June 2020 - NHS Providers

Tuesday 30 June

Health and Social Care Committee oral evidence session

The Health and Social Care Committee held an oral evidence session as part of their enquiry into Delivering Core NHS and Care Services during the Pandemic and Beyond. Re-watch the session here.

The first session heard from Chris Hopson, Chief Executive, NHS Providers; Professor Andrew Goddard, President, Royal College of Physicians.

The second session heard from Sir Simon Stevens, Chief Executive, NHS England and Improvement; Professor Stephen Powis, National Medical Director, NHS England and Improvement; Amanda Pritchard, Chief Operating Officer, NHS England and Improvement.

First session:

Significantly increased demand: backlog, pent up demand, COVID demand
Trusts have significant capacity constraints: losing 20-40% of pre-COVID capacity
Trusts working hard to restart services – growing gap between demand and capacity
Only 7% of members feel ready to meet needs of users
Need mature debate about priorities and recognise the need to be realistic about what the NHS can do
No clear plan for regular staff testing – trusts need time to prepare, little progress in last two months
Need to continue using independent capacity, more capital investment, community services under pressure with COVID rehab – needs more investment to recognise extra demand, recognise mental health demand
Respiratory and rehabilitation medicine is seeing a lot more demand from COVID
Concerns about winter – potential big flu season and second wave of COVID
Workforce concerns – exhaustion and retention
Problems to take up returnee clinicians – need to work through for winter
Need national guidance for prioritisation
Trusts want to keep flexibility to help with recruitment and retention

Second session:

Elective treatment

Elective admissions in March/April were around 725,000 fewer than pre-COVID level expectations
Currently at 55-60% of pre-COVID elective activity levels – expecting 75% going into August
Waiting list actually dropped by 0.5m people between Feb and April – waiting list will go down before it goes up as fewer people coming forward
4/5 of patients on waiting list are typically waiting for a test/outpatient appointment rather than a hospital operation
Need to expand diagnostic capacity in new ways
Taking targeted action to support cancer pathways
Poor communications of bad news? Patients experience of cancer care has been highest in five years – hospital teams have work to communicate effectively to patients

Mental health

There will be increased mental health demand – the precise size and shape is yet to be determined (studies are underway)
Too many buildings are out of date for mental health facilities – welcome the PM’s capital investment announcement

Testing

A very difficult period of NHS staff – need to keep things that have worked well to support staff as a routine offer
17^th March letter – why did the letter not say patients going into care homes should be tested? Necessity to ensure hospitals could deal with the challenges, advice from SAGE was that up to 2m people may need hospitalisation therefore huge effort to free up beds. Only 2.8% of discharged patients went to a care home (significantly lower than last year). Guidance was changed in April. Testing capacity was constrained at the time.
Care homes asked for help from NHS and have been told community nurses will not be sent out. Would the NHS be willing to do this? Offer to all care homes on IPC. Clear commitment to bring forward enhanced carer’s package.
Why no routine testing for all NHS staff? Testing has evolved. Don’t have evidence base to know how frequently staff should be tested. Need to have a controlled study to understand the gold standard for testing. Do want to expand testing.
Aim is to have significant extra lab capacity for testing by end of Sept/Oct

PPE

PPE situation has improved dramatically and looking forward, DHSC have increasing confidence that supply will be available on a predictable basis rather than ‘just in time’. Working with organisations to ensure a range of different masks to ensure more flexibility in choice of masks. Also working with organisations which have a preference for a particular type of mask.
Will supply of PPE be able to keep up with winter demands? Security of supply is more robust. Important to build up capacity.
At what percentage do you expect NHS to function? Working hard to get back to, as close as possible, normal levels of activity. Short term – keen to keep arrangements with independent sector, supporting workforce, using technology.

BAME staff

Over 60% of healthcare worker deaths were from BAME backgrounds. What are you doing to protect BAME staff? Risk assessment frameworks and tools have been sent out to organisations which have been asked to complete them in the next few weeks.
Why has little progress been made in diversity at management levels? Demonstrable progress in core HR measures of fairness at work. 30% increase in BAME senior managers. Every organisation in London has BAME representation on the board. Independent Race and Health Observatory to catalyse wider changes in offering services to different community groups. Huge change programme needed across the NHS.
ITV news: 50% felt discrimination played a part in BAME NHS staff deaths – reports that white colleagues are being sent to green wards and BAME staff being sent to red words. Is there a structural problem in the NHS with racism? Systemic issues. BAME staff encouraged to speak freely. Difference of staffing mix across the country. Reality that NHS has always relied on a diverse workforce and must be a better employer.
Want to move away from competitive tendering of services.
Concerns that community health providers should undergo a tendering process right now.
Barriers to recruiting NHS professionals? Need to attract international staff and grow staff from UK. Plausible that biggest intake of undergraduate intake of nurses this autumn.

A&E

A&E attendances back to 2/3 of normal level, emergency admissions back to 80% of normal level
Want to move to a 111 first model – piloting in areas
Role of national aggregated targets – some argue leads to micromanaging of chief executives. Move towards local standards rather than aggregated targets? Continue to need national goals for overarching improvement. Engaging with considerations.

Social care

Should there be some other form of stepdown care to prevent discharge of COVID patients to care homes? Being considered.
Remote support to care homes was part of IPC response.
70% of care homes have accepted IPC support from NHS.

ONS deaths registered weekly in England and Wales week ending 19 June 2020 (week 25)

This week’s data gives us promising news that COVID-19’s impact on mortality is reducing, where total deaths in the country are now below the five-year average. This holds true in all settings except private homes, where deaths remain well above average. In most regions, total deaths are now approaching or below the five-year average, with the exception of East Midlands and Yorkshire and The Humber. Deaths due to COVID-19 fell this week to 783, down 29.7% from 1,114 last week.

