Cem Kemahli: Vaccination would be even more of a success were it not for problems with data

5 Apr

Cllr Cem Kemahli is the Lead Member for Adult Social Care and Public Health on Kensington and Chelsea Borough Council.

The UK vaccination drive has been a success. Over 30 million doses of vaccines which didn’t exist a year ago have now been administered. It is only through, sadly, seeing other nations struggling that we can understand the sheer logistical human endeavour which has gone into getting this right in the UK.

The vaccines provide a way to protect our most vulnerable and therefore help protect our economy and the livelihoods of our residents.  But they have also highlighted an issue in the way that the Office for National Statistics, the NHS and local GPs manage data and patient records.

As a local authority we have been caught between a data rock and a media hard place.

London, in general, sits below much of the rest of the country. This is a fact frequently reported by the national and local press, often highlighting particular boroughs without a firm understanding of the cause of the statistics.

We receive criticism in the papers for a rollout that we are merely supporting. “Low vaccine uptake in Kensington” reads better than “Low vaccine uptake in the West London Clinical Commissioning Group, encompassing Kensington and Chelsea as well as GPs in Westminster”.

The common media reasoning for lower take-up has been the ethnicity differences apparent on any London street – each bringing their own cultural quirks and often intrinsic hesitations of state-provided healthcare.  This issue is even more acute, given the propensity for Covid to impact these communities most virulently.

A fairer though somewhat less quantifiable or journalistically appealing reason is one of data management.

Our vaccination uptake is measured against out-of-date but best guess ONS population figures, as it is for every borough in London. The census will hopefully address these figures, although we in Central London have hesitations –  because our Capital is a transient city, our borough especially so, and this fact feeds through into the ONS data.

So, whilst our overall population might remain the same, the actual people accounting for these figures, and thus their NHS numbers, change frequently.

Lockdowns have provided some solace for GPs, in that everyone, bar a few exceptions, are where they say they are, and available at short notice to receive their jab.  That is, if they are in the country.

We know anecdotally that our borough has somewhat emptied out over the last year. We usually have 1.2 parking permits issued for every available space, and parking is always hard to come by.  But during the pandemic we have been able to accommodate over 4,000 key workers who wished to drive into the borough. These cars have had to go somewhere – and they have simply taken the spaces of those who have left.

The negative side of a transient population for GPs is that they have lists of patients that are constantly falling out of date. Usually, this is no problem: the data is cleansed often, and records updated as people move around or fall off their lists. GP practices work hard to manage their patient numbers and offer excellent services to our residents. But they can only work with those who engage with them, and update their information.

We are, along with our neighbouring borough of Westminster City Council, also home to an exceptionally high number of international residents, dual and indeed triple nationals who may not necessarily be eligible for NHS treatment.

In ordinary times, this is not a cause for concern: they are able to return home, go privately for treatment or use international insurance. But now we have a single point of access for vaccines this is bringing to light the inherent consequences of travel bans and access to healthcare.  Many of our residents simply aren’t eligible for the vaccine through the NHS.

This trifecta of residents out of town, residents not entitled to vaccination and residents who no longer reside here, but who remain on GPs’ lists, has caused the overall figures we see today. Whilst I have not seen the minutiae for other boroughs, I suspect this is true for most inner London authorities.

As a local authority, our role is not to carry out the vaccination drive, but it is to assist the NHS and local GPs in engaging with our harder to reach communities; the digitally excluded, non-English speaking and those not familiar with accessing healthcare have been our main target.

We have put on successful community pop-ups in faith settings, and reached out through digital and physical signage, as well as offering advice in a variety of languages to offer support to those willing, eligible, but not knowing how a vaccine can be obtained.

Thankfully, we see little anti-vax sentiment: far more pervasive is vaccine hesitancy. A wait and see approach which we can help to overcome with evidence-based sessions and information from trusted sources.

We have also been working with GPs by helping them to call their patients and take admin out of their hands, so that they can focus on vaccine delivery. Through this work, we have found profound issues with the NHS database. Deceased residents, residents already vaccinated, and residents who have left the borough years ago are all still showing as eligible for a vaccine. Each one pulls down the overall uptake – through either being a numerator which should be counted or as a denominator which should be excluded.

When you appreciate the inability to vaccinate the deceased, you start to understand the underlying problems with a vaccination drive that aims to reach 100 per cent of the adult population, but uses somewhat faulty databases on which to base success.

And a success it remains: we have reached well over 75 per cent of our residents over 70 years old, but when you factor in the dead, ineligible, abroad or already vaccinated we are more likely reaching 85 per cent. Much more in line with national figures. We have thankfully not had a single confirmed case in anyone over the age of 75 since the 11th March – a testament to a successful vaccination drive.

We have worked constructively with the NHS and local GPs so far, but the underlying issue remains one of data sharing. We have council tax lists of residents in the borough; we know where people live. GPs know who is registered with them, and the NHS knows who holds an NHS number. These three systems rarely need to work alongside one another but with contact tracing, self-isolation and now vaccination, knowing where a resident with an NHS number is residing is all the more important.

