Covid-19 update: 26 June

by Steve Brown

26 June 2020

The major relaxation of lockdown restrictions, which dominated this week’s headlines, has put an increased focus on the country’s test and trace system.

Prime minister Boris Johnson announced the further changes to lock down measures on Tuesday 23 June. Under the new rules, from 4 July, pubs, restaurants and hairdressers will be able to reopen and two households will be able to meet up in any setting, with social distancing measures in place. He also replaced the current two metre social distancing requirement with a ‘one metre plus’ rule.HFMA Covid-19

Niall Dickson, chief executive of the NHS Confederation, said the government was right to be cautious as the virus could return with a vengeance. ‘There are two things now that will make the difference between success and failure – common sense and Test and Trace.’

Labour has backed the easing of restrictions and leader Sir Keir Starmer (pictured) also underlined the importance of an effective tracing system as part of the package. But he added that there was a ‘big problem’ if two-thirds of those with Covid-19 are not being reached and asked to provide contact details.keir starmer p

Sir Keir’s figures drew on two sources. The Department of Health and Social Care’s new weekly report on the Test and Trace service showed that just over 10,000 people testing positive between 28 May and 10 June – 73% of those passed on to tracers – engaged with the service and identified contacts. However, the Office for 

The Office for National Statistics has suggested that there were an estimated 33,000 people in the community in England with Covid-19 at any given time between 31 May and 13 June.

Mr Johnson brushed the concerns aside pointing instead at the 87,000 contacts of those who had tested positive who had actually been reached and asked to isolate.

New figures from the Department, published on Thursday, showed that a further 6,923 people had their cases transferred to the contact tracing system between 11 June and 17 June. Of these 4,869 (70%) were reached and asked to provide details of contacts. Three-quarters of these (3,633) provided details for one or more recent close contacts and the rest said they had no recent close contacts.

To date, 74% of people with positive tests have been reached within 24 hours and 80% of identified contacts were reached within a further 24 hours – although week three performance was actually slightly worse than this. As a result of this, 30,286 people were identified as close contacts and 82% of these were subsequently reached and asked to self-isolate.

This means that 21,000 people have had their case transferred to the tracing service since the system began, with 15,225 reached (73%). Some 128,566 people were reported as close contacts and 113,925 (89%) of these were reached by the service.

The Confederation’s Mr Dickson said the third set of weekly figures continued to be a worry. ‘While there are more referrals, more than one in four people transferred to Test and Trace are still not being reached and this has not improved since the service was launched,’ he said.

While he acknowledged it was still early days for the new system, the easing of lockdown measures increased the risk of virus revival and of a second peak. ‘Only by effective social distancing and hygiene measures and a robust effective Test and Trace system can this be averted,’ he added.

Speed is key factor in both testing and tracing of patients and their contacts. And Commons health and social care committee chair Jeremy Hunt this week called for the prime minister to answer urgent questions about the number of Covid test results that are returned within 24 hours.

Questions were first raised three weeks ago. These included: whether there was an official target to return test results within 24 hours; whether this will be met by the end of June; and whether the government would publish to a daily update on progress towards the target?

Former health secretary Mr Hunt said he was concerned about the lack of reply.

Announcing a further increase in testing capacity, with the addition of new walk-through testing sites, the Department said that 8.5 million coronavirus tests had been carried out since the pandemic began. The majority of tests at regional testing centres and mobile testing units are returned within 24 hours, it said, with 90% returned within 48 hours.

Earlier in the week, Mr Dickson said the other implication of the reduced social distancing would be fewer restrictions in patient care settings, with at least some services able to run at higher rates of occupancy than had been envisaged. ‘But it will remain a very different and much less productive world with the need for separate areas, social distancing arrangements and personal protective equipment (PPE), including face coverings for staff and visitors,’ he said. ‘We are not back to normal and if we are to defeat this terrible disease, it will require eternal vigilance.’

NHS Providers has also been thinking ahead, warning of a ‘real risk of the health service being overwhelmed in a winter Covid-19 second surge’ if current extra capacity from the Nightingale hospitals and the independent sector is no longer available. Chief executive Chris Hopson said that the need to separate Covid and non-Covid areas had reduced capacity in some hospitals by up to 40%.

He also highlighted the need for increasing community services funding to match rising demand for rehabilitation when Covid patients were discharged from hospital. And rising demand for mental health service related to the pandemic would also need to be funded.

While the NHS focus has been firmly on acute providers during the initial phase of the pandemic, primary care has also transformed the way it works, moving effectively to a ‘digital front door’ model almost overnight.

But a new survey by the BMA has shown how primary care has also taken on a significant amount of overflowing secondary care work during the past months. More than half of 2,000+ GPs responding to the survey said they were now having to provide care that would normally be delivered in secondary care, including organising blood tests in the community. Four out of five GPs said they had been asked to carry out new investigations and manage ongoing care, which would also usually be done in hospitals.

The BMA’s General Practice Committee has set out five principles for change in general practice after the pandemic. Trust GPs to lead says this would include creating a framework that reduces the need for practices to re-input information from hospital colleagues’ correspondence onto their own systems. Investment would also be needed to maintain and expand the provision of remote consultations where this is clinically appropriate.

Meanwhile a BBC investigation found that nearly 150 local authorities had forecast a combined budget shortfall of at least £3.2bn for this year as a result of the pandemic. At least five English councils were warning that they may meet the criteria to issue a section 114 notice – issued when a council cannot achieve a balanced budget. The shortfalls are driven by loss of income and the increased costs of adult care and personal protective equipment for carers.

The pressures are despite an extra £3.2bn having already been given to English councils to help with coronavirus costs. The government is reported to be working on a ‘comprehensive plan’ for councils. However, while there is a need to address the short-term pressures facing local government, there are also increasing calls for the underfunding of social care to be addressed for the longer term. This point was underlined by HFMA director of policy and research Emma Knowles in a blog introducing the HFMA’s new discussion paper on The future NHS financial regime in England.

The Local Government Association said it was pleased the government had indicated it was working on a plan to address councils’ financial challenges this year and called for details to be brought forward as soon as possible.James Jamieson LGA p

Councillor James Jamieson (pictured), the association’s chair, said the plan would need to address three key elements. ‘The loss of business rates and council tax income combined in the past three months accounts for more than half of all income losses for councils over the same period,’ he said. ‘Any future package of funding measures from government will need to take this into account and provide a solution to cover councils for these losses.

‘The government must also meet all additional costs councils are incurring as a result of the pandemic and provide a guarantee that it will compensate them for all lost income from fees and charges and other sources.

The Office for National Statistics ended the week with an update to its analysis of the coronavirus related deaths by occupation. It reported that there were a total of 4,761 deaths involving Covid-19 in the working age population of England and Wales between 9 March and 25 May.

Men and women working in social care both had significantly raised rates of death involving Covid-19  at 50 per 100,000 men (97 deaths) and 19 per 100,000 women 171 deaths). Among health care profession as a whole – including doctors and nurses – only men had higher rates of death (30 per 100,000) when compared to the general population.

King’s Fund director of leadership and organisational development Suzie Bailey described the higher death rate among social care staff as a tragedy. ‘Hard-working care staff have been on the frontline in this crisis, but have been let down by government promises of support that have not been delivered. Lessons must be learnt. Social care must never again be treated as an afterthought to the NHS, but as an equal partner in an interdependent system.’