Key findings

For the first time in 14 weeks, the total number of deaths has fallen below the five-year average at 9,339 deaths (65 deaths or 0.7% below the five-year average).
Deaths in both hospitals and care homes are now below the five-year average. Private homes are the only setting with deaths above the five-year average this week, with 827 excess deaths (36.9% above the average). This could be because people are staying away from A&E through fear of catching COVID-19.
The proportion of deaths in care homes involving COVID-19 reduced from 17.3% last week to 12.9% this week.
The East Midlands continues to have the highest percentage of deaths above the five-year average (6.6% higher) whilst the North West continues to be the English region with the highest number of COVID-19 deaths at 134 deaths.

The number of total deaths falls below the five-year average for the first time in 14 weeks.

The number of deaths registered in England and Wales in the week ending 19 June 2020 (week 25) was 9,339, this was 637 fewer than Week 24 (6.4% fewer). For the first time since week 11, the number of total deaths has fallen below the five-year average, where there are now 65 fewer deaths than the five-year average (0.7% below the five-year average).
783 deaths registered in week 25 mentioned "novel coronavirus (COVID-19)", down from 1,114 last week. This week, the number of COVID-19 deaths accounts for 8.4% of all deaths registered, down from 11.2% the week before. This is the lowest number of deaths involving COVID-19 in the last 12 weeks.
Between 28 December 2019 and 19 June 2020, 49,371 deaths involving COVID-19 were registered in England and Wales.

Location – East Midlands continues to have the highest excess deaths

The number of deaths involving COVID-19 continued to decrease across all English regions, with four of the nine regions having fewer overall deaths than the five-year average in week 25.
The North West continues to be the English region with the highest number of COVID-19 deaths at 134 deaths (although down from 196 last week).
Yorkshire and The Humber had the highest proportion of COVID-19 deaths accounting for 11.7% of all deaths.
The East Midlands continues to have the highest percentage of deaths above the five-year average (6.6% higher, down from 18.2% last week) whilst the East of England has the lowest percentage of deaths below the five-year average (6.8% below).

Setting – deaths in all settings aside from private homes are now below the five-year average

In week 25, the number of excess deaths decreased in all settings compared with the week before. For the first time since week 11 (week ending 13 March 2020), care home deaths were lower than the five-year average (49 deaths or 2.5% below average). Hospitals also witnessed deaths below the average (782 or 17.9% fewer deaths than the five-year average). Private homes were the only setting with deaths above the five-year average at 827 deaths or 36.9% above the average (down from 923 last week).
While total deaths in private homes remain high, only 1.7% of these were due to COVID-19 this week, and commentators such as the Health Foundation suggest that the high number of excess deaths could be a result of people being reluctant to attend A&E amid fears that they will catch the virus (to read more).
In Week 25, the proportion of all deaths occurring in care homes continued to decrease to 20.7% (down from 21.4%).
There were 458 COVID-19 deaths occurring in hospitals, 249 in care homes, 52 in private homes and 21 in hospices.
In care homes, the proportion of deaths involving COVID-19 reduced from 17.3% last 12.9% this week.
The proportion of COVID-19 deaths occurring in hospitals decreased from 59.7% last week to 58.5%. The proportion of deaths occurring in care homes also decreased from 33.1% last week to 31.8%. In contrast the proportion of COVID-19 deaths in private homes increased slightly from 1.6% last week to 1.7%.
Year-to-date figures up to week 25 show that 63.5% of COVID-19 deaths occurred in hospital, 29.7% in care homes, 4.6% in private homes and 1.4% in hospices.

Deaths by age and gender remain consistent with previous weeks

The highest proportion of COVID-19 deaths were of those aged 80 to 84 years and 85 to 89 years, where 10.5% and 10.3% of deaths were due to COVID-19.

For the eighth week running, more females aged 85 years and over than males have died from COVID-19. Year to date figures show that 11,286 females in this age bracket have died compared to 9,566 males. This could be because due to there being more females (939,000) than males (564,000) in this age group.

Sources:

Source 1

Source 2

Monday 29 June

Matt Hancock gave an oral statement on local action to tackle a surge in COVID-19 cases in Leicester - https://www.gov.uk/government/speeches/local-action-to-tackle-coronavirus. The full debate is here - https://hansard.parliament.uk/commons/2020-06-29/debates/0F09C0AB-4A72-4E67-832A-1F8FC07F2D2E/Covid-19Update

ONS released data on Coronavirus and shielding of clinically extremely vulnerable people in England. This dataset is published once a fortnight and provides an analysis of the behaviours and mental and physical well-being of clinically extremely vulnerable people (the shielding population) in England during the pandemic. Note: The guidance for clinically extremely vulnerable (CEV) people changed on 1 June and advised that CEV people could leave the house for exercise.

Key findings:

Of the 2.2 million clinically extremely vulnerable (CEV) people, 1,423,000 people (63%) reported completely following shielding guidance. This is the same proportion as in the previous report.
46% of CEV people had left their home within the last seven days. The most common reasons for leaving their home were: for exercise (54%), for a GP or hospital appointment (26%) and to shop for essentials (24%).
Since being advised to shield, 36% of CEV people have reported that their mental health has got worse. This is up slightly from 35% in the previous report.

Source: https://www.ons.gov.uk/releases/coronavirusandshieldingofclinicallyextremelyvulnerablepeopleinengland9juneto18june2020

The Department for Health and Social Care has published guidance for the NHS Bursary Scheme rules 2020. The NHS Bursary Scheme new rules (9th edition) are for the academic year from 1 September 2020 to 31 August 2021.

