Hospitals

NHS Boss Orders Hospitals to Scrap Remaining Covid Visiting Restrictions

NHS hospitals have once again been told to scrap any patient visiting restrictions introduced during the Covid pandemic. MailOnline has the story.

Amanda Pritchard, Chief Executive of NHS England, yesterday told trusts to allow visitors to boost patients’ “experience, mental health and recovery”.

In a letter sent to hospital bosses, she said all healthcare settings “should now begin transitioning back towards their own pre-pandemic (or better) policies on inpatient visiting”.

Ms Pritchard added the “default position” should be “no patient having to be alone unless through their choice”.

NHS guidelines were updated in March to allow patients to have two visitors for at least one hour per day and “ideally for longer”.

But nearly half of trusts maintained policies so strict they flaunted the guidance, the Mail on Sunday found.

Last month Queen Victoria Hospital in Sussex, Yeovil Hospital and St Bartholomew’s in London came under fire for stringent visitor limits. MPs claimed the restrictions were illegal.

Ms. Pritchard said the guidelines were the “absolute minimum standard”. 

The letter also announced the decision to “reclassify the incident from a Level 4 (National) to a Level 3 (Regional) Incident”. The level was last raised on December 12th as Omicron surged.

Worth reading in full.

Hospital and Care Home Visiting Restrictions Are “Cruel, Inhumane and Unnecessary”, Doctors Tell MPs

The Pandemic Response and Recovery All-Party Parliamentary Group met this week to hear about visiting restrictions still being imposed by many care homes and NHS Trusts. Co-chaired by Rt Hon Esther McVey MP and Graham Stringer MP, the Group listened to evidence about the devastating effects visiting restrictions in hospitals have on patients and their loved ones. MPs also heard how visiting restrictions in care homes, along with the continued use of rolling lockdowns and over interpretation of testing guidelines, is leading to isolation, neglect and abuse of the residents.

Leandra Ashton, who co-founded The People’s Care Watchdog, Dr. Ammar Waraich, a medical registrar in the West Midlands, Carol Munt, experienced Patient Partner and Advocate and Dr. Ali Haggett, community mental health and wellbeing specialist, told MPs of the obstacles still in place when trying to visit a loved one and the shocking impact on vulnerable hospital patients, care home residents and their families.

All the speakers voiced serious concerns that obstacles are still in place in some healthcare settings. Politicians heard harrowing accounts of the harmful effects of isolation and loss of social contact on physical and mental health, safeguarding problems with medication, dehydration, hygiene and lack of basic care and the failures to uphold existing legislation to protect those who lack capacity.

Leandra Ashton’s mother was arrested in November 2020 for taking her grandmother out of her care home a day before the second lockdown. Two years on, many residents are still being isolated from their loved ones. She told MPs:

The Covid Rules That Won’t Go Away

The legal rules may have gone in England, but many contexts don’t seem to have noticed. The Telegraph has compiled a list of the places stuck in a neverendemic where Covid rules are still in force.

Hospitals across the country are still banning loved ones from visiting patients, even though the official NHS guidance has told them to open up. More than one in eight hospital trusts in England are still refusing to allow any visitors, while many more have some form of restrictions in place. …

Households are still having to book a slot before visiting rubbish tips – a system that has led to an increase in fly-tipping. …

Holidaymakers are still having to wear masks at airports and on flights, even though the legal requirement no longer applies. Major airlines, including British Airways, Virgin Atlantic, easyJet, Norwegian, Jet2 and Tui have relaxed the rules. However, they still require passengers to wear masks if the destination country mandates that people wear face coverings indoors. This means a passenger flying to the USA, where there is still a federal mask mandate on aircraft, will have to cover their nose and mouth for the duration of the flight. Airlines are still encouraging passengers to wear masks, even though it is not required, and are urging them to pack masks in case the rules change. U.K. airports are also strongly advising holidaymakers to wear masks in terminal buildings, bus stations and railway platforms. …

The days when visitors could wander into a gallery or museum have not yet returned. During the pandemic, many introduced booking systems which required people to obtain tickets in advance, so that visitor numbers could be better managed. Some have not yet reversed the policy, even though social distancing is no longer a legal requirement. …

Theatres are also sticking with some coronavirus restrictions. The Old Vic says it would “strongly recommend and request that you wear a face mask at all times”. It also asks visitors who are exempt to download a “mask exemption” badge on their phone to display it to staff. Visitors are being offered mask exemption stickers, even though everyone is legally exempt from wearing masks. Everyone is also required to sanitise their hands before entering the building.