Our local council has stood up a team in our “hub” to ring residents, and we have had great success in reaching those that have been missed.  We are imploring the NHS to give us more people to ring, we have the resource funded by government to make these calls, but we need to feed the system with the information, and make sure we find everyone willing and able to be vaccinated.

The borough knows the figures are wrong. The GPs know they are wrong. And the NHS knows they are wrong. But without someone to clean the information or update the systems, we will struggle to lift ourselves off the comparative bottom.

I fear the overall national success will mean not enough focus is brought back on ours and other residents who are being missed due to data issues putting themselves and their families at risk.

Resham Kotecha: Integrated community care is already here: it’s called the pharmacy

21 Jan

Resham Kotecha is a strategy consultant. She contested Coventry North West in last year’s General Election. She currently serves as the Head of Engagement for Women2Win, and is a Policy Ambassador for the Conservative Policy Forum, reaching out to BAME communities.

The Government has ambitious plans to vaccinate everyone in the four highest priority groups by mid-February. This equates to 15 million people, and while 4.61 million UK citizens had received their initial jab by the end of Tuesday, two million jabs a week are needed to reach the target.

Currently, the target would mean the bulk of the burden would fall to GPs. While they have been working valiantly, staffing numbers and an already monumental workload means they are unlikely to be able to deliver two million vaccines a week without significant support.

Hospital pharmacies are already involved in administering the Pfizer and Oxford vaccines, and community pharmacies are being brought in to join the vaccination programme. There are more than 11,000 community pharmacies in England; 1,200 in Scotland; and 700 in Wales. Two hundred pharmaceutical sites will be administering the Oxford / AstraZeneca vaccine next week, with Boots, Superdrug and Lloyds committed to delivering over 1,000 vaccines a week.

Simon Dukes, Chief Executive of the Pharmaceutical Negotiating Services Committee, said pharmacies have the capability to vaccinate about 1.3 million Brits each week. With community pharmacies joining the fight to dispense vaccinations, the Government is looking more and more likely to be able to meet its target to vaccinate people in the four most “at-risk” categories. It is absolutely right that we utilise all the skilled people we can during times of crisis, but it would be remiss to ignore the value that community pharmacists could add to tackling health inequalities and providing healthcare beyond the Covid-19 vaccines and medicine dispensation.

Community pharmacies are already involved in flu and travel vaccinations and have the knowledge and capability to diagnose minor health issues and support the delivery of health care for patients. Every day, about 1.6 million people visit a pharmacy in England and 37 per cent of people visit their pharmacy monthly. 89 per cent of England’s population has access to a community pharmacy within a 20 minute walk, and over 99 per cent of those in areas of high deprivation and low health outcomes are within this 20 minute walk of a community pharmacy.

An NHS study (pre-Covid) found that the average waiting time for a GP appointment was 19 days, placing additional pressures on stretched GP surgeries and hospital A&E departments. Pharmacists would make a great second line of defence to relieve pressures on GPs – and less than 20 per cent of pharmacy teams surveyed believe pharmacy is being fully utilised.

By expanding the services that pharmacies can offer, and empowering pharmacists, we could leverage a currently under-utilised pharmacy service, and reduce the burden on overwhelmed GPs, A&E departments and other parts of the NHS. To meet the increasing demands of an ageing population with rising rates of obesity, we need our cohort of 45,000+ pharmacists to be empowered to work alongside our GPs and to be appropriately and adequately financially rewarded for the services they deliver through NHS contracts.

An obvious opportunity is an enhanced vaccine programme. It is possible that the Covid-19 vaccine might need to be offered to vulnerable people every winter, or at regular intervals. Community pharmacists should be recruited to deliver the Covid-19 vaccine alongside the regular flu vaccine.

In addition to the Covid-19 vaccine, we should commission the provision of the National Childhood Vaccination Programme from pharmacies. Currently, community pharmacists provide a number of private vaccinations, including chicken pox, MMR, meningitis and HPV, but not NHS vaccines. By commissioning community pharmacies to deliver the NHS vaccination programme, a significant amount of work would be taken from overloaded GPs and would support cash-strapped pharmacies.

Finally, the Government should enable pharmacists to populate the patient record. Currently, community pharmacists can view Summary Care Records, but are unable to populate or update them. Many patients are unaware that when they get emergency medication from their pharmacy, their GP will not be informed via updated records. This means that GPs are unable to see “real time” updates and it is often left to the patient to update their GP when records are not accurate.

By enabling pharmacists to update patient records, GPs would have access to up to date records at all times, including around emergency meds provision, travel vaccinations and supervised methadone compliance. By making a few simple policy changes, we can extend the provision of healthcare into communities, tackle healthcare inequalities, reduce some work from overstretched GPs and ensure we utilise the full capabilities of our talented community pharmacists.

We may be seeing the light at the end of the Covid tunnel, but let’s ensure we take every step possible to strengthen our healthcare and empower community pharmacists to support people in their communities.

Ryan Bourne: Ministers must speed up the pace of vaccination. Here are some ways of doing so.

6 Jan

Ryan Bourne is Chair in Public Understanding of Economics at the Cato Institute.

