There is significant unmet health need and worsening mental health among the four million people who were identified as being ‘clinically extremely vulnerable’ and asked to shield during the pandemic.

The new research by the Health Foundation’s Networked Data Lab (NDL) reveals the extent to which the pandemic has had a devastating and lasting impact on this this group and is calling for these patients to be prioritised by the NHS to ensure that that their conditions do not deteriorate further. 

The analysis shows that clinically extremely vulnerable people experienced a higher rate of deaths compared to the general population over the pandemic. At the peak of the first wave (2 April 2020), the rate of deaths among the clinically vulnerable population was over two and half times that in the general population (1 in 2,500 or 0.039% compared to 1 in 7,000 or 0.014%). 

Furthermore, by the end of August 2020, the clinically extremely vulnerable population accounted for 19% of all deaths while only making up 4% of the total population in England. 

However, as well as the direct impact of Covid-19, in terms of high rates of infections and deaths, clinically extremely vulnerable people have also been profoundly impacted by the major reorganisation of NHS services in the early stages of the pandemic.

This was done to create capacity in order to care for Covid-19 patients and reduce infection risk in hospitals. However, as a result, planned admissions for this group decreased by 51% while outpatient appointments decreased by 48%. And although there was no intentional reorganisation of emergency care, emergency admissions for clinically extremely vulnerable people decreased by 32% from April 2019 to April 2020, while A&E attendances decreased by 42%. 

Worsening mental health in shielding group 

The research also reveals that the clinically extremely vulnerable population may have significant unmet mental health needs, having experienced worsening mental health during the pandemic.

Kathryn Marszalek, Senior Analytical Manager at the Health Foundation, said: "Those who are clinically extremely vulnerable are, by definition, a high-risk group and the government took rapid steps to ensure that they would be protected during the pandemic. Despite this, they have seen worse rates of infection and death from Covid-19 and, having greater health care needs, have been particularly impacted by changes to NHS services during the pandemic. 

"However, the negative impact goes beyond the harm to their physical health. Over a period of 10 months, those advised to isolate at home have been unable to take part in usual activities, such as shopping for food, exercising, or seeing friends and family. Our research reveals the toll this has taken on the mental wellbeing of many clinically extremely vulnerable people who were already more likely to suffer from mental health conditions than the general population."

She added that action is now needed by those planning the recovery at local and national levels to address the unmet need for NHS care and worsening mental health. Failure to prioritise the needs of the clinically extremely vulnerable population will inevitably result in further deterioration in their health, putting additional pressure on the NHS which is already struggling to deal with a massive backlog of care.