full article by Alicia Clegg in the FT

At the start of the pandemic, trainee GP Kaveri Jalundhwala was working on a hospital placement. By the end of March, she had become infected with Covid-19, which then developed into long Covid and forced her to pause her training. With stories emerging of how healthcare workers in makeshift masks and gowns — and sometimes no protection at all — were paying for failures to provide adequate personal protective equipment (PPE) with their health, Jalundhwala looked for a way to support her colleagues.  She joined Doctors’ Association UK (DAUK), a grassroots lobbying group. And rather than “just get angry at home”, Jalundhwala got involved with their “Protect the frontline” campaign. Its aims include to inform the public about conditions in the fight against Covid and press the government to give healthcare workers appropriate PPE and support.

The DAUK grew from doctors joining together to support a junior paediatrician, Hadiza Bawa-Garba. In 2015, Bawa-Garba was convicted of manslaughter by gross negligence after the death of six-year-old patient and was then struck off by the General Medical Council. But many medical professionals did not see a doctor who had failed, rather an overstretched colleague who was put in an unsafe situation and scapegoated. “Any one of us could be Bawa-Garba,” says Jalundhwala. It often feels that doctors are “a faceless number on a rota where [our] individual voice does not matter to the people who make decisions,” she adds. Bawa-Garba has since returned to medical practice, while the DAUK developed its “Learn not blame” campaign to improve the culture of the NHS so it can learn from mistakes “in a constructive and fair manner”.

When the pandemic hit, DAUK started its “Protect the frontline” campaign. As part of this, it broke the story of NHS staff being warned not to discuss PPE problems on social media or speak to the press. It also created an app that enables doctors and GPs to report on PPE supplies. In April 2020, DAUK also led calls for an independent public inquiry into healthcare worker deaths and PPE supplies, with its petition gathering more than 100,000 signatures. When this received no formal response from government, DAUK started legal proceedings with the Good Law Project.

“When something needs doing, we do not sit on it,” says Pushpo Hossain, who joined DAUK to amplify the voice of doctors working in the UK who qualified abroad.

In May, when a DAUK member heard about a plan to upload all NHS patients’ medical records to a central database that could be shared with third parties, the organisation joined forces with Foxglove, a digital rights campaign group, to help force a delay. “In less than a week we had decided to take legal action [later paused],” says Rosie Shire, a GP who led DAUK’s response to the plans. The scheme has now been postponed to allow time for more consultation with no new date for implementation.

Read the full piece by following the above link

The UK government is being threatened with legal action if it does not pause plans to collate the full medical histories of 55m patients in England into a single database from July 1. In a pre-action letter sent on Friday on behalf of five organisations and Conservative MP David Davis, the campaigners warned that “rushing this major change through with no transparency or debate violates patient trust, and that doing so without patient consent is unlawful”.

Read the full article here

London hospitals are admitting 800 coronavirus patients every day and will be overwhelmed in two weeks unless the current rate drops significantly, NHS officials have warned. Simon Stevens, chief executive of NHS England, on Thursday said the health service was experiencing a surge in admissions across the UK.

“We’ve seen an increase of 10,000 hospitalised coronavirus patients just since Christmas Day,” he said. The 800 patients being admitted each day in the capital was “the equivalent of a new St Thomas’ hospital, full of Covid patients, fully staffed, everyday”, he told a Downing Street press conference, referring to one of London’s bigger hospitals. “The entirety of the health service in London is mobilising to do everything it possibly can,” Sir Simon added. “But the rate of growth in admissions — that is what collectively the country has got to get under control.”

The assessment came a day after Vin Diwakar, medical director of NHS London, outlined stark forecasts indicating that even in the “best-case scenario”, in which the number of Covid-19 patients rises at the lowest plausible rate of 4 per cent each day, hospitals in London would be short of close to 2,000 beds by January 19.

In the mid-range scenario, a 5 per cent daily increase, there would be a 3,569 shortfall, and in the worst case, if the number of Covid-19 patients rises by 6 per cent each day, the NHS in London would need another 5,400 beds. Under all scenarios, the number of non-coronavirus patients stayed the same, the NHS found an extra 400 beds, relied on the private medical sector and some provision from the temporary Nightingale hospitals.