Back in May 2020, I wrote that a high-efficacy vaccine was the biggest economic stimulus available to us. Removing whatever barriers existed to its approval and rollout, so accelerating the end of the pandemic, was worth billions of pounds per week in GDP and hundreds of lives. Stock market reactions last year implied vaccines were potentially worth 5-15 per cent of global wealth. But it’s now clear there’s a need for even greater urgency in getting the UK vaccinated.

The disease outlook is grim. As of Sunday, the number of people hospitalised with Covid-19 in England was 32 percent higher than its April peak, with new daily admissions above those seen last Spring. In the South East, the number of Covid-19 patients in hospital is near double the 2020 peak. Chris Whitty explained yesterday how case curves are trending upwards in other regions. Given recent trends and mobility data less responsive so far than to lockdown one, things will get worse before they get better.

So a national lockdown was perhaps inevitable. To judge by Twitter, people were gearing up to revive their pro- and anti-lockdown talking points beforehand. But the armchair cost-benefit analysis from Spring 2020, or even November, is no longer valid. First, because we have vaccines already being rolled out that will, at the very least, mitigate against Covid’s worst effects. Second, because the new mutation appears more highly transmissible in the face of given suppression measures. Both realities strengthen the case for reducing interactions now. Both increase the urgency for rapid vaccination.

The benefits of measures that reduce transmission of the disease are more certain with vaccines available. Lockdown sceptics had a point when they said at least some “lives saved” from government mandates last year were deaths deferred until the next wave. Now, with only 20 million full vaccination courses required to inject demographic groups making up 97 per cent of cumulative deaths so far, avoiding infections today means avoiding Covid-19 deaths forever. That makes the case for breaking up social networks all the stronger, including through closing schools (evidence suggests children are seeding the virus into households).

The high transmissibility of the new strain supports this action. A more rapidly spreading virus increases the risk of “overshooting” ICU capacity. Such is the speed of spread (one in 50 people had the virus last week), each day of societal delay in reducing the transmission rate below one accelerates the crunch. So quickly are we becoming infected, herd immunity may even come this year. The choice before us is whether we achieve it through the route strewn with significant deaths and bad illnesses, or via a path where injections eliminate almost all severe cases.

It feels almost lame to say it—as if nobody ever thought of it—but both the public health and economic consequences suggest we must do everything possible to speed up the vaccination process. We are in a straight race between vaccinations and the virus, and I fear even Boris Johnson’s revised timetable is too slow.

In an ideal world, with plentiful vaccines, logistics ready, and vaccines preventing transmission, the best path to herd immunity would be to vaccinate high transmitters first in a geographically concentrated way. However, we do not know whether the vaccines actually reduce transmission yet, and Chris Whitty contends that there will be supply shortages for months. If that is true, prioritising those at highest personal risk, as the government is doing, makes sense.

The UK regulator was admirably swift in vaccine approval. But doses available have been revised down massively since November and it’s not obvious why things aren’t moving faster. Reported vaccinations in week two (through 27 December) were not even half the number of those in week 1. Sure, this was Christmas week, but why not have longer working hours on other days to compensate? With a spreading virus, delay costs lives. Oxford/AstraZeneca’s vaccine was approved last Wednesday. It was not rolled out until Monday. Why? The virus doesn’t take time off to celebrate New Year’s Eve and a bank holiday.

Yesterday, Johnson said that 1.3 million vaccinations had now been undertaken. That’s only around 350,000 in the past eight days – nowhere near fast enough given the balance of costs and benefits. By mid-February, he hopes that 13.4 million first doses will be achieved. That requires two million per week from now until then. Yet even that seems tardy given the costs of lockdowns.

We must be pulling every lever here. Constraints to early roll-outs should have been foreseen. And if there are unforeseen roadblocks, economists would advise that raising the price you are willing to pay encourages supply. If, as reported elsewhere, a lack of vials is really the problem, what incentives are being given to ensure manufacturers work round the clock, seven days per week? Making the activity more profitable increases the willingness to pay overtime, train new workers, and run machines hot. If not vials, identify the production or staffing bottleneck and apply the same logic.

Eliminating barriers to vaccinator volunteers is a no brainer. So it’s heartening that the government is “reviewing” red tape that says vaccinators must be diversity, terrorism, and fire-safety trained. But financial incentives could help too. The NHS is giving GPs an extra £10 for every care home resident they vaccinate this month, which makes sense given 36 per cent of deaths have been in homes. Yet what about financial inducements for extended hours, weekend work, and more?

This would not only help in getting more vaccinations delivered, but potentially space them out a bit too. So prevalent is the virus right now, hordes of people packed into waiting rooms could lead to infections even prior to vaccines being administered. Is anyone establishing drive-through or outdoor sites, as seen in Israel?

Nor can we afford wasted vaccines. The zero out-of-pocket price means no penalty for people or providers for missed shots. With the possibility of vaccines wasted or appointments missed, GPs, hospital workers, and (hopefully) pharmacies should have the decentralised authority to administer them to “ineligible” individuals without the threats of repercussions to avoid waste. A vaccine dose to someone is better than no one. Let’s not sacrifice lives on the altar of “fairness.”

