How's NHS doing at moment in relation to omicron and other pressures? New thread based on latest data. Note that we prefer to use numbers of covid-19 patients in hospital, rather than new admissions, as two days more up to date and better represents whole picture...1/19
Trust leaders looking at data very carefully. Number of patients with covid-19 in English hospitals is definitely rising, but not precipitately so. Numbers across country as a whole have risen by 27% in a week - comparing figures for 27 December (released today) to 20 Dec...2/19
It's notable that we are now seeing growth in these numbers across the country, not just in London, as before. North West numbers up 38% in a week, East of England up 33% and Midlands up 23%. All comparing number of covid hospital patients 20 to 27 December…3/19
London data, in particular, is important as it’s been the clear epicentre of omicron up to now. Number of covid-19 patients in London hospitals has grown by 45% from 20 Dec to 27 Dec. There's currently a 14 day doubling time (1,360 on Dec 13 to 2,640 on Dec 27)….4/19
And daily growth rates over the last week have been, from the 20th, 9%, 5%, 7%, 3%, 8%, 7% and 9%. Important to look at overall numbers as well as growth rates. 2,640 covid-19 patients in London hospitals versus 7,917 in last January’s peak (18/1/21) - a third of that peak…5/19
Equivalent figures for England as a whole are 8,474 covid patients in English hospitals today versus 34,336 in January peak (18/1/21) – 25% of that peak. So whilst numbers are growing, we are currently some way from number of hospitalised covid patients in previous peaks. 6/19
Talking to trust chief executives this morning, what’s very interesting is how many are talking about number of asymptomatic patients being admitted to hospital for other reasons and then testing positive for covid. Some are describing this as ‘incidental covid’… 7/19
Trusts not, at moment, reporting large numbers of patients with severe Covid type respiratory problems needing critical care. Also not needing to massively increase use of oxygen. Both of which we saw in last Jan’s delta variant peak + very difficult critical care surge…8/19
We should therefore be cautious about over-interpreting current raw covid admission data. As covid community infection rate rises rapidly due to omicron, we will get more cases of this type of incidental covid-19 in hospital. Raw data doesn’t distinguish between two. 9/19
Important to note these cases will bring complications for hospital/community services as patients will need to be isolated to avoid cross infection and they will add to overall pressure. But these cases are, obviously, not same as covid driven serious respiratory illness. 10/19
In the words of one hospital chief executive in the South West this morning: “we’ve seen a 30% increase in covid positive inpatient numbers compared to 7 days ago. But largest proportion are incidental finding on admission, so covid-19 is not the reason for admission….11/19
“It’s therefore important to look at the total number of patients admitted, not just the raw number of covid patients admitted, particularly if they don’t need full covid care. For our trust as a whole, overall admissions are no higher than they were seven days ago”…12/19
We must, though, keep broader omicron context in mind. We still don’t know, and are unlikely to know for some time, whether we’ll see large numbers of seriously ill older people in hospital as omicron reaches older population and effects of Xmas mixing work through… 13/19
Frustrating though it may be, we need more data before we can reach any firm conclusions on what the full risk from omicron is. It’s still far too early to say that we don’t need to worry about omicron and hospitalisations as some are unhelpfully saying / implying. 14/19
We must also remember that, as a whole, NHS remains under huge pressure. Trust leaders are telling us that, whilst they can cope with current covid caseloads, staff are at full stretch. Trusts also expect to come under greater pressure as they head into January. 15/19
The current combination of staff absences, very busy urgent care pathway, planned care cases that can no longer be delayed & extending booster campaign all bring significant pressure. Right across GPs, social care, ambulances, mental health and community services…16/19
Striking how many chief executives are saying that, on current evidence, they think omicron related staff absences may be a greater challenge than number of omicron related severely ill patients they have to treat. Several trusts told me today they’re now at point…17/19
…Where they need to redeploy staff to keep essential services going. If current trajectory in covid staff absences is maintained, these pressures will grow significantly. In this context even relatively small numbers of extra covid cases will bring big difficulties...18/19
Chief Executives incredibly grateful for commitment and professionalism of front line staff to cope with these pressures. At present, optimistic they can cope with current caseload. But worried about what may be coming. Preparing for the worst but hoping for the best. 19/19

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More from @ChrisCEOHopson

22 Dec
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
Read 10 tweets
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:…. 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

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