Data Journalism, Journalism

NHS Staff at breaking point, beds running out, backlogs, delays, and Brexit.

What does the future hold for the NHS?

Urgent and emergency care situation reports show how the NHS almost ran out of critical care beds during the second wave of the pandemic. Hospitals in London reached 95% of their capacity by January 2021, closely followed by the South East and the East of England.

The situation was perilously close to being an unmitigated disaster as the second national lockdown began across the UK. Yet many of the pressures faced by the NHS were predicted in advance.

Five Coronavirus spikes piercing the NHS

In early 2020, a study by the Health Foundation predicted five distinct areas of impact linked to the pandemic.

Severe illness & Death

The authors considered how the direct impact of Covid-19, measured in terms of severe illness, hospitalisations, and deaths, would almost break the NHS. The latest data back up their grim forecast.

Dr Alex Stockdale, NIHR Academic Clinical Lecturer in Clinical Infection, Microbiology & Immunology at the University of Liverpool, who worked on Covid wards during the first wave, said:

“Everybody was really afraid. Non-infection specialists particularly, because they hadn’t really dealt with infectious diseases. All of us had quite profound insomnia, lying awake at night worrying ‘is it going to be me next’?”

Existing socioeconomic inequalities were also exacerbated by the pandemic, with black and minority ethnic communities disproportionately affected

Acute system shake up

Acute care was also expected to suffer from decreased capacity, caused by the massive surge in demand of Covid-19. This transpired as thousands of people were discharged to free up beds for Covid patients, staff were redeployed en masse, enormous numbers of operations were cancelled, and GP appointments increasingly took place remotely.

Non-covid related hospitalisations fell dramatically during the first lockdown, with accident and emergency admissions dropping by 31.4% overall compared to 2019, according to a recent data release by NHS Digital. Around 45% fewer Children aged 0-4, and 21-27% fewer young adults aged 18-25 were admitted to hospitals than the previous year.

Non-acute care and GP clinics

Non-urgent, routine healthcare normally dealt with by GPs was also dramatically impacted by the pandemic. Cancer Research repeatedly raised concerns about the relative lack of early cancer diagnoses, which is likely to lead to adverse outcomes.

Dr Stockdale echoed their concerns: 

“What we’re seeing now is lots of late diagnoses of cancer. That’s going to be the biggest shadow: Cancer related death over the next 24 months.”  

Cancer surgery has also dropped since the first lockdown, meaning that many urgent referrals received alternative treatments like radiotherapy.

Remote GP appointments increased significantly during the pandemic. According to NHS data, between May and July 2020 almost 50% of all appointments were conducted by telephone, exceeding the number of face to face appointments. Previously, from October 2019 until March 2020, in-person appointments accounted for 80% of the total.

A GP from Kent, who spoke on condition of anonymity, said: 

Remote appointments can actually take longer than seeing someone face to face, because…you can’t pick up…non-verbal cues and use your intuition.”

“There is…technology to ask patients to send images…for example of a rash. Sometimes this can be a real time saver, but other times…you have to [see them] face to face…to get a clear view.”

They also worried about elderly, deprived, and vulnerable patients “missing out on access because of digital exclusion.”

A report by Health Watch concurred that “many people [were] struggling to access care”, and found the lack of clear communication about changes to the appointments system “frustrating” and “confusing”.

Delays and failures


Research by the British Medical Journal showed a “record high of 4.46 million” patients were awaiting planned treatment in November 2020, and “2.3 million people” were still “waiting for surgical care” earlier this year.

Repurposed wards, operating theatres and outpatient clinics, staff redeployment, absence due to sickness or self-isolation, protective protocols slowing down hospital treatment, and “delays or failures in patient testing”, were all cited as possible contributing factors to increased waiting times.

A decimated & demoralised workforce 

A report by the Health Foundation examined how perennial staff shortages hampered the NHS’ pandemic response. Despite a recruitment drive there were over 80000 staff vacancies in June 2020. Almost 50% of these were nursing jobs, keeping the UK below the OECD average for nurses per capita.

Evidence also suggests that NHS staff have increased levels of anxiety, depression, stress, and PTSD. Female nurses and ethnic minority workers were particularly affected, with the latter having “50% greater risk” of “high PTSD symptoms”, and being significantly more worried about getting Covid-19 than their white counterparts.

The NHS Staff survey 2020 provided a parallel perspective. Overall, 44% of staff reported “feeling unwell” due to “work related stress” during the pandemic, an increase of 10% from 2019.

Post-pandemic recovery in the shadow of Brexit

A report by the Nuffield Trust outlined the complexity of Brexit for the NHS. From the prospect of investor-state dispute clauses in the controversial Trans-Pacific trade deal allowing private companies to challenge public health regulation, to rising medicine prices, changes in the mutual recognition of qualifications affecting NHS recruitment, UK immigration rules ensuring that social care applicants cannot pass minimum “salary or skills thresholds” for visas, foreign nurses finding it harder to accept jobs, data sharing disruption, and the burgeoning crisis in Northern Ireland, the future looks fraught with problems.

Alongside issues related to Brexit, the NHS is on the verge of integrated care systems reshaping the current model of healthcare. New partnerships between NHS providers and local government are set to be fully operational by April 2022. The proposed changes have been met with scepticism.

What next for the NHS? 

Coronavirus shows no sign of disappearing in the near future. A “chronically underfunded” and understaffed NHS and social care system looks likely, at the very least, to have to maintain a delicate balance between:  

And much more besides. 

As the pandemic ebbs and flows these challenges represent the tip of an increasingly unfathomable iceberg. The question is whether the British government, healthcare providers, and key stakeholders can work together to steer the NHS Titanic through the tumultuous, storm-tossed waves threatening to sink the ship before any lifeboats can be released. 