The Government’s “first doses first” policy shows that Ministers understand inoculating more people sooner is essential, even with a potential efficacy trade-off. But this strategy only helps in the medium-term if the supply is ramped up. The economy and the public health effort require getting the manufacture, logistics, and physical delivery expanded in the swiftest time possible. It’s not easy, but the language from government sometimes treats the stated constraints fatalistically, rather than seeing them as an economic problem that prices, incentives, and regulations could affect.

Desmond Swayne: Same old Assisted Dying plan, same old unsolved problem – that it would put the lives of the vulnerable at risk

4 Dec

Desmond Swayne is a former International Development Minister, and is MP for New Forest West.

The pressures are being ramped up yet again to legalise what’s being called ‘assisted dying’ for terminally ill people.  No one can doubt the sincerity of those concerned, but the idea just hasn’t been thought through.

We are told not to worry, because there would be strict safeguards.  But when you look more closely at these, you see they are little more than vague phrases.  Let’s examine some of them.

Doctors can diagnose terminal illness and offer a prognosis, but their judgements and forecasts are vulnerable to error.  Lord Mackay’s Select Committee, which looked at the proposal, was told of errors, including misdiagnosis of terminal illness, revealed in around one in twenty post mortems.

Doctors pointed out to the committee that prognosis is far from being an exact science and that, at a range of six months, it was, in the words of one doctor, “pretty desperately hopeless” (House of Lords Report 86-I (2004-05), Paragraph 118).

But doctors would be expected to do more than diagnose and offer a prognosis.  They would be expected to make decisions on whether a wish to die was a settled wish, or whether there were any family or other pressures underlying a request.  These are not medical matters, and many doctors are in no position to offer a knowledge-based opinion on them.  Gone are the days when the ‘family doctor’ is a regular visitor to our homes and knows us and our families well.

We are told that doctors’ decisions would be referred to a High Court judge for confirmation. It’s one thing to ask doctors to give the Court their professional opinion on medical matters: they do this already in other contexts.  But they cannot be asked to make judgements beyond these.  If assisted dying were ever to be legalised, it must be on the basis that the sole decision-maker would be the High Court, and that doctors would be involved only to give the Court expert advice on matters strictly within their professional expertise.

Surveys of medical opinion reveal that there is no majority of doctors willing to participate in ‘assisted dying’.  Among doctors who specialise in care of the dying nine out of ten say they would not touch it.

Oregon has encountered just this problem.  People seeking lethal drugs there often have to shop around for doctors willing to assess them.  Yet a doctor introduced to a patient solely for this purpose is ill-placed to make a knowledge-based assessment of a request.

The inevitable result is multiple prescribing by a minority of doctors.  In 2019, one doctor in Oregon wrote no fewer than 33 prescriptions for lethal drugs.  The involvement of doctors in ‘assisted dying’ simply hasn’t been thought through.  

It’s easy enough to say a request for assisted dying must be voluntary.  But how is such assurance to be found?  The proposals being advanced are silent on this.  Freedom from pressure is presented as an aspiration, but there are no minimum steps mandated to ensure that valid judgements can be made about it.

And it’s not just pressure from others.  There’s also internal pressure – feelings of guilt in a terminally ill person at being a (perceived) care or financial burden on the family.  Such feelings can be much harder to uncover, yet they can be a major factor in a request for ‘assisted dying’.  Among people in Oregon who ended their lives through swallowing legally-supplied lethal drugs last year, nearly three out of five gave as one of their reasons that they felt a burden on family or caregivers.

It is proposed that assessing mental capacity for ‘assisted dying’ would follow the principles of the 2005 Mental Capacity Act (MCA).  But the MCA proceeds from the principle that a person must be assumed to have capacity unless it is established that he or she lacks it.  While this is a reasonable principle for the purposes for which the Act was designed, it’s a dangerous principle on which to proceed where people are seeking assistance to take their own lives.  Given the gravity and irrevocability of such an act, the burden of proof surely needs to be the other way round.

That aside, there’s the matter of depression.  It’s possible to have our thinking processes intact, but to have our judgement impaired either by illness or by circumstances.  Transient depression is a common feature of terminal illness.

This serious issue cannot just be brushed aside, as some of the advocates of ‘assisted dying’ do, by saying that a degree of sadness is inevitable in someone who is terminally ill.  We are not talking about sadness here, but about depression.  The Mackay Committee was told of “episodes of reactive depression as a result of the diagnosis of a life-limiting illness” and that “there is a significant incidence of moderate to severe depression and anxiety at various stages throughout the course of many diseases” (House of Lords Report 86-I (2004-05), Paragraph 124).

Proposals for assisted dying skate over this problem.  They require a doctor to consult an expert in capacity assessment only in cases of doubt.  Yet Oregon’s experience has shown that this ‘if in doubt’ approach can fail.  A study of a small number of persons expressing interest in ending their lives with legally-supplied lethal drugs found that one in three of those who had ended their lives in this way had been suffering from clinical depression, which had not been picked up by the assessing doctor or referred for an expert opinion.

