Covid-19 update: 12 June

According to official statistics, there were more than 900,000 fewer attendances at A&E departments in May compared with the same month last year – a reduction of nearly 42%. Within these numbers, there was nearly a 33% fall in attendances at type 1 A&E departments. However, the attendance figures do represent an increase in the numbers reported for April this year.

The 398,400 emergency admissions in May were also down by 27% compared with a year ago. New statistics also show that referrals for routine care in April were down 70% compared with the previous year. Just 612,600 diagnostic tests (not including Covid-19 tests) were undertaken in April – a decrease of 1.3 million from April the previous year. And urgent cancer referrals were down 60%.

Nigel Edwards, chief executive of the Nuffield Trust, said the figures showed the lasting impact that the nationwide lockdown and the Covid-19 measures taken by the health service will have on patient care. ‘The understandable and extreme steps taken to keep the NHS afloat during the pandemic have meant hundreds of thousands not getting the care they need,’ he said. ‘This means as services begin to come back, the NHS will face a mountainous climb to get anywhere near on top of this pent-up demand.’

He added that the service would not be able to catch up by working in the way it used to. ‘Increased infection control measures, social distancing and practical constraints to protect staff and patients will mean we will see the waiting list grow over the autumn as the services struggles to get patients through the health system as quickly,’ he said. ‘Rationing at a level previously considered unpalatable is here to stay in the NHS.’

The NHS Confederation this week suggested that the current waiting list of four million people waiting for routine procedures could reach 10 million by the end of December. In a letter to prime minister Boris Johnson, the Confederation’s chief executive Niall Dickson (pictured) called for realism about what could be achieved safely in the coming months. He called on the government to help manage public expectations and for assurance on key operational issues such as the availability of timely supplies of personal protective equipment (PPE). And he added that the temporary financial arrangements should stay in place, with the reimbursement of providers’ reasonable excess costs continuing to be funded centrally for the rest of the financial year.

In a report – Getting the NHS back on track – the confederation said that the combination of responding to ongoing Covid-19 demands, restarting elective and other services and balancing budgets was likely to prove impossible. Additional funding would be needed or the government would need to indicate which pressures should be treated as a lower priority.

As well as obvious pressures in acute care, mental health services are braced for a significant surge in demand over the coming months and primary care networks say the level of funding needed will depend on the level of delivery expected. Current ‘gold standard’ Covid responses including strict use of hot and cold sites are labour intensive and require significant space across multiple sites. ‘It is simply not possible to retain this gold standard as well as increase consultations for non-Covid-19 patients and address backlogs,’ the report says.

Calling for the extension of block contracts to the whole financial year, the report also says that a debate is needed on whether to return to pre-existing funding frameworks or ‘if the Covid-19 experience has provided an opportunity for a move to system-wide funding models’.

Among a number of issues for the government to address, the report says that a robust test and trace system will be needed across the whole country, with clear understanding between local government and health and care services.

The Department of Health and Social Care provided its first report on the operation of the new NHS Test and Trace service. Between 28 May – when the service launched – and 3 June, the service identified nearly 32,000 contacts, of which 27,000 were reached and advised to self-isolate. This was based on 8,000 people testing positive for coronavirus, with two-thirds of these providing details of recent contacts.

Although some concerns were raised about the third of people for whom the service couldn’t get contacts, executive chair of NHS Test and Trace Dido Harding insisted the service had got off to a good start. ‘For the first week of a scale citizen service, this is good performance and clearly it can, and needs to, and will get better,’ she said. Health secretary Matt Hancock added that the first week’s results – both in terms of the tested people who had been contacted and the number of their contacts who had been advised to self-isolate – beat his expectations. And he said the test and trace app would be introduced ‘when it is right to do so’ once the human based service was embedded.

A successful Test and Trace system is a key component to the easing of lockdown measures, which continued this week with the announcement that all shops will be allowed to reopen from 15 June, alongside outdoor attractions such as zoos, safari parks and drive-in cinemas. Adults living alone or single parents with children under 18 will now also be allowed to form a ‘support bubble’ with one other household.

The prime minister announced these further relaxations after asserting that the five tests for adjusting lockdown continued to be met. Hospital admissions are now at around 440 a day compared with a peak of 3,431 at the beginning of April. And the seven-day rolling average in daily death rates is now down to 200, compared with a peak of 943.

Official DHSC figures putting Covid-related deaths now at over 40,000 – or 45,748 up to 29 May according to the latest Office for National Statistics figures. However former government adviser Neil Ferguson told the Science and Technology Committee this week that the death toll could have been half the current total if lockdown had been enforced in mid-March – just a week before lockdown was actually imposed.

The scrutiny of NHS discharge practices also continued this week with the National Audit Office reporting that it was not known how many of the 25,000 people discharged into care homes at the peak of the outbreak were infected with coronavirus (See Lack of integration a key factor in speed of Covid response, says NAO). The focus has been on the period between 17 March, when trusts were advised to urgently discharge all medically fit patients to increase acute capacity, and 15 April, when a policy was introduced to test all patients before being discharged to care homes.

NHS Providers has argued repeatedly in recent weeks that trusts were testing patients prior to discharge well before the formal requirements to test were introduced. In its Recent NHS discharges into care homes  briefing, published in mid May,  it recognises that ‘in the first few days after 17 March, small numbers of asymptomatic Covid-19 patients may have been discharged into care homes’ but that new discharge arrangements were in place within one or two days.

However, Nuffield Trust deputy director of policy Natasha Curry, responding to the NAO report, this week said it was clear preparations for the social care sector came too late in the day. ‘A full action plan for the sector did not materialise until mid- April – an entire month after the initial guidance and long after hospitals were already discharging patients back into care homes,’ she said.

A survey by the Association of Directors of Adult Social Services  found that nearly a quarter of social services directors thought that more than half of care home Covid-19 infections were attributable to rapid hospital discharge combined with a lack of personal protective equipment and testing. According to the association’s Coronavirus survey, nearly every director (96%) highlighted the need for additional funding to help manage the local response to the pandemic.