Pyser Testing

NHS

NHS Told to Differentiate Between Patients in Hospital “For Covid” and Those in Hospital “With Covid” – and Not Before Time

After almost 15 months of various forms of lockdown, hospitals have finally been told to change the way they collect data on patients who test positive for Covid. They have been instructed to differentiate between those who are actually sick with Covid symptoms and those who test positive but are actually ill with something else. The Independent has the story.

NHS England has instructed hospitals to make the change to the daily flow of data sent by NHS trusts and told the Independent that the move was being done to help analyse the effect of the vaccine programme and whether it was successfully reducing Covid sickness…

One NHS source said the new data would be “more realistic” as not all patients were sick with the virus, adding: “But it will make figures look better as there have always been some, for example stroke [patients], who also had Covid as an incidental finding.”

In a letter to hospital bosses on June 7th, shared with the Independent, NHS England’s Covid Incident Director, Professor Keith Willett, said that from now on NHS England wanted “a breakdown of the current stock of Covid patients into those who are in hospital with acute Covid symptoms (and for whom Covid is the primary reason for being in hospital); and those who are primarily in hospital for a reason other than Covid (but for whom the hospital is having to manage and treat the Covid symptoms alongside their primary condition)”.

He added: “In lay terms, this could be considered as a binary split between those in hospital ‘for Covid’ and those in hospital ‘with Covid’. We are asking for this binary split for those patients newly admitted to hospital and those newly diagnosed with Covid while in hospital.”…

NHS England data on hospital admissions is published daily at a regional level and several days later on the Government’s dashboard. An internal daily dashboard of Covid data tracks infections across hospitals but is not made public.

Professor Ian Douglas from the London School of Hygiene and Tropical Medicine said: “I think there are good arguments for presenting these data separately – people in hospital ‘with’ vs ‘for’ Covid, as it does partly address the burden to health services due to the virus. Not completely though, because people in hospital with Covid will presumably also need to be treated differently to avoid further spread, which places some extra burden on the hospitals.

“I’ve got no idea what the split is like at the moment, and importantly we won’t know retrospectively what the trend is. Following on from that, there are only a few days before any announcement about June 21st, which may not give us long enough to be sure about what direction the ‘for Covid’ numbers are going.”

This change resembles the recent shift in the definition of a “case” by the CDC in America, where an infection in a vaccinated person is now only a “case” when the person is hospitalised or dies, whereas with the unvaccinated any positive PCR test still counts as a “case”, no matter how mild or asymptomatic.

Now, I’m all in favour of a more restrictive and conventional definition of case that gives a more realistic picture of the impact of the disease. But one can’t help suspect it’s more about politics than science when the kind of change many of us have been calling for since the start only comes once it helps to create the impression that the vaccines are working.

The Independent report is worth reading in full.

England’s NHS Waiting List Hits Five Million for the First Time

In striving to “protect the NHS”, we have instead placed it under record levels of pressure. The number of people waiting to start hospital treatment in England alone continues to rise and has passed five million for the first time. The number waiting for more than a year remains significantly higher than before Covid – and lockdowns – began. The number of people who actually require treatment will be higher still since many are expected to be living with undiagnosed diseases, such as breast cancer, having been reluctant to burden the health service with check-ups during the pandemic. The Guardian has more.

NHS England’s latest set of monthly performance figures, published on Thursday, show that the waiting list stood at 5,122,017 in April – up 171,720 in a month.

The total has risen from the 4.95 million who were on it in March, which was itself almost 252,000 up on the 4.698 million recorded in February – a month-on-month rise of 5.4%.

The number of people being forced to wait at least a year for treatment in hospital, especially surgery, has fallen for the first time in over a year but remains a serious problem. Thursday’s figures also show that 385,490 people have now been waiting more than 52 weeks, 50,637 down on the 436,127 who were in that position last month.

Such long waits are a new phenomenon. In contrast, in March last year – before Covid triggered a suspension of much NHS care – just 3,097 patients had faced such an unusually long delay.

Ministers, NHS chiefs, medical groups and health charities are worried that growing numbers of patients are facing lengthening waits for vital care including cancer treatment, a hip or knee replacement, heart operations and surgery to remove cataracts to improve eyesight.

