it saddens me to write this piece but the NHS is falling over with extreme stress in general practices, hospitals, the ambulance service, etc bmj.com/content/375/bm… stress is the result of rising demand for care colliding with constrained capacity of all kinds but especially staffing

I attended an NHS board meeting yesterday where we discussed the massive pressures facing health and social care these pressures include record attendances at ED, ambulances waiting outside hospitals with patients, bed shortages, and difficulties in discharging patients when they no longer need to be in hospital

today's report from @CommonsHealth @CommonsSTC sets out clearly and convincingly the strengths and many weaknesses of the govt's response to covid (1) blogs.bmj.com/bmj/2021/10/12… there are however two significant omissions: first, the UK's response was among the most centralised in the world, and better decisions would have been made by involving devolved administrations, regional mayors and councils (2)

how should @sajidjavid spend his first 100 days? My suggestions and spoiler alert: get out of the office and see for yourself the realities of health and social care first, spend time with carers to learn about the vital and undervalued work they do for people with disabilities and many others in the 'informal' but essential care system

the government's plans to establish integrated care systems as statutory bodies and to end the legacy of 30 years of market reforms to the NHS are welcome and feel different from previous reorganisations (1) every previous reorganisation I've worked through has been imposed by politicians. This time the main changes have been in development for 5 years and the law is catching up with work led locally by the NHS and its partners (2)

There are many lessons - positive and negative - on the response to the pandemic and we need to learn them now to be more effective in future
newlocal.org.uk/articles/covid… Let's start with three positives: partnership working at a local level through local resilience forums and integrated care systems enabled public services to use resources more effectively with focus on place and community @NHS_RobW

take home points from yesterday' session with @CommonsSTC @CommonsHealth led by @GregClarkMP @Jeremy_Hunt my evidence and that of others underlined need for contact tracing to be led locally and for councils to have the resources to do this effectively @Jeanelleuk

the govt must use the next 4 weeks to sort out test, trace and isolate. Here are the priorities @Jeremy_Hunt @GregClarkMP @JonAshworth @leicesterliz @didoharding @MattHancock @AndyBurnhamGM weekly testing of asymptomatic NHS staff in all settings should be routine

Just explained @BBCEngland that test and trace has picked up 10K new cases in last 2 weeks which is minority of new cases as reported by @ONS. National tracers have reached 10,000 out of 87,000 reported contacts thru 25,000 staff Remaining 77,000 contacts (complex cases) have been reached by @PHE_uk and council led local health protection teams who have been brought into test and trace late in the day

A tale of English exceptionalism - or how not to manage a pandemic like C-19 Lockdown later than other countries thereby resulting in many avoidable deaths (ref Edmund and Ferguson among others)

questions about today's easing of the lockdown announced by the PM @KateAlvanley @jimmcmanusph @Jeanelleuk @GregClarkMP @Jeremy_Hunt test and trace is still in development. When will it be ready to provide the protection we need to avoid a resurgence of C-19? when will every LA have a local outbreak plan and enough staff to do contact tracing?

The govt's approach to test, trace and isolate has been tactical and focused on specific commitments like 100K tests, 18K contact tracers and an NHS app (1) a coherent strategy on test, trace and isolate is urgently needed showing how testing will work at scale and the results used to trace contacts and support people who isolate (2)

Community testing, tracking and contact tracing of C-19 is a key part of the government's strategy as plans are made to relax the lockdown 1/11 Community testing requires sufficient capacity to test in convenient locations and to turnaround the results quickly - this currently does not exist and the whole testing programme to date has been beset by problems @NHSProviders 2/11