Will NHS meet the end December booster challenge? Incredibly stretching & ambitious target. Huge logistical issues that are much more complex than many realise. But vital to protect the nation’s health given what's coming. So NHS will do everything we can to meet it. New🧵1/25
Thread sets out 1. Why this scale of ambition is so vital. 2. What NHS is currently doing, at pace, to meet this ambition. 3. Elements of mission NHS leaders think will be most difficult to deliver. 4. Best current guess on likelihood of meeting target. 5. Advice for public. 2/25
1. Omicron spreading much faster than delta, quickly becoming dominant variant. Much greater protection from two vaccine doses plus booster jab than two doses alone. Irrespective of symptom severity, NHS looking at very large numbers of hospitalised patients... 3/25
A small percentage of patients needing hospital care from a very big number of omicron infections means a large number of hospitalisations. Every extra booster administered before omicron takes hold therefore vital. Don’t want to reach mid Jan and say “wish we’d gone faster” 4/25
2. Hugely impressive mass mobilisation across NHS and local government. 10 things NHS/local government and our armed forces, third sector and public service partners are currently doing to deliver this vital mission. Detail provided to show complexity of task…5/25
Work requires high quality partnership between national and local leaders. National leaders set framework, run national booking service, ensure vaccine and wider supply (200 pop up site kits ready to go), recruit workforce, set clinical standards and manage contracts… 6/25
System (ICS) & trust leaders in best position to plan and deliver capacity expansion. Key to work with local communities to get best plans which is why local government is so key. They have staff, know how, facilities, vital public health directors and link to social care... 7/25
Trusts & ICSs working at pace to: * Plan for massive capacity expansion as fast as possible. Better to create new sites inc. pop-ups or grow existing ones? What's best geographical coverage? What pattern maximises take up, tackles inequalities & matches staff availability?…8/25
* Extend opening hours/days on existing sites. Requires new staff rosters & ensure third party buildings remain open. Also need to answer important questions like which bank holidays will sites be open for & what are best opening hours to maximise take up and use of staff… 9/25
* Extend physical capacity in existing sites including ensuring appropriate cold / wet weather coverage and queueing arrangements given likely much higher volumes of patients being jabbed. Ensuring appropriate patient safety / comfort in any extended capacity…10/25
* For any new centre: find staff and create staff rosters including appropriate clinical skills; ensure IT works as needed; add capacity to the National Booking System as quickly as possible; ensure appropriate marshalling / queueing arrangements are in place… 11/25
* Identify which staff can be reassigned from current work to vaccination work. Including making difficult clinical prioritisation decisions on what work can be de-prioritised and creating interim arrangements to manage impact on, and communicate with, affected patients… 12/25
* Stand up training arrangements to train new staff. * Identify, train and integrate volunteers into vaccination operations. * Identify how to prioritise those residing and working in care homes, health & care staff, housebound, and severely immunosuppressed patients…13/25
* Work with police, fire service, local government and other wider public service colleagues to identify, train and then allocate any staff for re-deployment to vaccination effort. * Run great local communications campaigns so communities know where/when to get jabbed. 14/25
All in the context of a very pressured NHS which must continue providing care to all who need it. GPs, for example, are doing an amazing job balancing their normal and vaccination workloads. Similar great work in community pharmacy. Difficult judgements needed at pace. 15/25
3. We’ve spoken to trust chief executives over last 24 hours and they highlight following three big challenges to overcome to achieve end December target. Local NHS and partners now working flat out to address them but they are significant and will take time to address…16/25
Workforce. NHS really struggling with workforce shortages & will need to rely heavily on others inc. volunteers. Particular worries about potential loss of staff when omicron takes hold in community. Infection control vital in healthcare settings to avoid cross infection... 17/25
Speed of capacity build required. NHS has rapidly built capacity to vaccinate new cohorts e.g. 30-39s. Record level of booster vaccines delivered this weekend. But capacity build inevitably takes time and only 18 days left to 31 December 2021 including the Xmas period… 18/25
Scale of capacity increase needed. To reach the target NHS will need to regain its March 2021 record vaccination day of over 800k vaccinations as quickly as possible. And then consistently go beyond it every day, day after day. Saturday’s figure was 550k vaccinations. 19/25
4. Can the NHS do it? When the ambition was announced 36 hours ago it felt undeliverable. Too big a capacity ramp up too quickly. But hugely impressive work now underway. The idea of creating 34,000 beds for coronavirus patients at start of pandemic felt impossible…20/25
As did idea of coping with 40k simultaneously hospitalised UK covid patients in Jan 2021. But NHS did both. This ambition will be incredibly stretching to deliver – many think it’s biggest challenge of the three. But if we do fall short, it won’t be for want of trying. 21/25
Three key things. NHS can’t force people to come forward for boosters so there is a big element of achieving the goal NHS can’t control. Ministers need to constantly point, in background media briefing as well as in public, what/how much NHS is doing to achieve target…22/25
Right for Ministers to set big ambitious goals. But they also have a duty to calibrate expectations of what is realistic and how difficult the goals are to achieve. Their failure to do so for Test and Trace was a very significant mistake that mustn’t be repeated here. 23/25
5. Public health advice. Get your booster as quickly as possible. Book via National Booking Service. Capacity added all the time. Try walk-in centres but they'll prioritise bookings. Walk-in capacity varies across country. Unacceptable to abuse NHS staff if there’s a wait. 24/25
SUMMARY NHS doing all it can to deliver this vital new national mission. We understand how important it is. We are mobilising rapidly, with our partners, as we have done throughout the pandemic. It’s too early to tell whether we will hit target but we will do our very best. 25/25