Worth reading in full.

Stop Press: Professor Karol Sikora, on Lucy Johnston’s “Sketch notes on a pandemic” podcast, says: “I’ve been working in oncology for nearly 50 years and I’ve never seen a crisis like this before.”

“It’s like We’re Constantly in Crisis”: GPs Face Millions of Appointments Due to Lockdown Backlog

More than 28 million people booked appointments with their GP in March making it one of the busiest months ever, and practices expect to remain this busy for many months to come due to the patient backlog caused by lockdowns. The MailOnline has the story.

The figure was five million more than in February – a sudden spike of 20%.

And doctors say they no longer see highs and lows in patient flows throughout the year, and that instead it is like they’re constantly in crisis.

Dr Dean Eggitt, a GP in Doncaster in South Yorkshire, told the broadcaster: “The ability to catch up has gone. That was before Covid. Then Covid hit and then it’s just peak, peak, peak, peak all the time.”

During the height of the coronavirus pandemic people avoided the NHS – having been advised to except in emergencies during the first wave – and officials fear that many have developed serious illnesses like cancers and not been checked.

The number of people dying at home surged to above average levels while non-Covid hospital deaths were less common, suggesting people were missing out on end-of-life medical care.

A&E visits plummeted while the virus was circulating but they have surged again recently with the “worried well” returning to hospital emergency departments.

Dr Eggitt told the BBC: “We have almost a tsunami of patients coming to us. It feels like the river has flooded the banks.

“I see no end of it stopping. It just keeps coming and coming and coming in this one massive endless wave of patients.”

A Health Foundation analysis of NHS data found that there were around 31 million fewer GP practice appointments between April 2020 and March 2021 than in the previous year – 279 million compared to 310 million.

This was likely not a result of fewer people being ill but of fewer visiting their family doctor, meaning millions may have gone without care they usually would have had.

As a result, the patients now turning up to appointments are sicker than they would have been if they had seen a doctor six months ago.

Worth reading in full.

NHS Dental Patients Are Being Forced to Wait for up to Three Years for an Appointment

NHS dental surgery waiting lists have gotten so long that patients are being forced to wait until 2024 for an appointment, according to a new report. Waiting lists were long before 2020, and have only been made worse by lockdowns. Some people, unable to wait in pain, have gone into debt to meet private dentistry bills, while others have turned to pulling their teeth out themselves and performing “DIY fillings”. The Mail has the story.

A number of surgeries have thousands on their waiting lists and others have closed their books to new patients.

But some of the same practices will offer an appointment within a week to those who can afford to pay privately, according to research by Healthwatch England.

It found that one in three patients have felt pressured into paying for private care because of unbearable pain. Others say they have been driven into debt to meet dentistry bills.

Those who are unable to go private can be left waiting for up to three years to be seen, the report finds. Even emergency care entails waits of up to six weeks.

The delays can lead to “worsening of their dental problems and losing their teeth”, the report says. Healthwatch England claims public opinion of NHS dentistry has never been lower and highlights a “twin crisis” of lack of access and affordability. 

The number of dental surgeries offering NHS treatment fell from 9,661 in 2014/15 to 8,408 in 2019/20. The British Dental Association said dentistry was the only part of the NHS operating on a lower budget than a decade ago.

Spokesman Shawn Charlwood said: “For too long meaningful reform of NHS dentistry has been repeatedly kicked down the road. Covid has pushed a system already in crisis to breaking point, with millions left with no options.”

The Healthwatch England report highlights the case of a patient who needed hospital treatment after they overdosed on the painkillers they were taking to ease their dental problems.

Others have been told to use DIY filling kits or have been prescribed antibiotics with no prospect of a follow-up appointment to treat the underlying problem.

Some who called NHS 111 seeking emergency care were told to “use salt water” and carry on calling dental practices until they could find help. Waiting times just to get through to a surgery can be over an hour…

Four in five of those who contacted the organisation in the first three months of the year said they had struggled to access care quickly enough. And the number of complaints it received about dentistry was up 22% on last year.

Worth reading in full.