Hospitals Clogged With ‘Well’ Patients – 16% of Patients Are Fit to Be Discharged But Are Blocking Beds

NHS beds are being blocked by “well” patients, new figures show, with three quarters still on wards, adding to hospital pressures. The Telegraph has the story.

Of the 87,775 patients in ward beds as of April 5th, around one in seven (16%, 14,487) had Covid, the highest proportion since February 17th.

But separate figures published on Thursday by NHS England show 71% of patients deemed medically fit to leave remained stuck. 

Only 5,178 of the 17,968 deemed medically fit on April 3rd were discharged. 

In response to increasing pressures, one NHS boss has asked families to help discharge their loved ones from hospital even if they’re still testing positive. 

Dr. Derek Sandeman, Chief Medical Officer for Hampshire and Isle of Wight Integrated Care System (ICS), said staff sickness rates, rising Covid cases and “high numbers” of people needing treatment has created a “perfect storm” across the region.

If hospitals are ‘under pressure’, as was reported this week, then rather than telling sick people to stay away, promptly moving well people on would seem a good place to start.

Worth reading in full.

Doctors Warn Sacking the Unvaccinated Will Make NHS Staffing Crisis Worse

The Government has been warned by doctors and trade union leaders that the impending deadline for NHS staff to be vaccinated or lose their jobs will result in making the NHS staffing crisis worse. MailOnline has the story.

Trade union leaders have warned the Government that mandatory COVID-19 vaccines for NHS workers will make staff shortages worse.

Last month, MPs approved mandatory vaccinations for NHS and social care staff by April this year.

The Government decided that all NHS staff in England who have direct contact with patients must have their first dose of a Covid vaccine by February 3rd, so they can receive their second dose before the March 31st deadline. 

But the Trades Union Congress (TUC) has called for the policy to be delayed “with immediate effect” to avoid a shortage of key workers.

It comes after Steve James, a consultant anaesthetist at King’s College Hospital in London, who has worked in the ICU since early 2020 treating Covid patients, told Sajid Javid why he did not believe he should have to be vaccinated after being infected. 

Meanwhile, social care isolation rules have been relaxed following concerns over staff being off sick and problems discharging patients from hospital.

There are already fears of staff shortages as 39,142 NHS workers in hospital trusts in England were absent for COVID-19 reasons on January 2nd, NHS England data shows.

This was up a staggering 59% on the previous week and more than three times up from the start of December, when there were 12,508 workers absent. 

Hospitals in Lincolnshire declared a staffing emergency, while bosses at United Lincolnshire Hospitals warned that so many doctors and nurses were now absent from shifts that patient care was “compromised”.

It was announced earlier this week that hundreds of troops are being sent into London hospitals to fill in for NHS staff who are isolating because of Omicron.

But the TUC warned that the mandatory vaccination policy will worsen the staffing crisis, making it impossible for NHS trusts to maintain safe staffing levels in the coming weeks.

With over 90% of NHS staff double vaccinated while more than 60% have had a third dose, the mandate is unlikely to make a significant impact on transmission, particularly given how poorly the vaccines prevent infection with Omicron and how many NHS staff will already have been infected or exposed to the virus (surely all of them, exposed many times over). The rationale for such an illiberal and disruptive policy is therefore lacking. As Consultant Anaethetist Steve James told Sajid Javid yesterday: “The science isn’t strong enough.”

Sir David Nicholson, a former chief executive of NHS England who now chairs the Sandwell and West Birmingham Hospitals Trust, warned that his trust could lose hundreds of staff from the mandatory vaccination policy.

