Health Matters – OCT 2021

Three Issues in this month’s Health Matters

• Is the NHS at Breaking Point?
• Covid Update;
• Vaccine Protection


1. Is the NHS at Breaking Point? Let me try and sum up patient experience at the moment:-
• Pharmacies – generally coping well but there are supply issues
• Primary Care (GP Surgeries) are finding things really tough
• Ambulances – long waits
• Secondary & Acute Care – equally long waits!

So let’s drill down into the issues; first Primary Care:
1. Lack of GPs and Nurses – Surgeries are significantly under their planned headcount and are unable to bring in Locums to backfill. There is no desire to use services like Babylon as a backfill for the lack of GPs
2. Increase in Demand – at the Maltings the number of telephone calls per day has doubled from around 500 calls per day to over 1,000 per day. They typically get 400 between 8:00 and 10:00. The increase in demand exacerbates the issues relating to the lack of GPs and Nurses. 111 referrals to Primary Care also raises expectations that cannot be fulfilled.
3.Increase inExpectations – along with the increase in demand everyone is looking for instant solutions!
4. Increase in Workload – some tasks previously done by secondary care (e.g. prescribing) is now done by Primary Care – e.g. you have a virtual consultation in Secondary Care and need a new medicine, that can’t be done by the Secondary Care Pharmacy as no-one wants to bring them to the hospital pharmacy so it goes back to the GP (simple solution – acute care should use electronic prescribing!
5. Motivation Levels – three contributing factors, first exhaustion from handling the Covid Pandemic; second the fact that GPs are so dissatisfied they are threatening to strike; and finally that uncertainties over the future of thier GMS Contracts

The problem for Ambulances is fundamentally waiting times when they get to A&E along with some staff pressures; response times are now averaging over 50 minutes whilst the target response time is 18 minutes. And in secondary care it’s a combination of the backlog, motivation and exhaustion following staff experience during the Covid pandemic and staff shortages.

So, is it at breaking point? The answer is that it’s very close to it!

2. Covid Update – you may have heard that our Covid numbers were some of the worst in the country – we peaked on OCT 28th at 736 cases per 100,000 and that was very close to our absolute peak – in January of this year; that was 770. On OCT 28 we had 4,918 active cases in St Albans which is 1 in 34 people at that moment in time, if you remember they were reporting that the national average was 1 in 50. And that just highlights how bad it was. This morning, the number of active cases is down to 2,889 which means that we’re now at 1 in 53 people – still high, but a significant fall in the numbers!

The age group contributing most to the fall in numbers is the under 19 group they have fallen from 46% to 35% in just 3 weeks- and it’s continuing to fall so it’s not a “half term effect”! The next group are the 35 to 55 group – they dropped from 27% to 24%. But there are two groups of concern now; the 18-35 group are up from 15% to 22%, and the 55 to 75 group is up from 10% to 17%.

And to complete the picture let’s look at hospitalisations – the latest data I have is 5 days ago when there were 43 in Watford and 36 in the Lister – and that’s been pretty steady for the last 3 weeks (it was rising before that).

2. Vaccine Protection – Before the break we were saying that although the overall numbers with Covid were coming down the 18-35, and the 55-75 age groups were rising – the major cause for that is the way in which the effectiveness of the vaccines wane over time. One critical piece of data I haven’t given you so far is the extent to which people who’ve caught Covid have been fully vaccinated. In OCT 22% had been fully vaccinated but last week the percentage was up to 29% – that’s an increase of a third in just one month.

Recent research has shown that vaccine protection wanes significantly in the sixth month after the last vaccination. In the first month (after the two week generation period, protection is between 90-95%, and it holds pretty well until the fifth month but wanes quickly in the sixth month – typically down to 60%. Which is the reason that the period for the booster dose fell from 6 to 5 months.

And if you’re relying on the antibodies generated by catching Covid, you’re on very shaky ground. On average, someone who relies on antibodies generated by Covid who doesn’t have the vaccine can expect that the protection given by the antibodies generated in the blood stream could be less than 50% after 6 months.

So the message is very clear – if you’re due a vaccination, be it a first, second or booster dose, or even the flu vaccine, get it as soon as you can. For information on where you can get your vaccine contact your Surgery or call 119. Alternatively go to https://covid.healthierfuture.org.uk/events/vaccination-walk-in-clinic-times where there is a full list of walk-in availability. That especially applies to the over 40s getting the Booster jab and the 16-17 year olds second jab announced this week.

The number of 12-18 year olds that have been vaccinated is now just over a third – that’s encouraging but there’s still a lot more to get the jab!

Alan Bellinger
17th November 2021