23% Of British Health Workers Wary of Covid Vaccine, According to New Research

New research, which has not yet been peer reviewed, suggests that almost a quarter of British healthcare workers are hesitant about taking a Covid vaccine. Key reasons include concern about the speed of vaccine development, presuming Covid immunity because of previous infection and a lack of trust in the Government. As expected, ethnicity was also a major factor. The Guardian has the story.

Up to a quarter of British healthcare workers have expressed hesitancy towards Covid vaccines, the first comprehensive study of NHS and care staff suggests. Conspiracy beliefs, a paucity of black and ethnic minority participants in vaccine trials, or assuming immunity to Covid because of previous infection were some of the key reasons cited.

“Understanding these drivers is important, because without this understanding you can’t implement any interventions,” said Dr Manish Pareek, Associate Clinical Professor in Infectious Diseases at the University of Leicester who led the study.

Pareek and his colleagues previously identified lower rates of vaccine uptake among black and south Asian health staff, workers under 30, and those living in more deprived areas. To better understand the reasons for this hesitancy, they recruited 11,584 clinical and non-clinical staff working for the NHS and other health providers, such as dental practices and pharmacies. As well as completing detailed questionnaires about their attitudes to Covid vaccination, some of the participants were interviewed more extensively to better understand their concerns.

The research… found that 23% of health staff, were hesitant about Covid vaccines, and that hesitancy was more common among BAME health workers, particularly those from black Caribbean groups. However, some white healthcare workers were also hesitant, particularly those in white other ethnic groups. Younger staff, pregnant women and those who had not taken up the flu vaccine were also more hesitant – as were those who had previously tested positive for Covid…

Other leading reasons for hesitancy included concerns about how safe the vaccine was due to the speed of development and – particularly for black African and Caribbean health workers – the lack of ethnic diversity in vaccine studies. Experiences of discrimination and structural inequalities also contributed to hesitancy among these groups.

New NHS data shows that almost a fifth of staff at older care homes in England have still not had a first dose of a Covid vaccine. The Government is currently conducting a consultation on whether to make Covid vaccination a “condition of deployment” for care home staff.

The Guardian’s report is worth reading in full.

Royal College of GPs Opposed to Mandatory Vaccination

Forcing health and social care staff to take a Covid vaccine would lead to “resentment and mistrust”, says the Royal College of General Practitioners (RCGP), which boasts a membership of over 50,000 British GPs. The group “strongly urges” that all professionals (and members of the public) have a vaccine when offered, but says that making vaccination mandatory would be a step too far. Professor Martin Marshall, Chair of the RCGP, is quoted on GP Online:

While overall take-up [of the vaccine] is high, among groups where it is not, this needs to be identified, understood and addressed.

We would strongly urge all health and care professionals to have the Covid vaccine, unless there is a medical reason why they shouldn’t, and the vast majority have. Healthcare professionals are at high risk of contracting Covid and getting vaccinated will help protect themselves, their colleagues and their patients.

However, we don’t agree with making Covid vaccination mandatory as informed and educated choice about health interventions would be more beneficial long-term than enforcing them, which risks leading to resentment and mistrust.

The Covid vaccine is our most important tool in protecting people from the virus, and helping to get life back to normal. All vaccines that we’re currently using in the U.K. have undergone rigorous testing to ensure they are safe and effective – as such, we’d urge anyone who is offered a jab to have one.

GP Online has more on the current position of Britain’s vaccine rollout among healthcare professionals.

Polling by the BMA shows that the vast majority of GPs have now been vaccinated – 93% of GP partners, 86% of salaried GPs and 84% of locums have now received both doses of Covid vaccine.

However, increased vaccine hesitancy among some healthcare workers has been reported, and not only among staff working in care homes. In care homes, the Government says that just 53% of care homes for older adults currently meet the required level of vaccination coverage among staff and residents to protect against Covid outbreaks.

Earlier this month, the Royal College of Nursing, which has a membership of 450,000 registered nurses, also came out against mandatory Covid vaccination for health and social care staff, saying it would be wrong for staff to be “coerced” into having the vaccine. Professor Karol Sikora, former Chief of the Cancer Programme of the World Health Organisation, has also suggested that we stop focusing all of our attention on vaccine passports, mass testing and other “grand schemes” (of which mandatory vaccination is certainly one) and instead target our sights on the health-related issues which have been left behind during the Covid era.