They apply to:

medical and dental students (bursary-eligible study years)
non-medical students who started their course on or after 1 September 2012 but before 1 August 2017
non-medical postgraduate students who started their course on or after 1 August 2017 but before 1 August 2018
students on dental hygiene and dental therapy courses who started their course on or after 1 August 2017 but before 1 August 2018 (included in the capped numbers commissioned by Health Education England) or started their course on or after 1 August 2018 but before 1 August 2019 at certain institutions

Friday 26 June

ONS published data on Coronavirus (COVID-19) related deaths by occupation, England and Wales: deaths registered between 9 March and 25 May 2020

The Ministry of Justice published its first weekly report detailing coronavirus-related deaths across the prison and probation service, as well as the number of confirmed cases in prisons

Slides and datasets on coronavirus: 26 June 2020

Thursday 25 June

Today we are expecting:

Statistics from the ONS on COVID related deaths broken down by occupation
The Ministry of Justice will publish its first weekly report detailing coronavirus-related deaths across the prison and probation service, as well as the number of confirmed cases in prisons

Other things to note:

The Government has published a new dashboard, with stats that would previously have been presented at the daily press conference:

https://coronavirus-staging.data.gov.uk/

Yesterday

Weekly Test and Trace statistics

Overall

This week the data is worse on all measures. There were more positive cases transferred to the system (this was explained by some cases that could not be transferred the previous week being carried over), there were falls in the proportions reached (of both positive cases and close contacts subsequently identified), and fewer positive cases and close contacts who were reached were contacted within 24 hours.

Key data headlines from week three

6,923 people who tested positive had their case transferred to the contact tracing system (974 more than last week). This is because some cases from the previous week are carried over, due to the time between a sample being taken, tested and reported and being passed from PHE to the contact tracing system.
Of these, 4,869 (70%) were reached by the track and trace system and asked to self-isolate and to provide details of recent contacts. This is a lower proportion than last week (73%)
Of these, 3,633 responded with details of their close contacts. This is 75% of the 4,869 who were reached, or 52% of the 6,923 positive cases transferred to the system) this week. These are both lower proportions than last week (82%, 60%).
This week, 70% of positive cases reached were contacted within 24 hours (down from 77% last week)
30,286 close contacts were identified, an average of 8.3 per positive case. The total number and average are much lower than last week (45,840, 15.9), which might indicate different methodology being used.
Of these close contacts identified, 24,734 (82%) were reached and advised to self-isolate. (This is down from 91% last week)
82% of the close contacts reached were contacted within 24 hours (down from 86% last week)

In total, since 28 May 2020:

20,968 positive cases were transferred to the contact tracing system, of whom 73% (15,225 positive cases) were reached and asked to provide details of their recent close contacts.
128,566 close contacts were identified, of whom 89% (113,925 close contacts) were reached and asked to self-isolate.

Wednesday 24 June

PMQs summary
Opposition day debate on testing NHS Staff
Written ministerial statement on testing NHS staff

1. PMQs summary

Starmer / Johnson exchange

Starmer started on test and trace, saying that although Labour welcome the plan for releasing lockdown, for it to work, the UK needs an effective test and trace system. The latest figures show around 30,000 people are infected. But only around 10,000 people are being reached by test and trace. Johnson responds that 87,000 people have been contacted and have agreed to self-isolate. Starmer stays on test and trace and asked what the is strategy for reaching those missed. Johnson says Starmer has inadvertently misled MPs. He says the scheme has contacted the vast majority of people who tested positive.

Starmer says he is using the government’s own figures. He then moves on to local lockdowns, and says councils still don’t have the guidance they need to implement these local lockdowns. Johnson responds that there is an effective “cluster-busting operation and that councils will be supported.

Starmer turns to the app and asks how you contact everyone in a crowded place without one. The government used to say it was critical. Now it is only additional. Is it critical or not? Johnson says Starmer cannot name a single country in the world with a successful app, because there is not one. Starmer says Germany has a functioning app. It has 12m downloads. When are we going to have a working app? Johnson responds that Starmer is wrong. No country has a working, contact-tracing app. He says the UK has a fantastic test and trace system running that will be essential to the UK’s success. He asks Starmer is clear up whether he wants Labour councils to encourage pupils back to school?

Starmer responds that yes he does want them back. He says the children’s commissioner has said that Johnson was wrong about child poverty last week. He has been found out. Will he correct the record?

Johnson does not accept that, he says the biggest cause of child poverty is children not going to school.

Health and social care related questions:

Ian Blackford, Leader of the SNP in Westminster, highlights the letter from the BMA, RCN and others and says there is an economic emergency as well. Johnson says he will look at the report.

2. Opposition day debate on testing NHS Staff

Labour held an opposition day debate yesterday which called for routine testing of all NHS staff.

https://hansard.parliament.uk/commons/2020-06-24/debates/5056F5C3-1576-40AE-BFF7-CF84BE599156/TestingOfNHSAndSocialCareStaff

3. Written ministerial statement on testing of NHS staff

educing healthcare-associated COVID-19 infection is a top priority. Today, the NHS has set out plans for testing of NHS staff. This includes continuing to prioritise testing of all NHS staff with symptoms, asymptomatic regular testing of staff in situations where there is an incident, outbreak or high prevalence and regular surveillance testing across all staff. Under the risk-based approach advised by clinical experts, we are continually reviewing clinical evidence to ensure regular testing of asymptomatic staff is undertaken where appropriate. The CMO’s advice is that this is currently best done through a survey, which monitors prevalence in NHS staff. This survey, which will be expanded over the coming months, helps us to determine where wider asymptomatic staff testing is needed. Clinical advice is to focus intensive asymptomatic testing in those areas or settings identified to have high prevalence. This dynamic approach which responds to risk is essential as when prevalence is very low, the risk of misleading results is higher and this can undermine the value of testing. We will continue to keep clinical advice under review.

I also want to clarify a point on the predominant reason for the minority of positive cases that do not go into the NHS test and trace scheme. On June 17^th I set out that they are largely in-patients in hospital and therefore testing and tracing in the normal sense does not apply. Testing and tracing is different for hospital in-patients than for the general public, as contact tracing is usually done by the hospital rather than by NHS Test and Trace contact tracers. Local hospital infection control teams are often best placed to do the contact tracing for inpatients as these individuals may not be in a position to be able to communicate their contacts and hospitals will have a clear list of patients on wards, staff and shift patterns. This is standard practice for other infections. The data from these hospital in-patients do enter the NHS Test and Trace system. Positive cases who are not contacted by the contact tracing system are either those who do not respond to repeated attempts to make contact (through phone, SMS and email contacts) or for whom NHS Test and Trace has incorrect contact details. Further data will be set out by NHS Test and Trace tomorrow in the normal way.