It’s been proposed that an assisted dying law should empower the relevant Minister to issue ‘codes of practice’ to provide guidance on how those assessing a request should go about doing so.  These codes would, however, be issued only after Parliament had agreed to change the law.

Yet the nature and robustness of safeguards is of the essence of any decision to agree to such legislation.  Parliament needs to see how any proposed safeguards would work before, not after, agreeing to change the law.  The proposals we have seen are effectively inviting Parliament to sign a blank cheque.

These are just some of the unthought-through problems in the proposals for licensing doctors to supply lethal drugs to terminally ill patients.  There is nothing new about what is written here.  These serious deficiencies have been drawn to attention time and again, but nothing has been done to resolve them. The time is well overdue for the assisted dying lobby to address these and other issues seriously, rather than to be wheeling out the same failed ideas over and again.  Parliament deserves better.

Richard Holden: Access to cash. Here in County Durham, it matters to voters. Sunak should help to guarantee it.

28 Sep

Richard Holden is MP for North West Durham.

“Cash is King”. In the City of London that means liquidity, numbers on paper – but what it boils down to is freedom of action when things get tight.

For many of my constituents, it means something slightly different: it means hard currency and it means control. When I’m away in Westminster, I rarely use notes and coins. Transactions happen at the touch of a card or, more likely, at the push of a few buttons on my phone.

In the ‘real world’ of my constituency, though, cash is still very important. Recently, while I was queueing outside the Golden Fish Inn on Delves Lane to pick up fish and chip, mushy peas and some cans of pop for the team who’d been out leafleting, I remembered that the chip shop is still cash only. A quick dash across the road to get some money from the cash machine and all was well.

But for many in my community – particularly those on tight budgets, pensioners, and people trying to manage their way out of debt – cash is what they live by. It’s easy to manage because once it’s gone, it’s gone. You can take £20 to get some shopping for the next few days, or take £10 out with you to get a few pints (yes, London readers: you really can get ‘a few pints’ for £10 in Consett) and go home not having spent more than you intended to. Access to physical cash remains crucial.

There has been a big shift under Covid-19, and the Golden Fish Inn is now unusual. Shops and businesses which were ‘cash only’ are fewer and further between.

Even my Wolsingham local, the Black Lion (where during the election campaign the regulars didn’t bat an eye as the Education Secretary and I grabbed a couple of pints, picked eggs and played pool poorly one evening) a staunchly cash-only wet pub until lockdown has now got a card machine. But in North West Durham generally it’s cash-and-card, not just card. Card only is exclusive of those in the most need, as the recent transformation away from cash in Sweden has shown.

The issue of access to cash was highlighted a few weeks ago, when I got a call from a small local shop in Billy Row, a small village near Crook in the south part of my constituency. The shop is basically open from first thing until late evening, seven days a week, provides essentials and has a cash machine inside.

It also has a post office counter, open dor much more restricted hours. Post Office Ltd had got in touch with them to say that the contract with the cash machine operator had expired, and the machine would be coming out for good in a matter of months. The result, the shop keeper told me, was that it would probably end the business and the shop in the village.

Why? Because a lot of local people budget use cash, and they don’t want to only be able to withdraw it at certain times on certain days from the Post Office counter, when to check the balance means it being printed off and passed over before they know if and how much they can take out.

It also means the workers who swing by on their way by in the morning to pick up a can, paper, packet of fags and grab some cash for lunchtime wouldn’t carry on doing so. And for the pub across the green, it means a lifeline for the business (being able to deposit and do basic banking) and access to cash for customers would go too.

A short, local campaign, a bit of local media, touching base with LINK (who were superb) and a few letters to senior management all helped – and the Billy Row cash machine will stay.

But it got me talking to people about how important cash is more broadly. I discovered that in one of the least affluent parts of my constituency, the only nearby cash machine charges £2 a go. That’s a lot to get access to your own money when you’re on a tight budget, and just want to grab so cash to pay to top up your electric meter, pay your hairdresser or grab some bits and pieces from the local shop or sandwich shop. So I’m now campaigning to get a free-to-use machine there to replace it and reduce what has been called in some quarters the ‘poverty premium.’

In the months since I was elected, it’s often these day-to-day issues: cash machines, speeding, unadopted roads, street-lighting, potholes, low-level crime and anti-social behaviour that I’ve noticed my Labour predecessors didn’t try (or at least not very hard) to do anything about.

Either they felt it was beneath them (and too many Labour councillors think these issues are beneath them still), or they were too busy concentrating on planning the revolution to deal with the issues that mean so much in people’s everyday lives.

Throughout the global pandemic, the Government has stood up in an unprecedented way to support jobs and businesses across the country. My constituents know that nothing comes for free, and that the colossal short-term support that has been provided to save jobs and businesses cannot be provided in the long-term.

The broader levelling-up agenda – the defining mission of this Government – needs to be the focus, and delivering on key manifesto promised on hospitals, police numbers, nurses and doctors must be the overarching focus post-Coronavirus.