The GP Online report is worth reading in full.

NHS England Tells GPs Not to Give Pregnant Women AstraZeneca Covid Vaccine

GPs at sites that are only administering the AstraZeneca Covid vaccine have been told to cancel all appointments for pregnant women. This is in contrast to the advice issued by the Government last week, which was that pregnant women should be offered a Covid vaccine regardless of what stage they were at in their pregnancy. While the Joint Committee on Vaccination and Immunisation (JCVI) said that it would be “preferable” for pregnant women to be “offered” the Pfizer or Moderna vaccines “where available” due to there being more real-world data on these vaccines, it said the AstraZeneca vaccine should still be administered where an alternative was not available. This is in spite of the fact that the JCVI also said “more research is needed” on this vaccine because pregnant women were not included in the trials. NHS England has taken a more cautious approach, telling GPs to direct pregnant women to sites where alternative vaccines are available. MailOnline has the story.

A letter sent by NHS England bosses to practices on Saturday specified sites that do not have Pfizer or Moderna vaccines in stock should cancel all scheduled first doses for expectant mothers. 

It takes a more cautious stance than Number 10’s vaccine advisory panel, which says pregnant women should be offered jabs at the same time as their peers.

The JCVI originally said mothers-to-be should hold off on getting jabbed until there was more evidence. But it performed a U-turn last week after data from the U.S. showed they were safe.

It advised pregnant women should be offered Pfizer or Moderna vaccines in the first instance – but did not ban expectant mothers from getting AstraZeneca’s jab…

But the NHS England letter to practices the following day instructed all practices to direct pregnant women to primary care network sites, if they were unable to offer Pfizer or Moderna vaccines.

It said all “sites should implement screening procedures to ensure pregnant women are identified and offered the Pfizer or Moderna vaccine”. 

The letter added pregnant women who have already had a first dose of AstraZeneca should continue with their second dose as planned, in line with guidance for the rest of the population. 

NHS England told MailOnline that patients who have their AstraZeneca appointment cancelled would be rebooked instantly for an alternative.

A spokesperson insisted the cancellation policy would not result in pregnant women receiving their first dose later…

The Royal College of Obstetricians and Gynaecologists says pregnant women are no more likely to catch Covid than others, and that most have no symptoms or suffer mild cold or flu-like warning signs.

But there are a small number who can become unwell with the virus, and may be at increased risk of becoming severely ill compared to other women.

Worth reading in full.

Almost 15% Of English Health Service Workers Remain Unvaccinated

Reports are emerging that many health service workers in England are refusing the vaccine, as the numbers coming forward to receive a Covid jab have fallen significantly over the past couple of weeks. But despite (or, perhaps, because of) an ongoing Government consultation into making Covid vaccinations mandatory for care staff (which would likely extend into other health-related fields), opposition to coercing staff in this manner appears to be growing. The Guardian has the story.

Nearly 15% of health service workers in England remain unvaccinated, and the numbers coming forward for a jab have decreased sharply in the last two weeks, NHS figures have revealed, prompting concerns that many frontline staff are refusing the vaccine.

But health leaders, patients’ groups and unions have been quick to dismiss any suggestion of mandatory vaccinations after it emerged that Matt Hancock, the Health Secretary, had embarked on a plan before the pandemic to make flu vaccinations compulsory for NHS staff.

The latest figures show that only 6,259 NHS staff in England had their first dose in the seven days before April 11th, down from 11,483 the previous week and substantially lower than the average of 22,985 per week during March. Now 190,697 workers out of 1,378,502 directly employed by the NHS remain unprotected against the coronavirus, four months after they became eligible for vaccination. The figures do not include agency workers, and will include some under-45s who are not frontline staff and are still waiting their turn.

Some NHS trusts would like to introduce mandatory vaccination because they believe efforts to persuade remaining staff are a distraction from other important tasks such as tackling the enormous waiting lists that have grown during the lockdowns.