Hospital Appointments in Glasgow Being Cancelled to Reduce Road Traffic during COP26

Hundreds of patients in Glasgow are having face-to-face hospital appointments cancelled or rescheduled ahead of the 2021 United Nations Climate Change Conference (COP26) which begins next week in the hope that this will help to clear up the roads. The Herald has the story.

NHS Greater Glasgow and Clyde said it would be increasing the number of virtual consultations and moving some face-to-face consultations to different times of the day in order to accommodate a “temporary increase in population” in the city over the two-week climate summit.

Patients began receiving letters over the past week notifying them of changes to their appointments.

It comes amid warnings that the event itself could trigger a fresh spike in Covid cases, piling preassure on an already overstretched NHS.

Health cheifs at neighbouring NHS Lanarkshire – where the majority of non-urgent elective surgeries have been paused since August – have now escalated its risk status to ‘Black’ and confirmed that a number of cancer procedures will be postponed. These will be rescheduled “as soon as possible”, they said.

One Glasgow patient with long Covid symptoms, who is due to see several specialists, told the Herald their face-to-face appointments had been changed suddenly to telephone consultations after months of waiting. …

[They said] that it was ironic patients were being switched to phone and video appointments to free up roads for climate deligates flying into Scotland who “really should have held their meetings virtually”.

Worth reading in full.

To read more of the article without hitting a paywall, view the cover of today’s Herald here.

Air Filtration/UV Light Can Remove Airborne SARS-CoV-2 From Hospital Wards, Study Finds

In a study published earlier this year, Paul McKeigue and colleagues analysed data on all diagnosed cases of COVID-19 in Scotland, as well as a large number of matched controls. They found that a staggering 30% of severe cases (those that resulted in critical care admission or death) were linked to a recent hospital visit.

This suggests widespread nosocomial transmission of SARS-CoV-2. In other words, a lot of people caught their infections in hospital, and then became seriously ill.

The fact that such a large portion of severe cases were linked to a recent hospital visit is actually not so surprising. After all, people vulnerable to COVID-19 (the elderly and persons with underlying health conditions) are overrepresented among those who make frequent hospital visits.

Nonetheless, it’s rather concerning that hospitals – places where people are meant to come out healthier than they go in – were a major site of SARS-CoV-2 transmission.  

Given that COVID-19 patients, as well as those vulnerable to COVID-19, tend to be concentrated in hospitals, making efforts to reduce nosocomial transmission would seem like a top priority. Indeed, one would expect interventions that did reduce such transmission to have a large benefit/cost ratio.

Which makes a new preprint so interesting. Andrew Conway-Morris and colleagues investigated whether airborne SARS-CoV-2 could be removed from hospital wards using portable devices that filter and sterilise the air.

Their experiment involved two units within an English hospital: an ordinary Covid ward, and an ICU containing Covid patients. The presence of airborne SARS-CoV-2 was measured during three consecutive weeks: one in which the devices were turned off; one in which they were turned on; and one in which they were turned off again.

In addition to measuring the presence of SARS-CoV-2, the researchers measured the presence of various other microbial bioaerosols, such as E. coli and staphylococcus. Their results for the Covid ward are shown in the figure below.

When the devices were turned off, many microbial bioaerosols (including SARS-CoV-2) were detected. Yet when they were turned on, all of these except candida were undetectable. This means the devices were successful in removing not only SARS-CoV-2, but also other potentially dangerous pathogens.

As the authors note, SARS-CoV-2 was detected on “all five days before activation of air/UV filtration, but on none of the five days when the air/UV filter was operational”. The virus was again detected on “four out of five days when the filter was off”.

Interestingly, SARS-CoV-2 was barely detected in the ICU (regardless of whether the devices were turned on). This may be because viral shedding is lower among critically ill patients, or because ICU staff were wearing proper N95 masks.

