The Covid winter: can the NHS withstand the extra pressure?

Each year the UK faces an NHS winter crisis due to a rise in seasonal illnesses and a worsening of chronic health conditions. In addition, an ageing population and under funding means the service cannot always meet demand.

There were extra concerns last year, highlighted by the King’s Fund, because the NHS was headed into winter in unusually bad shape with no extra funding because of the timing of the election, high levels of flu, a staffing crisis linked to pensions, and the impact of Brexit.

This year we get to add a growing backlog of patients needing interventions and a potential second wave of Covid-19 into the mix.

A new report published yesterday by the Academy of Medical Sciences, ‘Preparing for a challenging winter 2020/21’, said that the UK needed to prepare for a peak in hospital admissions and deaths in January and February 2021 that could be similar to or worse than the first wave in spring 2020.

In a worst case scenario this could lead to 119,000 Covid-19-related hospital deaths between September 2020 and June 2021. This modelling figure does not include deaths from care homes or the community.

Professor Dame Anne Johnson, one of the advisory group of 37 experts who produced the report after a request by the Government’s Chief Scientific Advisor, said that every winter we see an increase in the number of people admitted to hospital and in the number of people dying in the UK.

She said it would be easy to feel hopeless and powerless, but the report shows that we can change things for the better. This can be done, but it must be done now.

Suggestions to reduce the risk of the health service being overwhelmed

The report highlights key things that could minimise coronavirus and flu transmission, especially in hospitals and care homes. These include:

• A public information campaign with advice tailored to individuals and communities at high risk.
• Ensuring that hospital and care facilities have Covid-19 and Covid-19-free zones to minimise transmission
• Increasing capacity of the test, trace and isolate programme to cope with the overlapping symptoms of Covid-19, flu and other winter infections
• Ensure there is adequate PPE
• A real-time surveillance system to monitor and manage a winter wave
• Ensure flu vaccinations are given to those at risk and key workers.

The report came the same week that the BMA called for a ‘credible plan’ and extra investment to deal with the NHS backlog of work that was postponed during the pandemic.

It said that patient safety is being severely compromised not just by the virus itself, but by the knock-on effects of an unprecedented disruption to NHS services.

The report estimates that there were up to 1.5 million fewer elective admissions than would usually be expected during those three months – and up to 2.6 million fewer outpatient attendances. During the same period, as many as 25,900 fewer patients started their first cancer treatments following a decision it was needed.

BMA Chair, Chaand Nagpaul, said: “This analysis adds to an already compelling body of evidence that the NHS has been left with an even larger mountain to climb,’ he added. ‘Even before Covid-19 struck, the service was underfunded, woefully understaffed, and with inadequate capacity – a lack brought even further into relief by the pandemic.”

Primary care and a second Covid wave

The Royal College of GPs, said it was sensible to look at potential worst case scenarios to ensure that the NHS is prepared to protect the most vulnerable patients and staff and so that procurement and supply of appropriate PPE was secured.

It produced its own report last week, General Practice in a Post-COVID World, that looked at how GPs would have to deal with a difficult legacy from the pandemic and the lingering physical and psychological health consequences.

It called on the four Governments of the UK to each produce a comprehensive plan to support GPs in managing the longer-term effects of Covid-19 in the community.

Professor Martin Marshall, Chair of the Royal College of GPs, said: “GPs and our teams have shown during this pandemic that we can be flexible and quickly change the way we do things in order to keep our patients safe, and play our part in tackling the virus. We will do what is necessary, in the best interests of patient care, but we need to know what the plans are and have the appropriate guidance and resources to swiftly respond to a second wave of the virus, mitigating its potential severity and helping to keep patients and their wider communities safe.”

The Royal College of GPs was also one of the medical organisations calling for a rapid forward-thinking review to reflect on our initial response to Covid-19 and to use what they have learnt to plan for the future.

This was to urgently prevent further loss of life and restore the economy as fully and as quickly as possible. It included involving existing regional and local structures, addressing the disproportionate burden on BAME individuals and communities, and ensuring ongoing international collaboration.

They said there was strong case for an immediate cross-party assessment of national preparedness, with the first results available no later than August, and that all its work should be completed by the end of October.

As Professor Stephen Holgate, a respiratory specialist from University Hospital Southampton NHS Foundation Trust, who chaired the Academy of Medical Science report, said: “With relatively low numbers of Covid-19 cases at the moment, this is a critical window of opportunity to help us prepare for the worst that winter can throw at us.”