Prof. Christina Pagel Profile picture
Apr 28, 2023 10 tweets 4 min read Read on X
THREAD: state of the NHS

The collapse of emergency services that we saw in December/January may be over (for now), but the broader NHS is still very much struggling as the latest performance indicators show... 1/8
Firstly, % of people waiting more than 4 hours in A&E from arrival to admission remains stubbornly high at 29%. Emergency care is still very stretched (often due to bottlenecks discharging patients from hospital) 2/8 Image
A record number of people are waiting for treatment - over 7 million or 1 in 8 of entire pop'n.

While backlog not growing, it's not shrinking either. Long waits are bad for individuals and bad for the economy as people in pain or sick can't work or work less effectively 3/8 Image
In cancer care, the % of people waiting more than 2 months to start cancer treatment has been going up since 2018 but this increase accelerated since 2020 and is now at 40% (double where it was a few years ago). Imagine the stress of those patients waiting. 4/8 Image
Exacerbating problems in the NHS is the fact that we are much worse than peer countries at retaining staff - both in this country and within hospitals.
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Pay is certainly a factor in this and medical staff wages have dropped much more than the average wage in real terms since 2009, meaning many can earn more in the same job in other countries.

But it's not the only factor 6/8 Image
NHS culture & burnout bigger factors. The latest NHS staff survey found that 9% reported experiencing discrimination; 19%-28% bullying from colleagues and patients; 74% said there were not enough staff at their org; 57% say they can't meet conflicting demands on their time. 7/8 Image
We urgently need a comprehensive plan for helping the NHS recover - this needs to cover improved pay; improved working conditions and crucially, a plan for reducing demand through strong public health action & much better social care provision. 8/8
PS thank you to Bob Hawkins for the slides & to @jburnmurdoch for his thread today!
PPS NHS staff survey here
nhsstaffsurveys.com/results/nation…

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More from @chrischirp

Apr 2
A short thread on why this is not a scary chart and why all the evidence suggests that there is not much Covid around right now. 1/6 Image
the above chart is recorded covid hospital admissions / reported covid cases. It is close to 100% now *because basically only hospitals can report cases since Feb 2024*

It is to do with changes in case reporting and NOT hospital testing
2/6
In fact hospital testing has been steady since the change in testing a year ago (only symptomatic patients get tested now).

The % of people PCR tested who have Covid is 4% - there is no evidence that there are loads of symptomatic people in hospital being missed. 3/6
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Read 6 tweets
Dec 21, 2023
Beyond a shadow of a doubt that England is in its biggest Covid wave for well over a year now, with latest ONS infection survey results published.

I've written about it here
1/7 tinyurl.com/ru7h3m28
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The UKHSA have now published their modelled estimates of what percentage of English population has Covid. And as of a week ago it's high (4.3%) and rising.

Read all about it here!
2/7
It's highest in London, South East and East & in young and middle aged adults.
The main thing is it's going up and fast, so prevalence will already by significantly higher now than it was last week. 3/7
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Read 8 tweets
Nov 30, 2023
Short thread on what I said on Channel 4 news tonight.

1. Did I find Hancock a sympathetic witness?

A: I find it hard to have sympathy for someone who repeatedly claimed to have thrown protective ring around care homes, while discharging covid+ patients into them.

1/5
There were *28,000* excess deaths in care homes Apr-May 2020.

Harries thought it was "clinically reasonable" not to treat covid +ve residents in hospital. Even it was, it was NOT reasonable to return them somewhere they could infect so many other very vulnerable people. 2/5
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2. Did I think scientists bear blame for not emphasising asymptomatic transmission?

A: No, because they very clearly did advise there could be asymptomic transmission before March 2020 - sources in next tweet. 3/5
Read 5 tweets
Nov 30, 2023
Hancock: "there was no way we could allow the NHS to become overwhelmed"

Except, the NHS WAS overwhelmed

Here is what NHS staff said about that time - Pls read whole 🧵
"Heartbreaking"
"Horrific"
"It broke my soul"
"We cried, we came home exhausted. We were overwhelmed"

1/16
"Overnight we were told that all “safe working rules” were gone. There was no choice, we were forced to do it"

"It felt like a death sentence. It felt out of control"

"We were put on wards with no senior support, sometimes makeshift ... with little of the right equipment"

2/16
"Terrifying. A huge sense of duty ... but also terror. We were unprepared & ovt clearly had no plan"

"We had patients on wards on 19 litres of oxygen - this would never happen under normal circumstances - they’d have come to Intensive Care but we didn’t have the space"

3/16
Read 17 tweets
Aug 31, 2023
THREAD: England Covid update

TLDR: modest August wave with flatlining hospital admissions, but expect a bigger wave later this autumn 1/12
Hospital admissions with Covid in England are still quite flat for 3rd week in a row and at a level below previous troughs.

Number of people with covid in critical care & primaril yin hospital because of Covid also flat & low.

Deaths ⬆️, from case rises few weeks ago 2/12


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However, Zoe symptom tracker app estimating significant increases recently. Very hard to know how reliable Zoe trends are, given far fewer people reporting, but it's worth bearing in mind.

So what could happen next? 3/12 Image
Read 14 tweets
Aug 29, 2023
THREAD: Various new or expanded cancer screening programmes have been announced recently and coverage has been overwhelmingly on the pros. But there are cons too.

So let's explore some of the pros and cons...

expansion of my @guardian article


1/24 theguardian.com/commentisfree/…



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First a screening recap : a relatively simple test that flags potential cause for concern. If flagged, you are offered more, gold standard, testing, often in a hospital (e.g. MRI scans, blood tests, other diagnostic procs). If those +Ve too, you are offered cancer treatment. 2/24
The benefits are clear: If you have undiagnosed serious cancer, screening can save your life if it leads to earlier treatment.

In this case massively beneficial to you *and* to NHS which can save on longer, more expensive treatment from later diagnosis 3/24
Read 26 tweets

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