Source:

Link to source

Tuesday 23 June

Daily press briefing
PM’s statement to the House of Commons
Health and Social Care oral questions
Deaths registered weekly in England and Wales, week ending 12 June 2020 (week 24)

1. Daily press briefing

Prime Minister Boris Johnson delivered the daily press briefing, alongside Professor Chris Whitty, chief medical officer and Sir Patrick Vallance, chief scientific adviser.

Slides and dataset

The Prime Minister went through the 5 tests and set out which parts of the economy will be able to reopen in July.

Sir Patrick Vallance:

R level is below 1 across the UK
Steady decrease in the number of people with COVID, important to remember the infection is still here
Coming back down to average levels of death

Professor Chris Whitty

Have to live alongside this virus for a long time, about finding a balance of risk
Decisions have been taken as part of a multi-layered defence to avoid the spread of the virus.
People must self-isolate and ask for a test if become symptomatic.
All have to do the things that make it harder to pass the virus on: Handwashing, wearing face coverings
Critical that individuals and firms take the new guidelines seriously: Stay 2m apart where possible, sitting side by side, physical barriers, ventilation, face covering, regularly cleaning areas.

Q&A

When will dental care and primary care restart properly?

Johnson: want people to return to services, dentistry and primary care have restarted.

Whitty: GPs have been working throughout this. Steady movement to return to normal services.

Journalists

Laura Keunssberg: BBC: Will you take responsibility whatever happens next? Johnson: Hopefully everyone will understand the balance. Of course take responsibility for these decisions.

Chris Whitty have you changed your mind on the 2m? Advice to stay at 2m if you can remains. Where it isn’t possible, have looked at mitigations, which if people take seriously, possible to reduce risk equivalent to 2m.

Robert Peston, ITV: Can we expect any further relaxation of social distancing, until have a vaccine or a majority are immune.

Johnson: Have R down and seeing reduction in incidence of virus in population. As the chances of coming into contact with someone with virus come down, there will be opportunities to ease further.

Whitty: we are going to be living with this virus for a long time. Measure might have to be reintroduced in the winter. Ministers shall decide on future relaxations. He added that epidemiology over time is key to looking at measures. The science can provide further information on the virus. He stressed this would be a long haul.

Sam Coates, SKY:

Johnson: Have been even handed in the way I’ve set this out. Couldn’t have been clearer that we must be cautious.

Have been clear the risk hasn;’t gone away, how worried are you that this might cause an uptick in cases. Did SAGE officially fully approve the changes?

The job of advisers is not to sign things off, it’s to give advice.

Daily Express: how long we would be living like this? He asked whether a vaccine or treatment is the only way for change? Vallance said that he cannot put a time on it. He said that therapeutics and vaccines are the way of fixing this and was optimistic of some progress. Whitty said he would be surprised and delighted if we were not in the situation into the winter.

2. Prime Minister’s statement to the House of Commons

The Prime Minister delivered a statement to the House of Commons, setting out the easing of lockdown restrictions.

The number of new infections declining between 2-4% every day
Four weeks ago, 1 in 400 people in England had CV-19 First half of June: 1 in 1,700
Do not believe there is currently a risk of a second peak which will overwhelm the NHS. Continue to meet 5 tests. Chief medical officers have downgraded alert level from 4 to 3.
PM warned there will be flare ups, and might require local action, and reverse the easing.
Each step will be conditional and reversable

2m social distancing rule will be changed from 4 July – where it is possible to keep 2m apart people should. 1m apart while taking mitigations to reduce transmission. Will be publishing guidance shortly.
Rules around social contact are now guidance instead of legislation. Gives people much more leeway to assess their own risks.
From 4^th July 2 households of any size will be able to meet inside. They do not have to be the same two households. But not recommending multiple households
People from several households can meet in groups of up to six.
Reopening restaurants and pubs, limited to table service, minimal staff and customer contact. Will need to give contact details for track and trace
Hairdressers will reopen with appropriate precaution
People will be able to stay at self-catering homes and camp sites
Outdoor gyms and playgrounds, theme parks, libraries, social clubs, will re-open
Nightclubs, soft play, indoor gyms, swimming pools and spas, bowling alleys and water parks will remain closed for now.
Recreation and sport allowed, but changing rooms and indoor facilities must remain closed.
Close contact team sports with members of household
Weddings with a maximum of 30 people, and social distancing.
Courts resuming face to face proceedings.
Wrap around care and formal childcare will restart over the summer.
Primary and secondary schools will restart in September.

Starmer / Johnson:

Starmer said Labour supports reducing the 2m rule and “welcomes the thrust” of the announcements. He supports some children back at school now and wants all kids back and offers to help. He asks for assurances that Johnson has the support of Sage and for assurances about test and trace. He says Labour wants more detail and more clarity.

Johnson replied that CMO / CSA have been ‘intimately involved’ in the decision. On test and trace, he says no country has no country has a functioning trace and trace app.

Full transcript

3. Health and Social Care oral questions

Today’s Health and Social Care oral questions covered topics on:

Delayed cancer treatment – drop in referrals and missed diagnoses
Health inequalities
Progress of NHS Test and Trace – local data flows, criticism of missed cases
NHS contract tracing app – criticism of delays
Mental health support for frontline NHS and care staff
Support for care homes – guidance for visitors, whole care home testing
Nursing – vacancies and students
Impact of Brexit
Vaccine

List of oral questions is here and full transcript.

