23/31 WHAT HAPPENS NEXT? Speed at which covid transmission & hospital admissions slow down is key. Some evidence that increases in rate of infection starting to slow in parts of London/SE. Current best guess suggests peak NHS covid demand might be 2nd/3rd week January?
24/31 Trust leaders also worried that usual early January demand spike now imminent and wider cold weather will mean more emergency demand and staff absence. On plus side, infection control measures mean low winter flu levels and, at moment, low levels of norovirus and D&V bugs.
25/31 The next two to three weeks are therefore critical. How much more capacity will London/SE need before the peak of demand is reached? How best to support trusts in North and Midlands if they start experiencing the scale of increase in covid cases recently seen in London/SE?
26/31 Latter point is key. London/SE trusts under huge pressure in meeting demands from new variant. But they started with very few covid inpatients. Northern/Midlands trusts still have many covid inpatients from Autumn second surge so at real risk if they see similar increases.
27/31 This means Government needs to think very carefully. It's vital to stop covid spread to save lives, reduce harm and give NHS best chance to treat all patients who need care. Full national lockdown, tier 5 and national delay to school return all need careful consideration…
28/31 …Particularly since it’s clear that new vaccines, now firmly on-stream with impressive early NHS rollout, offer a permanent way out. So these restrictions will be time limited. Concept of one more heave to get over the immediate hump of this winter more valid than ever.
29/31 KEY MESSAGES FOR PUBLIC. The NHS is still fully open for business. If you need help, please come forward. Contact NHS 111 online or by phone unless a genuine real emergency. Far too many people suffered in silence in first phase, making conditions worse. Help us help you.
30/31 Please follow the rules restricting social contact, however irritating & onerous they may seem. Following these rules is more important than ever given the massively increased transmissibility of new variant, confirmed today as between 40 and 70% more transmissible.
31/31 FINAL THOUGHT. Trust leaders angry that, despite pressure, anti-lockdown/anti-NHS ideologues are still spreading lies & disinformation on how quiet, or badly prepared, the NHS is. They feel it's disrespectful to NHS staff giving their all in near impossible circumstances.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
1/8 Speaking to NHS trust leaders across country and looking at today’s statistics on beds occupied by COVID patients, it's clear we have now reached a critical point. Immediate decisive action is now needed to stem rapidly rising rate of infections, hospital admissions & deaths
2/8 Trust leaders are clear about cost & impact of tighter restrictions. But, to prevent significant numbers of unnecessary deaths, reduce patient harm and give NHS best chance of treating all patients who need care, Govt must now immediately tighten current tier system rules.
3/8 Government will announce its new plans this evening. NHS trust leaders are insistent that any tightening should be immediate and decisive. Current tier 3 rules are insufficient and tier 4 rules appear to just slow down the rate of increase in Covid transmission, not cut it.
1/31 Lots of media coverage, rightly, on huge NHS pressure. What’s cause of, and how widespread, is pressure? How is NHS responding? How serious is this & what’s impact on patients & staff? What’s likely to happen over next few weeks? Long new explainer thread below in two parts.
2/31 WHAT'S CAUSE OF, AND HOW WIDESPREAD IS, CURRENT NHS PRESSURE? Remember overall context. Winter always busiest time of NHS year & NHS capacity always at its most stretched. Last five winters show that, despite increases in capacity, NHS at / over its capacity limit...
3/31 ...Whilst overall staff levels improved in 2020, NHS also entered year with 100k vacancies. Covid makes all this much worse. NHS balancing four sets of patients – winter patients; covid patients; planned care cases, incl. delays from first phase; and those needing vaccine.
1/10 What should happen next with the tiered restrictions and the proposed Christmas relaxation? Our new media statement just issued. Full statement is attached and new twitter thread of the key messages is set out below.
2/10 Having spoken to a number of our NHS trust members over the last 48 hours, three things are crystal clear. First, there is a ring of areas around London – for example, in the Home Counties – where trusts are alarmed at the rise in infection rates and hospital admissions....
3/10 ...The Government has rightly put London and parts of Essex and Hertfordshire into tier 3 earlier this week. It must now urgently consider adding other areas to that tier where infection rates are similarly worrying. Speed is of the essence here.
1/17 Very technical thread for those interested in detail of NHS finances. We've been discussing how to move to more system focussed finances in 2021/22 with members and @NHSEngland. We've turned that work into the following asks: nhsproviders.org/media/690684/f…. Asks in thread below.
2/17 If funding flows change before ICSs are put on a statutory footing, @NHSEngland must clearly set out the legal underpinning for how funds will flow to and within ICSs. Including how this will align with the formal responsibilities of accounting officers & trust boards.
3/17 @NHSEngland must publish its full methodology for determining the size of each ICS funding envelope. This should account for how each constituent element is calculated, including the logic behind any provider level allocations so this is fully visible to all within the ICS.
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.
1/9 Just to give a sense of how the 50 hospital hubs are actually managing their covid-19 vaccination campaigns, here's an anonymised plan from one trust we have been talking to today. Gives good picture of complexities, inter-dependencies and huge effort at pace involved.
2/9 Their local CCG and GPs are providing the hospital with a list of over 80s who are able to attend the hospital site. The hospital's appointment bookers will then ring those people to book them into a timed 15 minute slot. Number of people per slot will obviously vary by trust
3/9 Vaccination will take place in a separate dedicated clinic building. This is deliberately sited next to a car park to allow easy access by car for over 80s. This is obviously, and importantly, separate from main clinical space where there may be covid-19 patients.