But now that the budget is delayed until spring, we have a window of opportunity for the Chancellor and his team to also step back, and target support for schemes and policies that can really deliver those smaller changes that make a difference to families and communities in the ‘Blue Wall’, and also pockets in every constituency.

Not all of it needs to cost the earth – and in some cases, need not cost anything. Access to cash is one of these issues in the broader Treasury remit, and needs to be looked at. With a bit of time, we can drill down into the long-term issues that make communities feel left behind, isolated, ignored and yes, ripped off.

By listening to them, rather than talking at them, we can avoid the fate of our Labour predecessors across the newly Blue constituencies by getting things done on the ground that make an immediate difference to people’s lives, alongside our broader ‘levelling up’ agenda.

Matt Oakley: Hancock’s tech revolution is key to reducing mental ill health among NHS workers

20 Aug

Matthew Oakley is the Director of WPI Economics and a former Treasury civil servant.

The Conservative Party won the general election on a platform committed to public service reform. Alongside 20,000 new police officers and a £33.9 billion boost to the NHS, the party’s manifesto also promised the construction of 40 new hospitals and 50,000 extra nurses.

But improving public services, including the NHS, is about more than just buildings and numbers. It is about people. The team manning A&E departments 24 hours a day. The hospital porters transferring patients from wards to operating theatres. The clinicians going above and beyond to nurse us back to health.

It is the task of any government to ensure that those who commit so much time, energy, care and empathy looking after us, are allowed to get on and do their jobs. Matt Hancock recognises this; in a speech given in 2018 he stated that of his top three priorities – tech, prevention, workforce – “workforce is the most important.”

This commitment to those working in the NHS has become even more important this year, when the UK went into lockdown to suppress the spread of Covid-19. Doctors and nurses in the NHS, alongside care workers, receptionists, cleaners, and paramedics, have been saving lives day in and day out on the frontline. It has been an extraordinary effort, which will have taken an extreme physical and emotional toll on many.

In a report I have authored, published today and commissioned by the technology company VMware, we identify the scale of the mental health challenge among the NHS workforce. Using data from NHS Trusts and the Health and Safety Executive (HSE), we estimate that more than 10 million working days were lost to poor mental health among NHS staff across the UK in 2019 at a cost of £3 billion. That’s the equivalent of every single worker in the health service taking on average seven sick days off work. Unfortunately, due to the impact of Covid-19, we can expect the 2020 figures to be even worse.

There isn’t a one-size-fits-all solution to the problem of tackling mental health among NHS workers. A wide-ranging strategy is needed, which includes improved management practices and raised awareness within hospitals of what best mental health practice looks like. But there is one area which will be absolutely fundamental to any improvement: technology.

A recent survey of NHS professionals showed that six in ten thought NHS IT was not fit for purpose, and in a BMA member survey four in ten respondents stated that their stress levels were significantly affected by inefficient IT and data sharing systems.

Some of the IT issues which confront NHS staff are totally unacceptable and reform is long overdue: it takes around 10 minutes to log on to many NHS systems, for example, with multiple logins necessary throughout the day. Some NHS Trusts have as many as 110 different IT systems in place, without any connectivity between them. This means constantly moving files of patient data from system to system or, as is more likely, using apps on personal devices such as Whatsapp to share patient details. These digital silos are slowing NHS staff down, causing unnecessary stress, and creating huge inefficiencies and security issues right at the heart of the health service.

Whilst these issues currently place real pressure on the time and workload of the NHS workforce, there are clear routes through which they can be tackled by improved technology. One such example is establishing a simple principle that clinicians should have the right information on the patient in front of them, on any device that they are using and at any time, with the security you would expect to surround personal medical records. It is a simple principle, but one that would fundamentally change the experience of many clinicians today: saving time, easing workloads, reducing stress and improving patient care.

Creating a strong digital foundation in every hospital in the country won’t just relieve the pressure on staff and enable them to spend more time looking after patients. Replacing outdated IT systems will kickstart the roll out of game changing technologies in the health service. This could mean artificial intelligence predicting demand for hospital beds, cutting edge robotics technology revolutionising keyhole surgery, and pioneering machine learning approaches identifying rare diseases.

The Health Secretary understands the pressing need for this reform. The government and NHS England have committed to providing a core level of digitisation in all hospitals by 2024. Many trailblazing hospitals have stepped up to the challenge and are leading from the front. Other hospitals, however, need help in the form of technological expertise and funding. We should provide them with the tools to allow them to update their IT backbone and enable their staff to carry out their jobs more easily.

The UK is a leader in healthcare and technology. If we can combine our expertise in both, then it will go a long way in improving the mental and indeed physical health of our dedicated NHS workers, which in turn will help all of us.

Chandra Kanneganti: The Coronavirus challenges I’ve seen as a doctor and a councillor

31 Jul

Dr Chandra Kanneganti is the Chair of North Staffordshire’s GP Federation, and is a Stoke-on-Trent City Councillor.

It’s been almost six months since we have been dealing with Covid-19 pandemic. With the benefit of hindsight, it can be said that we could have handled the health crisis better.