English hospitals now have 46 per cent more confirmed coronavirus patients in hospital than at the peak of the first wave of the virus in 2020, according to Chris Hopson, chief executive of NHS Providers, which represents NHS hospitals, community, mental health and ambulance services.

He posted data on Twitter showing that significant rises in weekly Covid-19 hospital admissions had been seen across the country, although the biggest increases were in London and the South West. During recent winters, the number of people in London hospitals’ intensive care units at any time is about 700, rising to as high as 770 in January 2018 during the worst flu outbreak for 40 years. Covid-19 admissions this winter have shattered that record, with London ICU occupancy reaching 1,074 on January 3.

“The entire service from the front end to the back end is under strain,” said Dolin Bhagawati, a London neurosurgeon speaking on behalf of the Doctors’ Association UK. “We’re having to expand [intensive treatment unit] capacity, we’ve had to cancel a large amount of planned care, including operations.”

Access the article here: https://www.ft.com/content/6bf817cf-9ee6-4231-8f04-e86ae68bf0c6

The number of people in hospital with Covid-19 in England has surpassed the April peak, according to official data that emerged as the UK government prepared to decide whether to tighten restrictions on millions of Britons.

The high volumes are in part because of clinicians’ increasing understanding of how to treat the disease, according to NHS officials. Far more are surviving than earlier in the pandemic, but patients may require weeks on a hospital ward to recover fully, doctors noted.

But NHS leaders have warned that hospital capacity is at breaking point. “People are incredibly worried about what is to come. We’re in the eye of the storm, and the storm means something big and destructive — it’s a hugely challenging time,” said Saffron Cordery, deputy chief executive of NHS Providers, which represents leaders across the health service. 

The warning came as Boris Johnson, prime minister, chaired a meeting with senior cabinet ministers on Tuesday evening, and ahead of an update on the country’s tiered restrictions on Wednesday by Matt Hancock, health secretary.

More areas of England look likely to be placed under the highest level of curbs as government concern grows about the spread of the South African variant of Covid-19 and a second variation known as B.1.1.7. 

The prime minister’s official spokesperson on Tuesday said the government kept all measures and the latest scientific data under “constant review”, adding: “That is what we have done throughout the pandemic and that is what we will continue to do.”

The strain on hospitals was evident in official data showing that as of 8am on Tuesday, a total of 21,787 hospital beds were occupied by patients with Covid-19 — higher than the peak of 18,970 on April 12.

But the figures also showed that while total daily admissions of Covid-19 patients were 2,572 as of December 27 — the highest for about eight months — they were still roughly 500 below their peak at the start of April, when 3,100 people were being admitted each day. 

Meanwhile, the number of beds occupied by Covid-19 patients on mechanical ventilators stood at 1,728 on Tuesday morning, less than half the April peak of 4,000. 

NHS staff and executives pointed to the very different demands now being made on the health service compared with the early months of the crisis. Ms Cordery said: “People are surviving but they need to be hospitalised for longer. The profile of people with Covid is younger, but they need more treatment.”

She added that staff absences around the country were more than double the normal levels for this time of year. 

NHS leaders have spent months pressing the health service to make up lost ground by performing surgery and procedures delayed during the pandemic, with significant success.

However, Dolin Bhagawati, a London neurosurgeon who speaks for the Doctors’ Association UK, said rising Covid-19 admissions would have an inevitable impact on other services. “In London we’re at where we were in the first wave and it’s going to get much worse over the next few weeks,” he said. “A lot of places are cancelling planned care and surgeries to free up staff and beds for Covid patients.”

Independent Sage, a group of scientists who offer an alternative view to the government’s own advisory committee, said: “The pandemic in England is now at the most threatening stage of the entire year.” It forecast that with cases still rising steeply, pressures on the NHS in England would get significantly worse over the next few weeks.

One London health leader told the FT that the peak of Covid-19 admissions was not expected to be reached until the week after next in the capital.

