1/12 NHS monthly stats due out tomorrow. Although the number of covid hospital cases is significantly lower than many were predicting/fearing, the NHS is still under huge pressure due to a combination of six factors. Stats will show this tomorrow. Shorter thread (🤣) follows!
2/12 Particularly important to understand that every part of NHS is under pressure. Hospitals, ambulance, community & mental health services and general practice / primary care. Many CEOs saying that although the shape of the pressure is different, it feels as busy as Jan/Feb…
3/12 …Striking that some CEOs are saying that their trust is under the highest pressure they have ever known. Don’t measure overall NHS pressure by looking at covid-19 caseload. Vital to look at all demand and capacity pressures, particularly the latter at the moment.
4/12 Pressure 1. Trusts recovering care backlogs at real speed. This has been impressive, exceeded expectations and is under-reported / under-recognised. Suspect this good performance will show up in June activity levels in tomorrow’s stats e.g. diagnostic activity recovery...
5/12… But going at this pace inevitably puts pressure on staff, beds and equipment. EG Trust CEOs now seriously worried about lack of access to small amounts of tactical capital to maintain MRI/CT equipment that is being more heavily used than pre-covid given pace of activity.
6/12 Pressure 2. Hospital trusts really suffering from much lower bed capacity due to infection control. In simple terms, trusts losing 7.5-10k beds from a pre-covid bed base of c100,000 beds. Very large loss of capacity when NHS already had insufficient beds pre-covid.
7/12 Pressure 3, and universal across all types of trust, is the number of NHS staff self isolating. The changes announced a few weeks ago have helped, but nowhere near as much as leaders were expecting and hoping. Further changes on Aug 16 can’t come soon enough!
8/12 Pressure 4, NHS has hit peak annual leave season and that is, inevitably, impacting on capacity. Staff have significant leave delayed from previous covid waves. Big worry that leave isn’t being taken in some cases due to self isolation or operational pressures.
9/12 Pressure 5, urgent & emergency care demand now exceeding pre-covid levels. Scale of pressure varies by trust. EG Trusts with high levels of holiday-ers (e.g. Cornwall) under real pressure. Universal agreement that general patient acuity level definitely higher vs pre-covid.
10/12 Pressure 6. Although number of covid-19 patients in hospital now stabilised at 5,000 – at that broad level for last fortnight - that’s still a sizeable number of beds. Particularly when every bed is needed for admitted emergency and elective surgery recovery patients.
11/12 "Interesting" (but admittedly slightly esoteric) debate on which pressure is greater - workforce supply or demand. Definite sense that workforce supply has now become the critical problem. Trust leaders hoping that getting past summer leave and Aug 16 changes will help.
12/12 Trust leaders particularly worried about scale of pressure on ambulance services. Universal view that this is, genuinely, an unprecedented level of pressure. And it’s been like that for nearly 2 months. Worrying impact on staff. And patients, despite best frontline efforts.

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More from @ChrisCEOHopson

12 Aug
1/10 Important new joint report with @AACE_org on ambulance services released today.

Report: nhsproviders.org/media/691897/r…

Blog by @daren_mochrie & me here: hsj.co.uk/quality-and-pe…

News story by ever wonderful @AliJaneMoore here: hsj.co.uk/service-design…

Quick ( 🤣) thread follows.
2/10 It’s a very good time to talk about ambulance services given the unprecedented pressure they have been under for the last two months. This is a clear warning sign that we have to address the underlying demand / capacity mismatch ambulance services face. Risks increasing..
3/10 ...Growing risk of ambulance staff burnout given constant pressure. And growing risk of harm to patients because, despite best efforts of frontline staff, demand/capacity mismatch means ambulance services can't always provide quality/speed of care they want & need to.
Read 10 tweets
8 Aug
1/23 Health and care funding now centre stage as Govt sets 2nd half 2021/22 & longer term Spending Review settlements. Great article by @michaelsavage & @denis_campbell here: theguardian.com/society/2021/a…. My accompanying comment piece here: theguardian.com/society/2021/a…. Thread follows.
2/23 Health & care budget central to spending review, given the size of spend, so strong case to settle early. NHS budget for second half of 2021/22 must be set by end September. Increasingly likely this could be a single NHS money discussion, concluded relatively rapidly.
3/23 Decisions made here, over next two months, likely to set health and care funding for next three years. They will impact the health of our nation for a generation. So they’re very important to get right. They could also have a significant impact on the next General Election!
Read 23 tweets
27 Jul
1/25 @NHSProviders today highlighting current & future pressure NHS now facing. And, therefore, vital importance of getting NHS budget for second half of year right. Key Government decision on this due in next few weeks as NHS only got budget for first half of year due to covid.
2/25 Press release here: nhsproviders.org/news-blogs/new…. Letter to PM/Chancellor/Health Secretary and @NHSEngland here: nhsproviders.org/media/691810/2…. News coverage here:independent.co.uk/news/health/nh… and here: news.sky.com/story/nhs-as-s…
3/25 Trust leaders are telling us that, although the shape is different, the current pressures are, in aggregate, as great as they were in January. That was rightly described as the most difficult period for the NHS in a generation. Five main reasons for these new pressures.
Read 25 tweets
8 Jul
1/27 Lots of current focus on interaction between increasing levels of COVID-19 cases and NHS, in the context of relaxing restrictions on 19 July. New thread follows. Key questions to answer: what's the likely impact on NHS, can it cope and what does this mean for 19 July?
2/27 As we said a few weeks ago, vaccines have severely weakened the link between covid-19 infection and hospitalisation / mortality. Or, as we put it, for this set of variants, vaccines have broken link between infections and previously high hospitalisation/mortality rates.
3/27 So, there’s high confidence amongst trust leaders that increasing community infection rates, even to the levels we saw in January, will not translate into the levels of hospitalisation and mortality we saw in that peak. A peak that brought extreme pressure to the NHS. But…
Read 27 tweets
21 Jun
1/24 @MartinRCGP and I have highlighted the need for an Autumn covid-19 vaccination plan. Together our organisations represent almost the entire NHS frontline and we wanted to celebrate what's been achieved so far and highlight forthcoming challenges: bbc.co.uk/news/uk-575487….
2/24 There's huge focus on COVID-19 vaccinations as the NHS seeks to vaccinate as many people as possible so we can ease social restrictions. This is the latest step in an extraordinary NHS achievement. In six months our defences against the virus have been transformed.
3/24 Vaccines aren't just saving thousands of lives, they also offer a vital route back to freedoms we all miss so much. It's been a triumph of detailed planning, collaboration & commitment. Hugely ambitious in scale, speed and complexity involving tens of thousands of people.
Read 24 tweets
6 Jun
1/25 New update thread with latest on covid-19 infections and hospital admissions and what these might mean for June 21 decision on easing lockdown measures in England. Quick reminder: @NHSProviders is the voice of English NHS trusts: nhsproviders.org/news-blogs/pre…
2/25 Community infection rates rising steadily as Delta variant spreads and becomes dominant strain. In areas where community infections rates are increasing, hospital COVID-19 admission rates rising, but not alarmingly. Trust leaders telling us there are 3 consistent features.
3/25 First. Number of hospital COVID-19 admissions consistently a lot lower than in previous waves. Second. Patients admitted are, on average, younger with less requirement for critical care, more treatment in general & acute beds, lower acuity and lower mortality rates.
Read 25 tweets

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