1/25 Update thread on where NHS hospitals are at the moment, concentrating on 3 things: a) hotspot hospital admission rates. b) overall pressure. c) what this may mean for easing lockdown measures (spoiler alert - we will need a full, evidence based, debate given trade offs!)
2/25 Having spoken to NHS trust CEOs in hotspot areas in last 48 hours, central message remains broadly the same. Namely A. Covid-19 hospital admission rates not increasingly rapidly. They vary between climbing slowly, plateau-ing or, interestingly, starting to reduce.
3/25 E.G. In one key hotspot trust 47 covid-19 inpatients yesterday vs 49 day before. Stark contrast to c170 peak last Nov and c150 peak in Jan/Feb. B. Patients significantly younger than previous peak and this generally means less need for critical care than in previous peaks.
4/25 C. Very few patients in hospital - “a handful” - who have received both vaccination doses and those in this category usually have pronounced co-morbidities. Some who have had single dose. But the significant majority of hospital cases are unvaccinated….
5/25 …either because they are too young or, although patient was eligible, they haven’t had their vaccinations. This sends a very clear message about the overwhelming importance of getting both doses and the key role of surge vaccination in speeding up protection.
6/25 D. Particularly interesting that some trust leaders in hotspot areas are saying that their community infection rates are now beginning to plateau. They’re starting to conclude this means they’re unlikely to be as overwhelmed with covid cases as in previous peaks…
7/25 …They are describing this as “clear, on the ground, confirmation of the success of the vaccination campaign”. Not, of course, a massive surprise given clinical evidence on vaccine effectiveness. But very reassuring for NHS Trusts given what happened in previous peaks.
8/25 However, second area of focus for this thread – it is incredibly striking how busy and pressured hospitals currently are. This is pretty universal. Trust leaders are ascribing this to a combination of the following four factors: Factor one – care backlog recovery…
9/25 …Trusts going full pelt on recovering care backlogs, getting through as many cases as possible, starting with more clinically urgent, often complex, cases. Many of these require overnight/several days post operative recovery, so wards are very full with these patients.
10/25 Factor two. Urgent care demand has significantly increased over the last few weeks and there is a very marked increase in patient acuity / complexity. Many trusts report significantly more patients requiring admission and complex treatment than they were expecting...
11/25 …Trusts are working hard to understand reasons for this. One theory is significant numbers of patients “living with a growing problem” that has got so severe they must now be treated. But the required treatment is more extensive, requiring admission / some length of stay.
12/25 Trusts are also reporting significant increases in numbers of patients with severe mental health needs, particularly children / younger people needing complex care. Given pressure on mental health inpatient beds, hospitals providing temporary inpatient care.
13/25 Factor three. Worryingly, some trusts are also starting to report a slowdown in discharge flow, putting pressure on bed occupancy. Trust leaders saying some local authority colleagues are understandably worried about longer term access to discharge funding…
14/25 …Given uncertainty about access to this vital funding for the second half of the financial year. This important potential problem can be simply and easily solved by Government committing now to maintaining this funding on current rules for rest of the financial year.
15/25 Factor four. In hotspots / areas becoming hotspots, although the numbers are low, even small numbers of covid patients add to these pressures. Important to think about pressures holistically – not as separate covid-19, urgent care, and elective recovery silos.
16/25 In the words of one hotspot CEO this week “I can’t tell you how hard we are trying to keep our covid inpatient numbers below ten. That’s a fraction of what we had in Jan/Feb. But as soon as we go above ten we will have to convert elective recovery wards to covid wards…
17/25 …And we will do everything we possibly can to avoid this, for obvious reasons”. Don’t forget hospitals also already operating at significantly reduced capacity due to covid-19 infection control. More important than ever given increased transmissibility of this variant.
18/25 Particularly striking, with the Bank Holiday in mind, how worried some trusts are about the increased demand they will see from UK holiday makers. In the words of one trust CEO on the south coast yesterday: “I’m really worried about the next few months….
19/25 …We’re already at 96/97% bed occupancy and we know we are about to see a massive influx of tourists given how many will be stay-cationing this year. We know from experience this will create significant extra demand for us and, at the moment, we will struggle to meet it”.
20/25 So, third area of focus, what does this mean for decision about 21 June lockdown easing? Previously, with a [largely] unvaccinated population, there was no real choice other than to lockdown. The only way to prevent high levels of mortality and NHS being overwhelmed.
21/25 Trust leaders also share the current concerns about the much increased transmissibility of this variant. There are also still many more people to vaccinate, particularly with a double dose. And don’t forget the three weeks needed post jab for full levels of protection.
22/25 We also need to be very aware of the impact of long covid, including in young people, and the still largely unknown impacts of covid-19 on long term health / susceptibility to illness. Trust leaders are clear that we shouldn’t just focus on mortality rates.
23/25 We then need to factor in the above. Significant numbers of covid-19 hospital inpatients will adversely impact care backlog recovery. Current degree of pressure on hospitals is worrying especially since we saw clear summer demand surges in the two years before covid-19...
24/25 …But if, as evidence above suggests, success of vaccination campaign means much lower levels of hospitalisation, serious illness and mortality, even with new variant, that is very significant and important. This means there is a difficult decision to make for June 21.
25/25 We need a real quality of informed, evidence based, debate on the trade offs here. A debate led by political leaders, supported by high quality media coverage. A better quality and richer debate than we have had on these issues in previous phases, perhaps? Here’s hoping!
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