Lesley Watts, the Chief Executive of Chelsea and Westminster Hospital Foundation Trust, wrote to other NHS trusts with a draft letter to staff saying Covid vaccination would be mandatory. After the letter was leaked, Watts said there was “no intention to mandate vaccination of our staff”, but did not explain why the letter was written or distributed.

Hancock was a strident critic of anti-vaxxer movements before the pandemic, and told a fringe meeting at the Conservative party conference in 2019 that he favoured making vaccinations compulsory for all childhood diseases. He then asked civil servants at the Department of Health and Social Care to work out how to make flu vaccines mandatory for NHS staff. The DHSC did not say if the proposal was still being considered.

In perhaps the biggest intervention on the question of mandatory vaccination for health service workers yet, the Royal College of Nursing (RCN) – which has a membership of 450,000 registered nurses – said in a statement released on Friday that health and social care staff should not be “coerced” into having a Covid vaccine.

Like the wider population, health and care staff are a diverse group and there are both physical and societal barriers for some on the take up for the vaccine. 

The RCN do not support staff being made or coerced into having the vaccine. Staff vaccination should not be used as part of staff contracts, it should not be a condition of employment or part of employment contracts, linked to terms and conditions of employment or to pay.

The RCN do not believe that this approach is effective in improving uptake of vaccination in staff. The RCN recommend that all organisations have a proactive approach and make sure their staff have easy access to the vaccine within the working day. Staff should also have access to support with the right information, encouragement and clear explanation of the benefit and value of the vaccine. These measures will help to achieve a high vaccine uptake.

The Guardian’s report is worth reading in full.

Matt Hancock Owns Shares in NHS Contract Firm

hancock.jpg

The Government has been accused of “cronyism” after it emerged that the Health Secretary owns shares in an NHS contract-winning firm which his sister is also connected to. BBC News has the story.

Health Secretary Matt Hancock owns shares in a company which was approved as a potential supplier for NHS trusts in England…

In March, [Matt Hancock] declared he had acquired more than 15% of Topwood Ltd, which was granted the approved status in 2019.

The firm, which specialises in the secure storage, shredding and scanning of documents, also won £300,000 of business from NHS Wales this year.

A Government spokesman said there had been no conflict of interest. …

Mr Hancock declared in the MPs’ register of interests that he had acquired more than 15% of the shares in Topwood, under a “delegated management arrangement”.

Public contract records show that the NHS in England awarded the company a place in its Shared Business Services framework as a potential supplier for local trusts in 2019, the year after Mr Hancock became Health Secretary.

The MPs’ register did not mention that his sister Emily Gilruth – involved in the firm since its foundation in 2002 – owns a larger portion of the shares and is a director, or that Topwood has links to the NHS – as first reported by the Guido Fawkes blog and Health Service Journal (HSJ).

People in England Waiting to Start Hospital Treatment Hits Record High

The number of people waiting to receive hospital treatment continues to rise, with 4.7 million people stuck on a waiting list by the end of February in England. This is the highest number since 2007, highlighting the impact of a year in which the NHS focused on Covid patients at the expense of many others. BBC News has the story.

Around 4.7 million people were waiting for routine operations and procedures in England in February – the most since 2007, NHS England figures show.

Nearly 388,000 people were waiting more than a year for non-urgent surgery compared with just 1,600 before the pandemic began.

During January and February, the pressure on hospitals caused by Covid was particularly acute.

NHS England said two million operations took place despite the winter peak.

However surgeons said hospitals were still under huge pressure due to the second wave of Covid, which had led to “a year of uncertainty, pain and isolation” for patients waiting for planned treatment.

Tim Mitchell, Vice-President of the Royal College of Surgeons of England, has asked how much longer those whose treatments have been delayed can be expected to wait.

Although the most urgent operations for cancer and life-threatening conditions went ahead, hundreds of thousands of patients waiting for routine surgery such as hip and knee operations, cochlear implants and vascular operations had their treatment cancelled or postponed.

People have been patient as they’ve seen the battering the pandemic has given the NHS, but how much longer can they be expected to wait?

This news again highlights the importance of Professor Karol Sikora’s oft-repeated, yet consistently ignored proposal for a Government press conference to be held which is entirely dedicated to non-Covid related illnesses.

Worth reading in full.