Jeremy Hunt (Chair of Health and Social Care Committee): Up to 250,000 people may have been missed since the NHS Test and Trace programme began; the programme traces 700 people per day but ONS figures suggest 2,500 new cases per day. What is the government doing to improve test and tracing?

Hancock said he did not agree with Hunt’s assessment and the programme is expanding over time.

Rosena Allin-Khan (Shadow Minister for Mental Health): Is the government satisfied with the support for frontline staff?

Recognise the burden on frontline staff. As trauma may time to present, important that support is in place.

Jon Ashworth (Shadow Health Secretary): The government wasted £12m and three months on the NHS app. GPs cannot refer people for testing and NHS workers are still not receiving regular testing. When will there be a fully functioning test, trace and isolate programme?

NHS has been working on the app and the Opposition should support them rather than showing opposition for opposition’s sake.

Munira Wilson (LibDem Health Spokesperson): When will there be a white paper on the mental health bill which enshrines the tackling of racial disparities in mental health treatment?

Work is underway to bring forward the white paper.

Gareth Davies MP: United Lincolnshire Hospitals NHS Trust closed for admissions to Grantham Hospital. There is scepticism about this action. Will the Secretary ensure that COVID-19 is not used as an excuse to make these changes permanent.

Issue has been discussed and Grantham Hospital will be open as a 24/7 urgent treatment centre.

4. Deaths registered weekly in England and Wales, week ending 12 June 2020 (week 24)

This week’s data tells us that deaths due to COVID-19 continue to reduce nationally but total deaths (COVID-19 and non-COVID) remain above the five-year average. In care homes, the picture is similar where COVID-19 deaths are falling but total deaths are still above the five-year average. The North West of England continues to be the region with the highest number of COVID-19 deaths for the sixth week running.

Key findings

The number of deaths registered in England and Wales in the week ending 12 June 2020 (week 24) was 9,976. This is 733 fewer than the previous week, but still 5.9% (559 deaths) higher than the five-year average.
The number of COVID-19 deaths continues to decrease, and is the lowest in the past nine weeks at 1,114. This accounts for 11.2% of all deaths in England and Wales (down from 14.8% last week).
Total care home deaths continue to be above the five-year average (199 more deaths) despite the proportion of deaths in care homes overall decreasing this week (now 21.4%, down from 22.6% last week).
East Midlands is the region with the highest proportion of excess deaths this week (18.2% above the five-year average), while the North West again has the highest number of COVID-19 deaths (196 deaths)

The number of COVID-19 deaths is the lowest for nine weeks

There were 9,976 deaths registered in England and Wales this week, which is 733 fewer than the previous week, but is still 5.9% (559 deaths) higher than the five-year average.
Of the deaths registered in week 24, 1,114 mentioned "novel coronavirus (COVID-19)". This is the lowest number of deaths involving COVID-19 in the last nine weeks and accounts for 11.2% of all deaths in England and Wales (compared to 14.8% of all deaths in the previous week).
A total of 48,538 deaths involving COVID-19 were registered in England and Wales from the start of the year to 12 June.

Location – East Midlands has the highest number of excess deaths

This week, total deaths remain above the five-year average in all regions except the North East. The East Midlands had the highest percentage of deaths above the five-year average (18.2% higher).
The number of deaths involving COVID-19 continued to decrease in all regions in England.
The North East had the highest proportion of deaths involving COVID-19, with 14.9% of all deaths in the region involving COVID-19 (down from 19.6% last week).
The number of deaths involving COVID-19 was highest in the North West for the sixth week at 196 deaths (down from 250 deaths last week).

Setting – Care home deaths falling, but total deaths remain above the five-year average

While the total number of excess deaths continues to decrease, the number of deaths in care homes this week remains higher than the five-year average (199 excess deaths).
This week there were 369 COVID-19 deaths in care homes, down 35% from last week (195 fewer COVID-19 deaths).
In week 24, the proportion of total deaths occurring in care homes fell slightly to 21.4% (down from 22.6% last week) while deaths involving COVID-19 as a percentage of all deaths in care homes decreased to 17.3% (down from 23.4%).
In week 24, the proportion of COVID-19 deaths occurring in hospitals increased to 59.7% (up from 57.2% in week 23) while the proportion of COVID-19 deaths occurring in care homes has decreased to 33.1% (from 35.5% in week 23).

Age and gender

COVID-19 related deaths remain higher amongst the older age groups. The highest proportion of COVID-19 deaths were in the 85 to 89 years old age group, where COVID-19 deaths accounted for 14.2% of all deaths (243 deaths).

For the seventh week running, more females aged 85 years and over than males have died from COVID-19. Year to date figures show that 11,035 females in this age bracket have died compared to 9,427 males. This could be because due to there being more females (939,000) than males (564,000) in this age group.

Source:

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/articles/comparisonofweeklydeathoccurrencesinenglandandwales/latest

Monday 22 June

Today’s roundup includes:

Daily press briefing
Summary of Public Accounts Committee oral evidence session on Readying the NHS and social care for the COVID-19 peak – with Simon Stevens, chief executive at NHSE/I and Amanda Pritchard, chief operating officer at NHSE

1. Daily press briefing

Today Matt Hancock, secretary of state for health and social care , was joined by Dr Jenny Harries, deputy chief medical officer for England.

Slides are available here.

Over 8 million tests in total have been carried out
The number of cases confirmed is under 1000 for the first time since the peak
Fewer than 5000 people are in hospital with COVID-19 for the first time since the peak
Yesterday 15 more deaths were reported – the lowest figure since 15 March (but it is a weekend figure)
1 in 1700 people have the virus

Dr Jenny Harries

Community transmission levels are back to those before shielding commenced and therefore we are in a position to relax the advice in the coming weeks.
From 6 July – people who are shielding may meet up with groups of up to 6 people outside and shielding people living alone may form a support bubble.
From 1 August – shielding programme will be paused for all but people will still be advised to minimise contact with others, continue social distancing and handwashing, and people may return to work as long as it is safe.
Work is underway to ensure that if the shielding programme is restarted, it will take a more individualised approach.
New Risk Assessment Research Methodology will be published today.
New guidance from RCPCH recommend children and young people are very unlikely to need to continue to shield in the future.