David Strain, a geriatrician who co-chairs the British Medical Association’s medical academic staff committee, noted that the steroid dexamethasone was proving even more effective than in clinical trials and significantly reducing deaths from Covid-19. But he said that the time from admission to release could be up to 35 days, in contrast to the flu, where a patient would generally be admitted for no more than five or six days. 

A two-week illness “is actually deconditioning far more than we normally see”, he said, adding that in some cases, “we are looking at a month’s worth of rehabilitation” before people can be discharged.

Read the article here: https://www.ft.com/content/9e4ffdab-8245-44d6-a110-206c6cc94796

In London we’re at where we were in the first wave and it’s going to get much worse over the next few weeks. A lot of places are cancelling planned care and surgeries to free up staff and beds for Covid patients.

The number of people in hospital with Covid-19 has surpassed the April peak in England, according to official data that emerged as the UK government prepared to decide whether to tighten restrictions on millions of Britons. 

The high volumes are in part because of a deeper understanding by clinicians of how to treat the disease, according to NHS officials. Far more are surviving than earlier in the pandemic, but they may require weeks on a hospital ward to recover fully, doctors noted.

NHS leaders have warned that hospital capacity is at breaking point. “People are incredibly worried about what is to come. We’re in the eye of the storm, and the storm means something big and destructive — it’s a hugely challenging time,” said Saffron Cordery, deputy chief executive of NHS Providers, which represents leaders across the health service. 

NHS leaders have spent months pressing the health service to make up lost ground by performing surgery and procedures delayed during the pandemic, with significant success. 

However, Dolin Bhagawati, a London neurosurgeon who speaks for the Doctors’ Association UK, said rising Covid-19 admissions would have an inevitable impact on other services. “In London we’re at where we were in the first wave and it’s going to get much worse over the next few weeks,” he said. “A lot of places are cancelling planned care and surgeries to free up staff and beds for Covid patients.”

Read the rest of the article here.

The BMA is seeking assurances that these payments will be guaranteed even if a doctor’s current employer or even NHS England were to not exist in their current form at such a time. In addition, the BMA is seeking assurances that there would be no unintended tax liabilities arising from these payments and the scheme would not be treated as “tax planning” or “tax avoidance”.

However, this comes as a The Doctors’ Association UK survey of hospital doctors suggested the emergency plan would not be enough to convince doctors to return to the wards. Nearly 96 per cent of 959 hospital consultants who responded to DAUK’s poll on the deal said it was insufficient to get them to pick up extra sessions over winter.

Dr Rinesh Parmar told the Financial Times (full quote):

“The pensions taxation crisis has forced many Consultants to reduce the overtime and additional work they were doing for the NHS on top of their contracted hours for fear of facing unexpected tax bills stretching to the tens of thousands of pounds. Some have faced the prospect of re-mortgaging their homes to pay for bills that have arrived without warning, simply for working above and beyond to help our NHS.

With over 4.41 million people in England alone awaiting elective operations there are patients who are suffering in pain, coming to harm or even dying whilst waiting for surgery.

We’ve seen the number of patients dying whilst on a waiting list rise from 18,876 in 2012/13 to 29,553 in 2017/18; this government-made crisis will undoubtedly put more patients at risk. This was an entirely predictable and preventable crisis for which the Conservative government has had multiple warnings, all of which have fallen on deaf ears.

Doctors have been clear that the only solution is scrapping the taper and annual allowance for the NHS pension. These panicked short-term proposals will not fix the problem, and by the Health Secretary’s own words may even amount to tax avoidance. Our poll shows that consultants do not trust this government’s hurried promises that they will one-day be repaid their tax bills on retirement, and that an overwhelming majority of respondents said this proposal would not encourage them to resume extra work over the winter.

None of the major political parties have committed to what doctors are calling for, only pledging a review of the pensions taxation, this ship has sadly already sailed. We urgently need reform of pension taxation and DAUK will continue to lobby all parties for a clear commitment to scraping the taper and the annual allowance for the NHS, representing a fairer system that values doctors and safeguards patients.”

For the full article see here:

https://www.ft.com/content/3a1b77d2-1109-11ea-a225-db2f231cfeae