As we near December 2, we need complete clarity on what will happen next. Whilst there are welcome signs that the rate of hospital admissions in Liverpool and Manchester is finally starting to slow down, this hasn't yet happened consistently in places that imposed tougher restrictions on social contact later.
It's therefore still too early to tell if our current national lockdown will have the consistent effect that's needed. The working assumption is that it will do, but the next five to seven days will be crucial in confirming that.
There is, rightly, significant optimism that the combination of access to vaccines, therapeutic drugs and rapid turnaround testing offer a sustainable way to combat coronavirus in the medium term. But, for the moment, restricting social contact remains the only effective way to prevent the spread of the virus and the devastating impact it can have on those who are infected.
It would be a great mistake to think that, as soon as the first vaccine dose is delivered, hopefully next month, we will be free.Chief Executive
It would be a great mistake to think that, as soon as the first vaccine dose is delivered, hopefully next month, we will be free. The key immediate issue confronting the NHS is how to navigate the hump of winter – late December to March – when the NHS is at its busiest.
The NHS must have sufficient capacity over the next three months to treat three groups of patients. First, coronavirus patients. Second, emergency cases, including the large influx of emergency patients the NHS always sees over winter. Third, those who need planned care. A number of these patients, despite the NHS' best efforts over the last few months, are still waiting for treatment following the need to delay care in the first phase of coronavirus. It is vital they are seen as quickly as possible. But the NHS faces real constraints.
NHS capacity is always at its most stretched at this time of year. We now have significantly fewer beds available due to the need to separate coronavirus and non-coronavirus patients, to keep them safe, with hospitals reporting between 10 and 20% lost capacity. Staff are tired. Sickness absence rates are rising, particularly in areas with high rates of transmission as NHS staff reflect the infection rates of the communities they serve. Trust leaders are doing everything they can to maximise their capacity. But there remains a real risk of the NHS being overwhelmed.
Worrying signs are already emerging, well before we have reached the peak of the normal NHS winter surge. Demand for emergency care is now rising rapidly. Discharge flow is slowing down. Bed occupancy rates are rising. The number of 12 hour waits in hospital emergency departments is increasing quickly.
Ambulance trusts are starting to report significant handover delays. Trust report significantly higher levels of the sickest patients than usual, often due to delays in coming forward for treatment. Many trusts are already under the degree of pressure they normally only see in the depths of winter. In the words of several leaders from across the country this week "it feels like we've hit winter six weeks early".
On December 2 we are likely to be in a halfway house. Infection rates will be coming down. The rate of increase in hospital admissions will have slowed down. But we won't be properly on top of the virus.Chief Executive
On December 2 we are likely to be in a halfway house. Infection rates will be coming down. The rate of increase in hospital admissions will have slowed down. But we won't be properly on top of the virus. It'll be there waiting to flare up again if we let down our guard too much, just as happened in the second wave we are now experiencing.
Christmas is incredibly important to many of us. But, to coronavirus, December 25 is no different to November 25 or January 25. There is a real risk that in our desire to celebrate Christmas, we swap a few days of celebration for the misery of a full third wave a few weeks later. At this point, the logic is inexorable and merciless. The more social contact there is, the higher the rate of deaths and long term ill health. Not just for coronavirus patients. But for the emergency and delayed planned care patients who the NHS will be unable to treat if we are swamped by cases.
What should happen on December 3?
NHS trust leaders are clear on three things. First, we should only come out of national lockdown if we are certain the NHS can cope with this second phase. Second, we need to avoid a third phase in January by retaining appropriately tough restrictions to minimise social contact. The last few months have showed that the restrictions in the old first and second tiers were insufficient and that we will need a stronger regime than the old third tier in areas of greatest spread. Third, those tougher restrictions need to be adopted quickly and automatically wherever needed. We can't afford the crucial lost days we saw in Liverpool and Manchester as local and national leaders debated what to do.
Trust leaders recognise that it is difficult to ask politicians and a weary nation to continue tough restrictions. Particularly if the calculation involves an uncertain prediction of the likely forward pressure on the NHS between late December and February. But there is a definite sense of "one more heave". If we can surmount the hump of this winter, there is good reason to believe that next spring and summer we will be free.