog for @timesredbox on why the NHS needs the Government and local authorities to now move quickly and decisively to create tougher local lockdowns wherever required:
thetimes.co.uk/article/hospit…
2/14 Increasing numbers of coronavirus cases have translated into rapidly rising hospital admissions, especially in NE, NW and Yorks. For a few trusts, the number of COVID-19 hospital patients is now at the same level they had reached at the height of the first phase.
3/14 Trust leaders clear about lessons from the first phase of COVID-19. The virus strikes at very different rates in different localities, so appropriate local responses are needed. The only way to control the spread of COVID-19 is by reducing social contact.
4/14 Two other crucial lessons from first phase. First, there is an inevitable lag between lockdowns being introduced, them taking full effect, and hospital admissions falling. Second, looser lockdowns have proved much less effective, as current infections rates show.
5/14 NHS challenge over the next few months is different from the first phase in three crucial respects. 1. Trusts must treat covid and non covid patients alike over the winter months when the NHS is at its busiest and NHS capacity is at its most stretched.
6/14 2. Every single hospital has lost between 10 and 30% of its capacity given the need to separate covid and non covid patients to keep them safe. 3. Frontline NHS staff are fatigued and in danger of burning out. To protect them, we must ensure a manageable winter workload.
7/14 NHS needs quick, decisive, consensual action on local lockdowns. Quick, because trusts in areas where virus is spreading rapidly can't wait any longer. Given lag in taking effect, lockdowns needed well before NHS capacity overwhelmed. If we wait longer it'll be too late.
8/14 Decisive, because lockdowns that rapidly and effectively cut covid transmission rates are now needed. It would be a mistake to introduce half hearted lockdown measures, only to have to tighten them later because they hadn’t been effective.
9/14 Consensual because local lockdowns need public consent and compliance to have the required impact. That needs clear messaging, the right financial support for impacted businesses and the endorsement of local politicians whose voice will be key in the areas affected....
10/14 …We must maximise the public consent for the tougher lockdowns that are now required. The most recent polling from Ipsos Mori suggests that 70% of the population are already behind the idea, so that is a very good start to building the required consent.
11/14 Trust leaders recognise difficult judgements to make here. No one can predict future. Everyone in NHS acutely aware of health risks from economic recession & long periods of enforced social isolation. NHS leaders can also see public frustration/fatigue with restrictions..
12/14 …Also a worry that, unlike the first phase, there is now a vociferous body of political and media opinion that opposes tougher lockdowns. And that this will make it more difficult for national and local leaders to take the tough, urgent, steps that are now needed.
13/14 But it’s the job of NHS trust leaders to protect communities they serve, provide treatment & save lives. Fight any public health threat with all resources at their command. Ensure they’re in the best possible position to treat all patients who will need help this winter.
14/14 That’s why, looking at the evidence and the risks, trust leaders are clear that quick, decisive, consensual local lockdowns are now needed. To manage the current challenges and avoid a more damaging national lockdown later.

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More from @ChrisCEOHopson

11 Oct
1/6 There has been an ongoing debate on the degree to which hospital discharges were responsible for the high mortality rates in care homes in the first phase of covid-19. This paper, considered by SAGE on 25 Sept, provides important new evidence: assets.publishing.service.gov.uk/government/upl…
2/6 It says that retrospective genomic analysis and serpositive studies found evidence for multiple routes into care homes. Staff, visitors, visiting professionals, hospital discharges, new admissions and persistent infections may have all contributed to introduction of covid-19.
3/6 However, and here is the key para (para 4.3 in the document): Weight of evidence is stronger in some areas than others. Evidence of staff to staff transmission has emerged in the genomic analysis (high confidence)......
Read 8 tweets
16 Sep
1/14 NHS financial allocations for second half of the year released overnight. Thread of initial thoughts below. Probably of most interest to those steeped in, and fans of, the delights of NHS finances. But some potentially big issues depending on how this plays out.....
2/14 NHS frontline been waiting for allocations for some time, so good that they have finally arrived. There is a lot of complexity here. These allocations have been made at system level for the first time and they also include some detailed calculations on individual items.
3/14 Four specific areas of concern that we expect trusts to raise. First, some ambitious assumptions about recovering non-NHS income that will be a significant issue for a number of trusts who are a long way off from seeing their non NHS income return to pre-COVID levels.
Read 14 tweets
15 Sep
1/14 Widespread media pick up this morning of our press comment on trust leaders' concerns that current test shortages are impacting negatively on NHS staff and patients. Press comment can be found here: nhsproviders.org/news-blogs/new…. Thread follows.
3/14 Trusts are concerned that current test shortages mean NHS staff are having to self isolate because they, and their family members, who need a test, can't access one. Worries this will affect vital service delivery, service recovery and winter preparations.
Read 14 tweets
16 Aug
1/11 @NHSProviders response to reports on future of PHE. Quick thread summarising the argument below - we all need to learn lessons from covid-19 in a spirit of learning, not blame apportionment. Government included. Much that we can do better, together, in public health. ImageImage
2/11 Five obvious issues on public health that NHS trust leaders think COVID-19 has highlighted. We look forward to seeing whether the Government's plans for the future of @PHE_uk reflect these lessons.
3/11 Lesson 1: Years of underfunding for Public Health England, and public health more widely, resulted in UK not being properly prepared to tackle pandemic like COVID-19. E.G. local authority public health grant has been cut by 25% in real terms over the last five years.
Read 12 tweets
12 Aug
1/12 Trust leaders frustrated and disappointed to see the service they have been providing over the last few months described, and widely reported, last week as "covid only". It's untrue, unfair and potentially dangerous. My new blog here: nhsproviders.org/news-blogs/blo…. Thread follows.
2/12 Even at the height of coronavirus, for every one COVID-19 patient in hospital, there were two non-COVID inpatients being treated for other conditions. More than three million urgent tests and checks were provided over the pandemic and 3.6 million people were treated in A&E.
3/12 NHS has continued to deliver, on average, 1,800 babies a day every day since the pandemic started. Although cancer referrals did drop, 65,000 patients started treatment for cancer during the pandemic. Yes, 14% fewer than same three months last year. But hardly covid-only.
Read 12 tweets
30 Jun
1/17 Today, we're launching results of first major survey of NHS trust leaders since covid-19 started. The report - "Recovery Position, What Next for the NHS" looks at challenges facing NHS to treat covid 19 patients and restart services. Report here: nhsproviders.org/media/689775/r…
2/17 You can find the press release (good summary) of our new report on the challenges facing the NHS as it restarts services here: nhsproviders.org/news-blogs/new…. Linked blog can be found here: nhsproviders.org/news-blogs/blo….
3/17 Four key messages from first member survey post covid-19: lot more patients now needing treatment; trusts losing lot of capacity due to covid-19 (up to 40%); trusts going as fast as they can to restart services; but it will take some time to resume full range of services.
Read 18 tweets

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