Thread by @ChrisCEOHopson

1/18 The Government is reviewing operation of tiers system on Dec 16. We've written to PM to set out NHS trust concerns. Letter here: nhsproviders.org/resource-libra…. @BBCNews coverage here: bbc.co.uk/news/health-55… @thesundaytimes coverage here: thetimes.co.uk/edition/news/n…. Thread follows.

2/18 Three requests to the Prime Minister in our letter. 1. Extreme caution in moving any area to a lower tier. 2. Move areas to Tier 3 as soon as needed, without any delay. 3. Personally lead a better public debate about the risks inherent in the guidance for 23-27 December.

3/18 Letter based on current evidence and conversations with members over last few days. Whilst there are good signs of progress on infection rates in some parts of country, overall, current trajectory is at bottom end of hopes and expectations trust leaders had a month ago.

4/18 Evidence from last fortnight shows rate of COVID-19 patients leaving hospital is considerably slower than it was in the first wave. In some areas, the number of COVID-19 inpatients is increasing. Taken together, this is placing significant pressure on hospital beds.

5/18 The NHS had 500 COVID-19 patients in hospital beds at the beginning of September. As of Thursday 10 December, there were 13,000 hospitalised COVID-19 patients. More than a quarter of all hospital trusts saw covid patient admissions rise by more than 20% last week.

6/18 Over last 5 winters, demand for NHS beds significantly outstripped capacity. Yet NHS now facing extremely concerning prospect of 10,000 fewer beds (9%) in operation than last year, due to infection control measures, and thousands of remaining beds occupied by covid patients.

7/18 Whilst infection rates dropping in many northern parts, now seeing a worrying increase in infection rates across wide range of areas, including Essex, Kent, London & parts of Lincolnshire. Particularly concerning these increases come at tail end of second national lockdown.

8/18 Trust leaders have two concerns. 1. We may be seeing spread of high infection rates we saw in northern half of country in September and October to southern half of the country. 2. Evidence from second wave suggests that unless infections rates fall to a very low level.....

9/18 ...Unless infection rates fall to a very low level, as they did in London after the first wave, the virus will spread again quickly as soon as restrictions on social contact are relaxed. Underlying logic remains same: more social contact = more virus spread.

10/18 Trust leaders are very worried about the task they face between late Dec & Feb - NHS's busiest period - as they balance four sets of patients. 1 Large numbers of COVID-19 patients. 2. Planned care, particularly cases delayed from first phase that can't wait any longer...

11/18 ...3. Emergency “winter pressure” patients, particularly if there's an extended period of the cold weather we've already started to see in some parts of country. 4. New demands of vitally important COVID-19 vaccination work trusts have started so successfully this week.

12/18 Trust leaders are convinced that the only way they can meet these demands is by controlling the level of COVID-19 infection and, hence, the number of hospitalised COVID-19 patients. Tight restrictions on social contact are the only current means of achieving this.

13/18 The evidence of the last fortnight, following Thanksgiving celebrations in the USA, is also clear. A relaxation of restrictions on social contact, combined with the natural desire to celebrate a traditional festival, inevitably increases the spread of the virus.

14/18 As of yesterday, the latest COVID-19 data from the US is now showing record numbers of cases, hospitalisations and deaths. Compared to a fortnight ago, the number of daily cases is up by 25%, daily hospitalisations are up by 20%, daily deaths are up by 60%.

15/18 Trust leaders are worried about the nature of the current public debate on Christmas relaxation of restrictions. The prevailing public perception is “thank goodness we can celebrate Christmas, as long as we stick by the rules it'll be fine".

16/18 Whilst we are not, at this point, asking for a change in the proposed Christmas relaxation of restrictions, we are concerned that the current public debate on these rules is ignoring the significant extra risks involved in this temporary relaxation.

17/18 It's vital for the public to understand that any extra social contact, particularly with those who are vulnerable to the effects of the virus, is risky. Everyone needs to think very carefully before initiating such contact over the Christmas period.

18/18 Trust leaders recognise the very difficult trade-offs here, but wanted to clearly impress upon the Government how worried they are on the basis of the evidence they have seen this week. Hence our @NHSProviders letter to the Prime Minister.

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