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More from @ChrisCEOHopson

12 Dec
How’s NHS? Staff completely flat out & beyond full stretch. Busier than ever before at this time of year. Major workforce/demand challenges. Before full impact of winter/omicron. Worrying. But as committed as ever to providing outstanding patient care to all who need it!🧵. 1/25
Five features of current pressures, each explored below. 1. NHS staff working very hard delivering high levels of activity despite context/constraints. 2. Pressure universal across entire health & care system. 3. Pattern of pressure very different to this time last year...2/25
…NHS currently has lower covid caseload but experiencing more extended/universal pressure. 4. Workforce challenges wide ranging & difficult to address. 5. NHS beyond full stretch before we have reached traditional winter peak which could coincide with Omicron peak 3/25
Read 25 tweets
14 Nov
1/25 New report from @AACE_org on the impact of ambulance handovers on patients. @Independent story here:
independent.co.uk/news/health/am…. Thread below on the broader context and why everyone in the NHS needs to help rebalance current levels of risk to protect patients.
2/25 In the words of one senior national NHS leader last week “we have all become used to the ambulance service being the brilliant bedrock of the urgent and emergency care pathway. Always providing a fantastic, rapid, quality of care whatever the level of pressure”.
3/25 But, over the last few months, the pressures on ambulance services across the country have risen significantly. It’s striking that this is universal – all ten ambulance services in England have been on high alert for a very long, and continuous, period of time.
Read 25 tweets
2 Nov
1/14 Brilliant visit to @SurreyDownsHC, part of @SurreyHeartland ICS today. Very impressed with the excellent progress they have made in actually integrating services on the ground, delivering better care and improving outcomes. Thread below with what particularly impressed me.
2/14 Impressed with the way that the @SurreyDownsHC’s vision for integration starts with concrete action to improve services. Of course governance, finances and structures are important. But they start with a data driven understanding of the needs of their population…
3/14 …And they then put the relevant professionals together to work out how they can improve the relevant service or pathway. Strong emphasis on enabling right collaborative relationships between different people from different disciplines and organisation to drive improvement.
Read 14 tweets
1 Nov
1/5 Thanks for everyone's responses to my thread / your contributions to this important debate. They show how complex this issue is and how there are strong views here, understandably. Three quick thoughts in response to some of the comments that have been made.
2/5 A. The patient perspective is, of course, vital. There will be many patients who will feel very strongly that they have a right to be treated by staff who have been vaccinated. Equally, there are some staff who feel very strongly it is their right not to be vaccinated...
3/5 ...One of the complexities here is that there is a potential conflict between people who believe, equally strongly, that their fundamental rights are at stake and should not be breached. B. Thinking further about the patient perspective and the NHS looking after patients...
Read 5 tweets
1 Nov
1/13 Possible Government will announce approach on mandatory NHS staff vaccination this week. Consultation has now closed. A complex issue. Tweet thread follows, based on conversations with, and intelligence from, trust leaders. There are differing views in trust sector…
2/13 Our intelligence suggests c2/3 of senior trust leaders - hospitals, mental health, community & ambulance - favour mandation & 1/3 don't. Everyone agrees there are two risks to manage here, not one. Not just the risk of covid/flu cross infection from unvaccinated NHS staff….
3/13 …It’s also about managing the risk of losing unvaccinated staff when the NHS is at full stretch and carrying 93,000 vacancies. The issues currently facing social care providers illustrate the very significant scale of risk to care / patient safety if we get this wrong.
Read 13 tweets
2 Sep
1/19 Media reports suggest Govt now finalising health & care part of spending review and we're heading for a potential £5 billion NHS funding gap next year. We've issued a new report today with @NHSConfed showing why frontline NHS needs £10bn extra next year. New thread follows.
2/19 Bit of background context first. The NHS budget for five years, including next year and the year after, was set in June 2018, before covid. Over the last two years the Government has suspended those plans and given the NHS the extra money it needed to deal with covid…
3/19 ...Last year NHS received £18bn extra on top of original plan. In 1st half of this year NHS received an extra £7bn with more to come for 2nd half of year. According to Monday's Times (thetimes.co.uk/article/nhs-bo…) Govt now wants to return to pre-covid budget plan next year...
Read 19 tweets

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