1/14 Front page story from @thesundaytimes on how NHS treated patients in first phase of covid-19. We think it's given an inaccurate and misleading picture of what happened. Initial thread below. Gathering more detail from members to add to a blog later this week.
2/14 Article alleges NHS was routinely excluding elderly patients from hospitals / intensive care during first phase of covid-19. Evidence includes routine usage of triage tool to deny critical care & not admitting care home patients. Trusts tell us this is incorrect.
3/14 Some facts from an NHS trust perspective. 1.The NHS did not run out of critical care capacity at any point during the first phase of covid-19. Critical care capacity remained available to everybody who would benefit from it. The key is the concept of “benefit from it”.
4/14 It's important to remember the key clinical principle that every patient should be given the best care appropriate to their individual medical needs. We know that not everyone with covid-19 was best treated in a hospital or a critical care or intensive care unit.
5/14 The best therapy for most Covid-19 patients in hospitals has actually turned out to be oxygen therapy which can be given on a general ward. We also know that, sadly, for some patients, ward or home based palliative care was the best available clinical option for their needs.
6/14 2. The NHS did not formally change the way it made decisions about who got admitted to critical care beds. There was categorically no blanket national decision to refuse care to any group of people, including on the basis of their age. This simply didn't happen.
7/14 Work on the so-called triage tool was never completed and it was never formally issued as it wasn’t needed. The trusts we have spoken to today do not recognise the statement in today's story that it was widely used across the country.
8/14 3. Data from @ICNARC shows thousands of over 60’s were treated in critical care and owe their life to that care. Over half of ICU admitted covid-19 patients were aged 60+ throughout whole pandemic. ICU covid age patterns consistent with patterns pre-covid too.
9/14 We understand why newspapers want to use individual case studies and anecdotes to illustrate a story. But extrapolating from those to general statements about what the NHS was doing as a whole, without robust system level data and evidence, carries significant risk.
10/14 We also know that anecdotes from individual frontline staff can sometimes lack context and perspective, e.g. the formal relevant trust policy. The interpretation of at least three of the anecdotes / case studies used in the story is contested by the trusts concerned.
11/14 We should also balance any individual distressing case studies with the thousands of stories from older patients whose lives were saved from covid-19 by the 'incredible NHS'. Here, for example, is one from the ever wonderful @MichaelRosenYes: theguardian.com/lifeandstyle/2…
12/14 I agree with @NHSEnglandNMD that “These untrue claims will be deeply offensive to NHS doctors, nurses, therapists and paramedics, who together cared for more than 110,000 severely ill hospitalised Covid-19 patients during the first phase”......
13/14 ...Nobody is asking that we place the NHS on a pedestal immune from criticism or challenge. We all know there is much that needs to be improved and much to learn. But we owe it to frontline staff to be balanced and evidence-based when making damaging claims like this.
14/14 Nit pick. The use of the phrase “health authority(ies)” in an English context is incorrect. They were abolished in England on 31 March 2013 as part of the Health and Social Care Act 2012.

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More from @ChrisCEOHopson

12 Oct
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.
Read 15 tweets
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

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