Photo by Markus Spiske from Pexels

Data Journalism

Revealed: 80% of UK adults ready to trust a coronavirus vaccine

Why herd immunity could be achievable despite anti-vax attitudes

 

Source: Alexander Koch on Pixabay.com

Three recent studies suggest a substantial majority of UK adults are ready to be vaccinated against Covid-19, making herd immunity possible, and potentially banishing the coronavirus pandemic to the realm of bad memories and fever-dreams. If 79% of UK adults receive an effective vaccine, this would match or surpass the hypothetical threshold scientists expect a population typically needs in order to defeat a disease like Coronavirus.

Aneesh Thakur, assistant professor of vaccine design and delivery at the university of Copenhagen, though quick to caution against making generalisations, explained that the ‘R’ number has a crucial role to play in how much of the population needs to be vaccinated to ensure success:

Assuming that on average [the ‘R’ number] is 2.5-3, then around 70% of the population should be vaccinated to get herd immunity in order to prevent further spread within the population. We cannot generalise, but that is a theoretical estimation.” 

– Professor Aneesh Thakur, university of Copenhagen, September 2020.

It appears that a substantial proportion of the UK public is ready to put their trust in a vaccine, meaning that it would be possible to meet this theoretical threshold. Comparing data from surveys conducted by King’s College London, YouGov, and University College London, a clear pattern of positive attitudes to taking a coronavirus vaccine emerges. In contrast to widespread media coverage of anti-vax attitudes in the national press, most recently in response to the figures released by UCL, a significant majority of respondents signalled that they were ready to get vaccinated:

Survey results per study – KCL / YouGov / UCL:

UCL survey did not offer respondents a “don’t know” option

Chart: Miguel Roca | Sources (click to Getthedata): KCL / YouGov / UCL | Fri Sep 25 2020

UCL Covid-19 Social Attitudes Survey:

The largest and most recent dataset shown above is the landmark study conducted by University College London, sponsored by the Nuffield foundation, which has been tracking the psychological and social impact of the pandemic on a weekly basis since the original Coronavirus lockdown began. Their evidence overwhelmingly suggests that “on balance”, a significant majority of UK adults have a positive attitude to taking a Coronavirus vaccine. Nearly 80% of UCL survey respondents, taken from a sample of over 70000 people, said that they were very likely, moderately likely, or more likely than not to take a safe, effective vaccine against Covid-19:

“Positive/negative” = varying degrees of how likely/unlikely people thought they would be to take a vaccine.

Chart: Miguel Roca |Fri 25 Sep 2020 | Getthedata

Herd Immunity:

As confirmed cases of Coronavirus rise exponentially across the UK and parts of Europe, society must pin its hopes of stopping the pandemic on an effective vaccine. Estimates for a successful vaccination strategy which could lead to safe and effective herd immunity range from between 43% and 67% of the global population, meaning that an 80% vaccination rate should comfortably meet the required target to put the brakes on the pandemic.

Whilst the estimated “threshold” for herd immunity differs considerably between different diseases, and exists within a hypothetical range, if a sufficiently high proportion of the UK adult population were immunised against Covid-19, it should comfortably match the threshold for related diseases such as SARS1 and influenza:

Chart: Miguel Roca | Sources (click to Getthedata): Statista / IJRR / Harvard / Our World in Data | Wed Sep 23 2020

Although some scientists are cautiously optimistic about the possibility of a mass immunisation program, provided that the vaccines are highly effective against the virus, others remain sceptical and caution against making unsubstantiated predictions about vaccine-induced herd immunity to Covid-19. Dr Alexander Stockdale, NIHR Academic clinical lecturer in clinical infection, microbiology and immunology at the university of Liverpool, stressed the need to resist jumping to conclusions in the absence of real world data:

The level of herd immunity necessary for COVID-19 control is unknown given that we haven’t got a vaccine with evaluable data and these estimates rest on a number of assumptions yet to be validated. I don’t think we could say as such there is scientific consensus at all as these are predictive models not actual data. 

For example, the WHO has suggested a threshold of 50% disease risk reduction for approval of a candidate vaccine. There is a debate about whether disease reduction would translate to a reduction in transmission given that the type of immunity induced by vaccination may not be sterilising, i.e. it might reduce severe disease but not necessarily reduce transmission to the same degree. 

Answering a related question on how effective a vaccine would need to be in order to halt the pandemic if it were administered to 70-80% of the population, Dr Stockdale said:

In general terms vaccine coverage must be higher if efficacy is lower. I cannot provide an estimate as there are still many unknowns here – the proof is in the pudding and evaluation of this must wait for the approval of a vaccine and publication of the phase 3 trial data! There may be surprises along the way and we may be in for a bumpy ride.

For example, issues of fair vaccine allocation, differential efficacy in different populations, the potential effect of rare but serious side effects on population uptake, the role of anti-science and anti-vaccination influence over time. 

Dr Alexander Stockdale, university of Liverpool, September 2020.

As reported in the Financial Times, with 300 potential vaccine candidates in the pipeline – 9 of which have already proceeded to phase 3 clinical trials – the flood of data helping humanity make sense of its latest invisible pathological enemy continues rushing down our digital waterways at breakneck pace.

According to Devi Sridhar, professor and chair of global public health at Edinburgh university medical school, based on other diseases which have plagued humanity throughout history, vaccine-induced herd immunity combined with other measures presents our best realistic hope of controlling and/or eradicating Covid-19. By contrast, since so-called natural herd immunity has never been achieved for many of these deadly pathogens, pursuing this latter, highly controversial approach looks likely to be a dangerously ineffective strategy against the novel Coronavirus:

End Notes

1. This is assuming that the median herd immunity threshold for SARS, which based on these datasets is 65% (between 50-80%), is similar to SARS-Cov2.