The NHS and social care are beyond full stretch.

Drawing on the latest performance, COVID data, and recent intelligence fed to him by trust leaders, Chris Hopson, CEO of NHS Providers, explains where the NHS is up to and why the government must be ready to introduce new restrictions at pace if they’re needed.

Chris Hopson, CEO of NHS Providers. | Sky News

In a series of tweets he posted on New Year’s day on Twitter, the chief executive of the membership organisation for all of England’s 217 ambulance, community, hospital and mental health trusts, explains the post-Christmas situation for the NHS with the Omicron variant, looks also at staff absences, access to LFT and PCR tests and the NHS work to create hubs to deal with extra surge capacity.

On COVID infections and hospitalisations

“The latest infection data show a rapid increase in community infections. Now turning, as expected, into increasing numbers of hospital admissions. 31 December data show the fifth day in a row of around 1,000 extra new patients with COVID in hospitals.

“National COVID hospital patients are up by 68% in a week. 12,400 hospital patients with COVID-19 vs last January’s 34,300 peak. But remember that comparing numbers of hospitalised COVID-19 patients between now and last January peak is not a good measure of overall NHS pressure. The NHS is now under different, arguably more, pressure compared to last January – much busier urgent and emergency care pathway, many more planned care cases that cannot be delayed without patient harm. The booster vaccination campaign is significantly more resource-intensive/complex.

“Staff absences are having a greater impact in many trusts. There is much greater pressure on social and primary care. All are having a big impact. The NHS – community, mental health, ambulances, and hospitals alike – and social care are beyond full stretch. Staff are facing a mountainous workload day in day out.

“The NHS – community, mental health, ambulances, and hospitals alike – and social care are beyond full stretch.”

“Covid is now spreading more rapidly across England. 7 day increases in hospitalised patients with Covid-19. North West and North East/Yorks are both up 93%. Midlands up 67%. London and East of England up 61%. South East up 55%. South West up 44%. London is still at the front of the curve in terms experiencing higher infection rates first and is therefore worth scrutinising. London CEOs are saying that hospitalisation rates early to mid last week were very concerning – around 8% average daily growth vs a maximum of 6% in last January’s peak. But they have come back down to 4-5% over the last two days. If the growth rates go back up again (e.g. with the Christmas effect) trusts are likely to have to start standing up extra surge capacity late next week. Putting pressure on less urgent elective activity. Trusts will do all they can to keep going with the urgent and high priority elective activity.”

Important detail and nuance

“ICU occupancy is broadly stable. Unlike last January, there are currently many fewer, seriously ill, older people needing critical care. Therefore less pressure to expand critical care and increase oxygen usage vs last year. The length of stay is lower. The problem, therefore, is less one of patient acuity, intensity of care and length of stay required. More one of the sheer volume of patient numbers needing general and acute (G&A) beds. Particularly if the numbers grow fast. A relentless demand growth, if sustained, is becoming the biggest concern.

“The latest data show some progress pre-Christmas on speeding up discharge. But CEOs are now reporting an increasing pressure on discharges given staffing pressures on NHS services like step down, rehab, and physio. But also yet more massive pressure on social care in the last fortnight as staff COVID-related absences and COVID outbreaks reduce care capacity. One London Borough is reporting that nearly all its care homes are closed to new admissions. But one CEO also pointed to an interesting upside – no admissions from care homes with outbreaks provides more evidence that vaccines work with Omicron and the risk of serious illness for fully vaccinated elderly looks much lower than before.

“No admissions from care homes with outbreaks provides more evidence that vaccines work with Omicron and the risk of serious illness for fully vaccinated elderly looks much lower than before.”

“The latest primary diagnosis data show growing incidental COVID – patients coming to hospital for another reason and testing positive. But the issue is G&A bed pressure, whatever the reason for the admission. COVID cases require isolation, potentially reducing capacity. So it is important not to over-emphasise the “beneficial impact” of incidental COVID, as some are doing today. I hope this is a tall thin peak that plateaus soon.

“There is some evidence that London infections have peaked before Christmas and have plateaued since. Upside: hospitalised COVID numbers may be bigger due to the holiday period slowing discharges. Downside: the lack of testing capacity under-estimating infections and the Christmas/New Year/school return effect is still to show.

“The striking general view is that the future London trajectory remains very unclear. There is a significant uncertainty. All options are open, from hospitalisations that will shortly plateau and then start to drop to increases growing rapidly post-Christmas. And all points in between. Planning is very difficult!”

On staffing absences

“The latest data show staff absences have doubled in a fortnight. This is a major and growing problem for many trusts – the impact varies. A rapid, appropriate staff access to LFT and PCR tests remains a major issue that the Government and the NHS working together need to address.”

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Responding to reactions to a previous Twitter thread, Chris Hopson finally tried to explain the situation with hospital hub surge capacity.

“I agree that, after a decade of the longest and deepest financial squeeze in its history, the NHS and social care partners are in a very difficult position. The NHS has not been able to grow the capacity to meet the growing demand. It had to try to close the gap by asking staff to work harder, giving them an impossible workload, meaning they can’t provide the care they feel patients need. And successive governments have failed to solve the growing social care problems.

“After a decade of the longest and deepest financial squeeze in its history, the NHS and social care partners are in a very difficult position.”

“These are all major contributors to current issues and need to be addressed on the longer term. But, right now, the NHS is facing a potential immediate emergency it needs to prepare for. The choice could potentially be leaving patients untreated or creating extra temporary capacity.

“In the words of one CEO: “I initially thought new hubs were a wrong idea. But having seen growth in hospitalisation numbers last week, I can now see why they may be needed”. But the NHS must use up all other options – social care capacity, virtual wards, ordinary surge – first.

“This will only work with an emergency staffing model. This is far from ideal, e.g. quality of care. But this will be an emergency. It will only work with the commitment and the flexibility of front line staff. As demonstrated in the first wave and in the January 2021 peak.”

In a nutshell

“The pressure and the trust leaders’ concern are mounting as hospitalisations increase. The next few days will be crucial. London hospitalisation rates could plateau echoing community infection rates as we hit Christmas. Or they could rise on the back of intergenerational Christmas mixing.

“So we still need to watch and wait. The government must be ready to introduce new restrictions at pace if they’re needed. The positive news is that we are still not seeing the large numbers of severely ill older people that we have seen in previous peaks. The vaccine effect is very pronounced.

“The NHS is preparing for the worst and hoping for the best. The staff is flat out, especially giving the level of staff absences. We will need to ask them to perform flexible heroics again if hospital covid numbers continue to rise. We can’t keep doing this. Long term NHS capacity issues must be addressed.”