We should have imposed the lockdown much earlier, and made sure we had enough PPE to support and protect our health care workers. We could have communicated better the precautionary measures that should be taken. As we move forward, it is critical that we evaluate our Covid-19 response. However, such assessments should be defined by empathy and humility.

I am a GP of 14 years’ experience. As medical professionals, we were never trained to handle a health crisis of this magnitude. Like military exercises during peacetime, the healthcare professionals never conducted nation-wide pandemic-response exercises during normal times. Much less, many health care professionals never even attended a single workshop on pandemic response during their careers.

This is not surprising, since we have never seen something like this in our country or for that matter, no country has ever anticipated a crisis of this magnitude. Our health care infrastructure was tested and stretched by this once in a generation health crisis. Our people and the health care professional community have demonstrated remarkable resilience in the combat against the deadly pandemic.

Over the past few months, my colleagues and I worked every weekday and many weekends in GP practices, in Covid Hot clinics and extended access clinics. Many of us had at least 40-50 contacts of patients every day as a GP. During the breaks, which were always few, we would ruminate on the experiences narrated by the pandemic infected patients, and we would think of the safety of our loved ones at home.

But there was always extraordinarily little time to pause, and we had to get back to patients to work with clinical precision. In the midst of all this, I had to respond as Chair of British International Doctors Association (BIDA), and have led campaigns to scrap the NHS Immigration Health Surcharge for NHS workforce and for research with actions into disproportionate BAME Covid deaths and infections.

As a Conservative councillor, being there with the residents in my ward provided me with the opportunity of experiencing the remarkable ‘British resilience’ up and close. I had the privilege of working with the local church to start a voluntary group that helped in distributing medicines as well as food and shielding patients. It was heartwarming to see people supporting each other in the communities. A resident in my ward collected food and kept it outside every week for anyone to come and collect it.

I am sure there are many such good Samaritans in all communities. The lockdown also provided us with an opportunity to get potholes fixed in my ward by the council. Keeping up the local business in lockdown was also an important priority. I worked with the local authorities to deliver grants to businesses quickly and offered help to vulnerable people.

While there were PPE problems in some parts of the country, Stoke On Trent and North Staffordshire never faced such issues. This was largely due to innovative solutions created by people working collaboratively to supply PPE to general practices and care homes. Indeed, one of our administrators made visors for doctors working in Covid hot clinics. Further, these clinics to see Covid-suspected patients were opened in record time. We must note with some pride that Stoke had one such clinic, which was first of its kind in the entire country.

It is essential to recognise the achievements in our pandemic response, as it will help us to build a more robust health care infrastructure. Based on my work as a medical professional and as a councillor, let me share with you four important accomplishments.

First, in terms of infrastructure, hospitals have come up with Covid wards in record time with well-trained staff ready to serve. Our health care staff was trained quickly to shield vulnerable people and protect them. Today, there are thousands of intensive care beds, ventilators ready to be used along with Nightingale Hospitals across the country. There was no problem in accessing an intensive care bed and ventilators during the pandemic in our country. Thankfully, we will be spared the experience of Italy, where doctors, unfortunately, had to choose patient’s for ventilation and treat the patients in corridors.

Second, with regards to processes, general practices have been trying to digitalize for ages. Within one week of Covid pandemic, GPs across the country shifted to remote consultations, using various digital tools and continued to be there every day for their patients. Whenever there was a perception that the decision-making process was erring in its policies, there were quick corrective measures. For instance, all doctors’ associations have united in one voice to support BAME NHS Staff who are disproportionately affected. Eight GP colleagues and a Practice Manager in Greater Manchester prepared a risk assessment tool called SAAD tool in memory of a GP colleague who unfortunately died of Covid.

Our democratic political process and the elected, as well as accountable leadership, are important assets that we have. We are one of those few countries in the world that reported Covid deaths with complete openness and transparency.

In fact, the fatality rate may have been over-reported. I have seen a number of reports of deaths, particularly in care homes that were reported as Covid deaths, based on care staff and paramedics observations without any valid medical test results. Our democratic ethos and administrative frameworks do not permit us to push inconvenient numbers under the carpet.

Third, the response of our political leadership has been brilliant throughout the pandemic. Boris Johnson has been in ICU with high flow oxygen and has recovered. The Prime Minister gave us hope and showed considerable fortitude in crisis. Rishi Sunak was fantastic, and all my constituents have nothing but praise for him. Matt Hancock’s knowledge of the issues and his engagement with scientific and medical advisors showed a mature health secretary with a reassuring presence in the hour of crisis.

We are at the forefront of vaccine development with contracts of millions of vaccines in place, which is marked contrast to some of the developed economies which are yet to sign a contract with vaccine producers.

Fourth, there was a robust societal response. The British public has demonstrated remarkable generosity with the wonderful campaign of Sir Tom Moore. His campaign collected £32.79 million. I had the first-hand experience of the British kindness, as I was able to collect 17,000 in a short time through British International Doctors Association (BIDA), and distributed this to number of stranded doctors for their living expenses. Through various symbolic measures, such as clapping, our society has shown immense appreciation to all the key workers for the work that they are doing.

