1/19 What should happen on December 3? My new blog: nhsproviders.org/news-blogs/blo…. Covered in today's Times: thetimes.co.uk/edition/news/m…. 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.

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More from @ChrisCEOHopson

4 Nov
1/11 Some are arguing that because hospital intensive care is currently no busier than normal for majority of trusts, national lockdown isn't justifiable. See, for example this: telegraph.co.uk/news/2020/11/0…. This ignores three key issues and the argument is therefore erroneous.
2/11 Issue 1. Measuring the degree of pressure in a hospital just by looking at its ICU capacity is wrong and potentially very misleading. Hospital CEOs saying that you need to look at general and acute ward bed pressure as well as ICU bed pressure...
3/11 ...At the moment, hospital CEOs tell us that the pressure is often greater in acute and general beds and not in intensive care. This is partly because many more covid-19 patients are being treated with oxygen therapy on general wards than in the first phase.
Read 12 tweets
1 Nov
1/17 Where are we up to? The NHS trust perspective on the current COVID-19 second surge and the imminent national lockdown set out below in one of my threads. Usual statement at the top - @NHSProviders is the voice of NHS trusts. We are not the Government or @NHSEngland.
2/17 NHS trust leaders have been saying for a very long time that the task they faced this winter already looked very difficult. Clear risk of a “perfect storm”: full blown second covid surge, usual winter pressures as well as recovering important care backlogs from first phase…
3/17 …At a point when NHS capacity has been reduced (hospital trusts saying by between 10-30%) due to need to keep covid and non-covid patients separate. And when staff are tired, with risk of sickness absence rising in any covid second surge. All on top of 80,000 vacancies.
Read 18 tweets
1 Nov
1/6 A final twitter plug for the lecture I delivered to @ActuaryCompany this week on the lessons to learn, as a nation, from covid-19. I asked five questions, deliberately taking a wider, stand-back, view of what has happened so far...actuariescompany.co.uk/chris-hopson-c…
2/6 Q1. Do we need to improve the way we manage infrequent, but very high impact, way of life changing, events such as global pandemics? Many organisations (e.g. NHS trusts) spend a lot of time thinking about how to better manage risk. Do we now need to do this as a nation?
3/6 Q2. Most of big, way of life threatening, risks are global - they transcend nation state boundaries. So do we, as a nation, need to do more to strengthen the currently weak international architecture to manage those risks? We are in a potentially good position to do so.
Read 6 tweets
25 Oct
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”.
Read 14 tweets
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:
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

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