It’s important to note: the study didn’t show that the devices actually prevent transmission of SARS-CoV-2 in hospitals. However, the results constitute strong circumstantial evidence that they would reduce transmission.

While attempting to halt transmission of SARS-CoV-2 in the community at large is costly at best and futile at worst, attempting to do so in high-risk hospital environments makes a great deal of sense. Further investigation into the efficacy of these devices is clearly warranted.  

The Dangerous Myth of Health Service ‘Collapse’

In the U.K. we are facing threats once again of restrictions and vaccine passports being imposed over winter should the prospect of an ‘overwhelmed’ NHS be sounded by the Government’s medical advisers in the coming weeks.

But how realistic is this threat of health service ‘collapse’? South Korea is currently providing an object lesson in how the concept appears to be very much in the eye of the beholder.

The South East Asian country has been experiencing a spike in reported infections in recent weeks as the Delta variant has become dominant, hitting over 3,000 in one day for the first time on September 24th.

English Hospitals Told They Can Drop Some Covid Measures to Help Reduce Backlog

In a move aimed at helping to cut down long and ever-growing treatment waiting lists, English hospitals have been told they can scrap some of the ‘anti-Covid’ measures they were forced to introduce during lockdown, including testing and isolating patients before planned operations. BBC News has the story.

The changes, recommended by the U.K. Health Security Agency (UKHSA), are aimed at easing pressure on the NHS.

It says testing and isolating patients before planned operations can be dropped and hospitals can return to normal cleaning procedures.

Social distancing can also be reduced from 2m to 1m in some areas.

More than five million people are waiting for NHS hospital treatment in England and hundreds of thousands have been waiting more than a year.

Although the Government has announced an extra £5.4 billion over the next six months to respond to the backlog caused by the pandemic, ministers have warned waiting lists could get worse before they get better, as more people come forward.

UKHSA Chief Executive Dr. Jenny Harries said the new recommendations would help local hospitals plan more elective care.

“This is a first step to help the NHS treat more patients more quickly, while ensuring their safety and balancing their different needs for care,” she said. …

Local hospitals will be left to decide when and how these changes are introduced.

Guidance on which measures can be relaxed in GP surgeries, dentists and for ambulance trusts are still being considered.

The recommendations were based on reviews of evidence and broad agreement from experts in infection prevention and control, the UKHSA said.

Worth reading in full.

NHS Cancer Patient Backlog Could Take Over a Decade to Clear

Almost every day brings more bad news on the cancer patient backlog in the NHS, caused in large part by the “stay at home, protect the NHS” drive. New research suggests that the waiting list could take more than a decade to clear, and backs up a study released earlier this week showing that thousands more will die along the way because of delayed treatment. The Telegraph has the story.

The analysis of NHS statistics by the Institute of Public Policy Research (IPPR) estimates that around 20,000 cancer diagnoses have been missed during the pandemic.

Waiting lists have reached a record high of 5.5 million, with fears they could reach 13 million, as patients come forward after struggling to access services, or from fear of being a burden on the NHS during the pandemic.

It comes amid growing concern about access to face-to-face appointments with GPs.

The Prime Minister said on Wednesday that patients were entitled to see their doctor in person, raising concerns that without the option, deadly symptoms could be missed. 

Before the pandemic, around 80% of consultations took place in a doctor’s surgery – but in July the figure was just 57%.

The new study by the IPPR and CF, a data analytics consultancy, says it could take until 2033 to clear the backlog – and come too late for many of those whose diagnosis was missed or delayed. 

Even this timetable would require a 5% increase in cancer care activity levels above pre-pandemic levels, it says.

However, boosting this to 15%, with a major expansion in diagnostics and staffing, could clear the backlog by next year, the analysis suggests. …

The research shows that in the year following the first lockdown, 369,000 fewer people than expected were referred to a specialist with suspected cancer. …

Concerns about the spread of Covid, and efforts to free hospitals for patients with the virus, resulted in a major reduction in access to diagnostic tests. …

The report said: “Behind these statistics are thousands of people for whom it will now be too late to cure their cancer.”

Worth reading in full.