Matt Hancock

Hancock thanked the 2.2m people who have been shielding and acknowledged the burden they have had.
In the coming days, everyone shielding will receive a letter with updated advice.
Medicine deliveries and food boxes will continue until the end of July.
Money is available to councils for those struggling to buy basic necessities.
Employers are expected to do the right thing.
NHS will maintain the shielding list and shielding may be reintroduced if the clinical guidance calls for it.

Q&A

Hugh Pym, BBC: what reassurances are there for people who have been shielding will not be returning to work will continue to be supported?

Hancock: employers must be understanding and ensure the work environment is COVID-secure.

Harries: all the guidance for businesses is scrutinised to ensure the safety of employees is maximised.

Sam Coates, Sky: will shielding children be able to go to school in September? Is there concern about the increase in global cases?

Harries: Children will be able to return to school, continue to monitor the global situation.

Andy Woodcock, Independent: is there a division between the scientists and the government over relaxing lockdown? How concerned are you about how Germany’s R rate shot up after easing lockdown?

Hancock: have been taking advice from the scientists, science has competing voices and we listen to all the advice.

Harries: people must continue to adhere to social distancing and handwashing. As number go down, the R rate becomes less reliable.

Chris Lloyd, Northern Echo: what explains the high rate of COVID-19 in the north east regions? What assurances can be given to people shielding who are concerned about hotspots in the north east?

Hancock: levelling up agenda is even more important as a result of this pandemic, needs to be a more even distribution of health and wealth. Will need to look at regional differences.

Harries: less affluent areas have been worst hit across the world.

Other topics:

Government borrowing and infrastructure projects
Travel corridors – 29 June is the next review date for formalising travel corridors
Bank of England
Children and schools
Employee rights and support for shielded people

2. Summary of Public Accounts Committee oral evidence session on Readying the NHS and social care for the COVID-19 peak – with Simon Stevens, chief executive at NHS England and Improvement and Amanda Pritchard, chief operating officer at NHS England

The Public Accounts Committee held an oral evidence session as part of their inquiry into Readying the NHS and social care for the COVID-19 peak. Questioning in the session is based on the NAO report Readying the NHS and adult social care in England for COVID-19.

Witnesses:

Sir Chris Wormald, Permanent Secretary, Department for Health and Social Care,
Sir Simon Stevens, Chief Executive, NHS England,
Amanda Pritchard, Chief Operating Officer, NHS England and NHS Improvement,
Catherine Frances, Director General, Communities, Ministry of Housing, Communities and Local Government,
Steve Powis, National Medical Director, NHS England,
Ros Roughton, Director General, Adult Social Care, Department for Health and Social Care,
Professor Paul Johnstone, National Director for Place and Regions and Deputy SRO for PHE COVID-19 response, Public Health England

Adult social care sector:

Discharge into care homes from hospitals

Wormold: did a lot of work with social care up to April. More challenging to work in social care sector. “I’m not denying there were big problems ... But I don’t accept ... that decisions were not soundly based on science at the time”
Powis: first few weeks of March, number of cases, was not high. Could see there would likely be large increase in cases. Clear from worst case planning that NHS risked being overwhelmed. The ask was to discharge those who were clinically fit to be discharged. The vast majority of COVID cases were not in hospital – wrong to equate hospital treatment with COVID. There are processes in place in hospitals to ensure people who no longer require treatment can be discharged.
Wormold: not going to say every piece of guidance was correct, in a process of learning as we go along. Based on information we had at the time, our guidance was correct. Guidance is carefully considered and based on best clinical advice we had at the time. Considerable risks to people staying in hospital both outside COVID outbreak and within.
Was there more money available to care homes willing to accept COVID patients / non tested patients out of hospital? No
What's going to change so in future there's equal clarity around support for NHS (beds and ventilators) as for the safety of people in care homes? Wormald: there is a considerable consensus in Parliament and elsewhere that there needs to be change [on social care] and I do think our experiences with COVID heighten that need.

Testing:

Why did it take so long to ramp up testing? In late Jan were able to identify recipe for test, and distribute so by the end of March 40 NHS labs could do the test for COVID-19. Fastest deployment. Wider testing strategy was about bringing in other players. We achieved ‘pillar 1’ and remaining tests led by DHSC – pillar 2 – ramped up in April. Worked internationally, deployed it and supported ‘lighthouse labs’.
Could you not have prioritised care homes? Wormold: NAO report sets out clearly the build up of capability. Number of tests in early period was limited, and smaller than we would have wanted. Acted on clinical advice on how to use limited capacity. We will learn from testing experience, have evolved most over the period of this epidemic.

As testing capacity grew more tests were made available to care staff.

Increasing testing for NHS staff, have started testing all patients coming in and testing all staff who may be asymptomatic. Different trusts have been asked to review locally. Will continue to guide trusts as learn more.
Testing for care staff – blanket testing to all staff, will be making decisions shortly about frequency of repeat testing in care sector.

PPE:

Roughton: At no point was there an instruction to prioritise the NHS. Things weren’t redirected from the care centre to the NHS. Emergency lines through National Distribution Centre.

Restarting services:

Trying to find right balance between keeping patients and staff safe, with continued coronavirus cases, but also support to restart critical services. Making sure we think about flexible capacity as we head to winter. Planning to maintain the Nightingale facilities on a standby basis. Have been careful about maintaining access for critical services, and believe this is where the partnership with the independent sector can be re-geared

How is winter being planned for? Active discussions underway. Part of answer is maintaining Nightingale capacity and to have continued access to independent sector, emphasising flu vaccination programme.
Independent sector. Stevens: want to make use of independent sector until end of year. Want to use them for elective care, diagnostics, cancer in the next phase.
How much has contract cost: How much will you need for next phase? Contract on an ‘at cost basis’ figures are still in basis of being worked out. Different type of arrangement going forward.
How many of the private sector beds have been used? Stevens: several hundred thousand patient treatments have taken place -- which is a combination of operations, outpatients, chemotherapy (etc).