Despite these achievements, we must never forget the fatalities that we registered due to the pandemic. Death is not a statistical data point, and the loss of life of a mother, a father, a child, and a key worker can never be filled. There are concerns that there may be a second wave of coronavirus in the winter. There is no time to rest. We must continue to help each other and support the government. We are in this together – and will come out of this much stronger as a country.

Paul Bristow: The biggest challenge for our NHS may still lie ahead, but it’s also an opportunity

30 Jun

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

Our NHS has done an excellent job looking after us during the Covid-19 crisis. But the biggest challenge for our NHS may be about to begin as the service deals with the backlog of delayed operations and treatments.

The lockdown began in order to protect our NHS. This was the early central message. The Government was concerned that hospitals would be overwhelmed as we saw in Italy and elsewhere at the start of the pandemic. This didn’t happen. Our NHS ramped up capacity as former NHS workers came back to serve, new hospitals were built, and a deal was struck with the independent sector. This push for increasing capacity within the system needs to continue.

We need a national effort backed by the Government PR machine – supported by the charisma and optimism of the Prime Minister – to back our NHS and clear the backlog. I have heard personal harrowing stories from NHS patients through my role on the Health and Social Care Select Committee.

Rob Martinez from Bracknell, who needed a double knee replacement, had his operation due in April cancelled. He told our committee that he had taken early retirement. I asked him if he would have continued to work if his operation had taken place – he confirmed he felt he could have worked for another 5 years. What was the most bitter blow is that he has been told there is ‘zero chance’ of his procedure taking place this year.

Another patient from Sevenoaks had her chemotherapy stopped. And while it has restarted, there remains huge concern that the number of patients receiving chemotherapy is far fewer than would be expected. Cancer Research UK estimates more than 20,000 patients did not get treatment because of the virus crisis.

Whilst official statistics have been paused, it is estimated almost two-thirds of Britons with common life-threatening conditions have had care cancelled. The NHS Confederation is saying that NHS waiting lists could rise to 10 million in the autumn, and take up to two years to clear. The Royal College of Surgery has called for a five-year strategy to tackle the waiting list situation.

This is now one of the Government’s central challenges.

We can do this. The NHS has shown its remarkable ability to cope, and yet again the British people have shown great resilience through this emergency. But it needs to be framed as a national effort with the Prime Minister and the Secretary of State personally leading this.

Those who have re-joined the NHS to help with the Covid-19 crisis need to be persuaded to stay. I appreciate staff will be tired, and those that have returned will need to be properly motivated. The appreciation that the public has shown to our NHS staff should help, but efforts will need to be made to make the NHS a better place to work and should be prioritised.

The Prime Minister had it right with the simple message about workforce at the General Election, promising to recruit and retain 50,000 nurses. We need to look with urgency at long-term recruitment issues. The NHS needs staff in almost every setting, as many begin to reach retirement age. According to the latest annual census from the UK Royal College of Radiologists, in 2020 approximately 200 doctors will qualify as radiology consultants – not enough to fill even half of the estimated 466 vacancies.

The Government needs to be alive to the challenges associated with the safety of NHS staff and patients. The need for PPE and new designed layouts will affect theatre capacity. Diagnostics, which underpin clinical activity in hospitals, and a backlog in MRI/CT scans, endoscopy and laboratory tests are also limiting factors.

Back in March, Matt Hancock was right to sign a deal with the independent sector. In peace time this would have been an incredibly courageous thing to do with those on the left gleefully pointing to proof of Tory privatisation. I hope that the Covid-19 emergency has dismissed the lazy assumption that the independent sector and the NHS cannot work in partnership.

A similar long-term deal agreement with independent providers to retain capacity will be crucial in the years ahead. They can help ramp up elective capacity, power through knee, hip and cataract procedures, and improve lives – and in the case of Mr Martinez may even allow him to return to work and generate more tax revenue to fund public services. It will also allow for cancer treatment and cardiology procedures to resume at pace and scale. With appropriate testing arrangements, these could quickly become a significant proportion of the ‘Covid-light’ units that are being regularly discussed as the means to reduce the elective backlog.

The NHS does so many things well. But few would claim – especially staff – it cannot become more productive. We have seen the NHS conduct GP appointments and other consultations through digital challenges. This has worked. It is also worth noting that much of this would have been impossible if it wasn’t for the visible presence of the NHS on our streets in the form of community pharmacies offering that face-to-face reassurance for many routine issues.

This obviously needs to continue, but it is only the beginning. Let’s start a conversation about how the NHS can change many care pathways to become more productive. We can accelerate the uptake of already established treatments, which can keep patients out of a secondary care setting or at least not in expensive hospital beds for days at a time, by the adoption of less invasive procedures.

Changing pathways to enable the adoption of technology has often meant local evidence needed to be established – this could take years and was often completely unnecessary. We can expediate the move to integrated care working, especially with regarded to initiatives such as shared waiting lists and flexibility in payment mechanisms. This is a chance to improve existing practice.

We can be optimistic and ambitious for the future of our NHS. So much goodwill has been garnered and our staff are more valued than ever. But it is also an opportunity for change. A national effort led by a transparent and upfront Government is what is required.