We need to give proportionate focus to daily London hospital admissions data. The data is important as it should give the earliest clinical evidence, and a good sense, of likely severity of omicron and hospitalisation/mortality rates for the specific UK context...1/10
But we also need to take a much broader view of NHS pressure. All demand - non covid as well as covid care. Level of staff supply, including level of staff absences. And recognise that the NHS isn't just about hospitals - health and care is an interconnected system...2/10
So pressures in community services, mental health, primary care, social care and ambulances can be just as serious/harmful for patients as pressures in hospitals. And those pressures will also then show in hospitals, e.g. pressures on discharge and extra A&E demand....3/10
It's far too simplistic to just look at covid hospitalisations and say "they're not that high [e.g. compared to previous peaks] and the NHS should therefore be able to cope". The question is what quality of care is all of the NHS able to provide to all who need it?...4/10
It's very striking how many trust chief executives are saying that they think workforce pressures are the fundamental challenge. Trusts are currently facing a very difficult combination of staff absences, vacancies and difficulties sourcing agency / bank shifts...5/10
Important to remember that the NHS is coping with three major challenges at once. Very high levels of non covid demand e.g. urgent care and planned care backlogs. Massively extending booster vaccination campaign at pace. Preparing for omicron surge should it arrive...6/10
Any one of these is a big challenge. All three at once means the NHS is currently beyond full stretch. But, as shown over last 18 months, thanks to the professionalism and commitment of frontline staff, NHS is remarkably resilient and keeps meeting extraordinary challenges...7/10
So, even if the omicron hospital covid caseload is lower than some of the worst case, or even mid range, predictions, we need to recognise and acknowledge how pressured the NHS will still be. And how hard we will still be having to ask our frontline NHS staff to work….8/10
We are not calling for tighter restrictions on social contact at this point as the data on omicron severity remains inconclusive. Government should, however, be getting ready to move very fast should the evidence show that further restrictions are necessary....9/10
Some really important underlying issues to address here. Including massive ongoing mismatch between demand & capacity. And the need for rigorous long term workforce planning. These are key to ensuring frontline NHS staff have a reasonable workload on a sustainable basis. 10/10

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More from @ChrisCEOHopson

18 Dec
London NHS pressure mounting rapidly. Hospitalised covid patients up 30% in week vs national 4%. At 1,534 yesterday (vs 8k in Jan'21 peak). Covid linked staff absences up 140% from 1,900 Sunday to 4,700 Thurs. Some trusts now having to postpone non essential activity 🧵..1/6
Trusts beyond full stretch doing three things at once, each of which is a massive task by itself. Cope with huge pressure in non-covid care (e.g. urgent care and care backlogs). Exponentially expand booster vaccination campaign, at top speed, working with local govt partners..2/6
And get ready for rapid onset of potentially large numbers of new omicron hospitalised covid patients with very large numbers of staff on omicron related sick absence. Trust leaders, as always, doing all they can to provide best possible care in a very pressured context...3/6
Read 6 tweets
14 Dec
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
Read 26 tweets
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

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