PPE:

Wormald: the government did implement recommendations from the Cygnus planning exercise in 2016 but that involved plans for a flu pandemic. Coronavirus has created a much higher demand for PPE in hospitals. Stockpiles we had have been used, but weren’t specifically designed for this pandemic.
Where are we in planning for sufficient PPE for second wave? Do we have that in place? Wormold: In a better place with PPE supply. Now at a position looking 90 days ahead. Putting in place plans to go beyond 90 days. Stevens: NHS have provided central PPE team with suspected demand volumes, they are seeking to source that volume 90 days and beyond.
Wormold: Guidance changes as we learn more about virus. Put out guidance that is clinically appropriate and that we can supply that.

Mental health:

How is NHS looking after mental health of employees? Stevens: part of response has to be to ensure support for staff. Last year introduced dedicated mental health programme for doctors, and asking for that to be expanded in trusts.
When will people plan be published? Have been getting on with elements of people plan regardless. A lot of the things we were planning to do we have fast tracked. People plan is about funding for education and training, as well as current staff. Getting on with aspects we can.
What problems are we likely to see in wider population (loneliness) Stevens: Do believe there will be extra pressure on MH services, so will need to fast track services outlined in people plan.

Funding:

How has £6bn from Treasury been spent? Funding planning for future peak? Stevens: Having discussions with government as we speak. The fact that the NHS wasn’t overwhelmed shouldn’t be taken for granted, spending on extra capacity was necessary.
How will you make sure the money already invested will get used in case of second peak? Having dialogue on this now. Ensuring NHS get clear early signal of potential rise in cases is important.

Workforce:

Did you have enough staff and do you have enough staff ready to deal with second peak? Went into dealing with pandemic with over 100,000 shortage of staff. Under highly stressful circumstances NHS was able to cope.
What are you doing to make sure staff are ready to cope with another peak? Want to try and make people who came back to stay.
Can you afford to staff the NHS at a higher level? Actively discussing this at the moment. Vacancies were to do with supply rather than lack of resources.

Other topics:

NHS volunteer scheme - cost to department / value for money
Data on deaths in care homes
Restarting dentistry
Temporary NMC register and the student placements

Friday 19 June

Today’s round up includes:

Daily press briefing
COVID outbreaks in care homes - 8-14 June data
ONS data on COVID-19 deaths by ethnicity, disability and religion
Coronavirus and the social impacts on Great Britain data

1. Daily press briefing

Gavin Williamson, secretary of state for education led today’s briefing.

Slides and datasets (not yet published)

Data

The COVIDalert level has moved from level 4 to level 3 across the UK in agreement with the Chief Medical Officers from the four nations
Daily stats:

As of 9am 19 June, there have been 7,433,114 tests, with 169,600 tests on 18 June.
301,815 people have tested positive.
As of 5pm on 18 June, of those tested positive for coronavirus, across all settings, 42,461 have died, an increase of 173 from yesterday.

The R rate estimate still remains at 0.7 to 0.9. We need to keep this below 1

On schools

Government wants as many children back in school as possible
He thanked teachers and support staff for their work so far
He outlined the catch-up plan announced today which will provide a £650m universal catch up premium for all state school children in the UK. The Education Endowment foundation has published a briefing on how the premium can best be spent
Schools will have the discretion to tailor this funding
Further information and guidance will be published in the coming weeks, so that all classes can return in September

Q&A

Public

Swab test is difficult for children.

Williamson: government is trying to get better testing for all children

When will new shielding advice be available?

Williamson: Government will publish guidance shortly

All other questions focused on education:

How will all children be back in school in September?
is 2m rule going to be relaxed now UK is at level 3?
Additional money for educations sector
Should children be taught more about Britain’s colonial past and will you change the curriculum
Should state schools be doing more interactive lessons

COVID outbreaks in care homes - 8-14 June data

The data from 8-14 June which shows how many confirmed or suspected COVID outbreaks in care homes Source: https://www.gov.uk/government/statistical-data-sets/covid-19-number-of-outbreaks-in-care-homes-management-information

Take away: the number of outbreaks in care homes remain stable and only slightly lower than last week - but the pace of decline has slowed/nearly halted

Findings:

There are 15,507 care homes in England. This week there were 101 confirmed or suspected outbreaks in care homes (106 last week). This figure is the lowest its has been since the second week in March.
The cumulative data shows there has been 6,438 outbreaks in care homes - this means that 42% of all care homes have had a suspected or confirmed COVID outbreak.
There is variation by region. Below are the cumulative figures:

Region	Outbreaks	Coverage of outbreaks in area (%)
East of England	778	45.2%
East Midlands	546	35.5%
London	654	46.9%
North East	398	53.3%
North West	901	47%
South East	1,215	41.2%
South West	594	29%
West Midlands	671	39.5%
Yorkshire and Humber	681	45.6%

PHE also put out a useful infographic: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/893025/COVID19_Care_Homes_17_June.pdf

ONS data on COVID-19 deaths by ethnicity, disability and religion

ONS data published today continues to show those from BAME groups have higher death rates from COVID-19. Data has also been released on COVID-19 deaths by disability and religion, with those with disability having higher death rates, while those from Muslim, Jewish, Hindu and Sikh religious groups also have raised death rates.

Coronavirus related deaths by ethnic group, England and Wales: 2 March to 15 May

Overview

The latest ONS data out today (covering 2 March to 15 May 2020) continues to show those from BAME groups have higher rates of death from COVID-19. This is an update from the previous ONS analysis in early May, which considered COVID-19 deaths up to 10 April. the ONS have published a comment blog to accompany the data.

Headlines

For all ages, the rate of COVID-19 deaths for black males was 3.3 times greater than that for white males of the same age, while the rate for black females was 2.4 times greater than for white females.
After adjusting for region, population density, socio-demographic and household characteristics, the raised risk of death involving COVID-19 for people of Black ethnic background of all ages together was 2.0 times greater for males and 4 times greater for females compared with those of White ethnic background.
Males of Bangladeshi, Pakistani and Indian ethnic background also had a significantly higher risk of death involving COVID-19 (1.5 and 1.6 times, respectively) than white males once the above characteristics were accounted for; whilst for females in Bangladeshi or Pakistani, Indian, Chinese and Mixed ethnic groups the risk of death involving COVID-19 was equivalent to white females.

Comments

ONS analysis continues to show that people from a Black ethnic background are at a greater risk of death involving COVID-19 than all other ethnic groups. The risk for black males has been more than three times higher than white males and nearly two and a half times higher for black females than white. Adjusting for socio-economic factors and geographical location partly explains the increased risk, but there remains twice the risk for Black males and around one and a half times for black females. Significant differences also remain for Bangladeshi, Pakistani and Indian men. The ONS will continue to research this unexplained increased risk of death, examining the impact of other health conditions.

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronaviruscovid19relateddeathsbyethnicgroupenglandandwales/2march2020to15may2020

Coronavirus related deaths by disability status, England and Wales: 2 March to 15 May

Overview

ONS data also released today (covering 2 March to 15 May 2020) that shows those with disabilities have higher rates of death from COVID-19.

Headlines

For those who said their daily activities were “limited a lot” by a health problem or disability, the rate of deaths for females of all ages was 4.0 times greater than those with no disability, for males this was 2.8 times greater.
After adjusting for region, population density, socio-demographic and household characteristics, the relative difference in mortality rates between those "limited a lot" and those not disabled was 2.4 times higher for females and 1.9 times higher for males.

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronaviruscovid19relateddeathsbydisabilitystatusenglandandwales/2marchto15may2020

2. Coronavirus related deaths by religious group, England and Wales: 2 March to 15 May

Overview

ONS data also released today (covering 2 March to 15 May 2020) that shows those in the Muslim, Jewish, Hindu and Sikh religious groups have higher rates of death from COVID-19.

Headlines

The highest age-standardised mortality rates (ASMRs) of deaths involving COVID-19 were in the Muslim religious group with 198.9 deaths per 100,000 males and 98.2 deaths per 100,000 females; people who identified as Jewish, Hindu or Sikh also showed higher mortality rates than other groups.
When taking account of region, population density, socio-demographic and household characteristics, and ethnic background, those who identified as Jewish at the time of the 2011 Census showed an increased risk of a death involving COVID-19 compared with the Christian population; Jewish males were at twice the risk of Christian males, with the difference in females being 1.2 times greater risk (additional data and analyses are required to understand this excess risk).
Those who reported having "No religion" in the 2011 Census had the lowest rate of death involving COVID-19 with 80.7 deaths per 100,000 males and 47.9 deaths per 100,000 females.

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronaviruscovid19relateddeathsbyreligiousgroupenglandandwales/2marchto15may2020

3. Coronavirus and the social impacts on Great Britain data

This week’s findings refer to 11 to 14 June 2020 and references made to last week cover the period of 4 to 7 June 2020.

Key takeaways: as restrictions are easing people are returning to a new normal with more people going back to work and children returning to school. People are more accepting and willing to adhere to social distancing measures such as keeping two metres apart and more people are wearing face coverings. However, loneliness, impact on well-being and concerns related to the virus remain.

Key findings

More people have gone back to work this week, increasing from 70% last week to 79% (inclusive of both working from home and travelling to work).
Less than half (45%) of those who travelled to work in the past week and had a job requiring physical contact with people said they often or always wore PPE.
More people are now using face coverings outside of their home, increasing from 30% to 40% and are also more likely to wear one in the next seven days, increasing from 40% to 51%.
Two-thirds (67%) of adults who were asked to send their children back to school said that their children were now attending school some or all of the time.

Leaving home

This week, the same proportion of people in Great Britain have left their home compared to last week at 92%. Of these, almost 1 in 5 (18%) said they had visited somewhere that was crowded.
Travelling to work saw the largest increase compared to any other reason for leaving the home, increasing from 26% last week to 29% this week.

Self-isolation

Regardless of whether they had the virus or not in the past seven days, a similar proportion (15%) to the previous week had self-isolated (13%).
There was a similar proportion of adults (13%) who reported that everyone had self-isolated over the past seven days in their household compared to last week (11%).

Social distancing

84% of adults said that they had avoided contact with older people or those who were vulnerable. 10% of these said the people they are avoiding are those that they provide care for.
The majority of people (95%) said they always or often kept to a two-metre distance.

Employment

A higher proportion of adults said that they had worked this week (travelling to work and working at home), increasing from 70% last week to 79% this week.
This is partly due to there being a reduction in those furloughed, where 5% of the workforce had returned to work after being furloughed between 18 May and 14 June (Business Impact of Coronavirus Survey).
A greater proportion of those who had worked in the past seven days did so from home, with 49% saying they had either exclusively worked from home or had worked from home alongside travelling to work, an increase from 41% last week.
42% of those who travelled to work in the past seven days did work that required direct physical contact with others. 45% of these said they often or always wore personal protective equipment (PPE) while at work but 29% reported never wearing PPE.

Face coverings

A higher proportion of people this week reported that they had used face coverings outside of their home in the past week at 40% (up from 30% last week).
A higher proportion of people are now wearing face coverings while travelling on public transport, increasing from 45% last week to 62% this week.
Those with a health condition were most likely to report wearing a face covering when outside of their home this week (49%), followed by those aged 70 years and over (46%).
Regardless of whether they had worn a face covering in the past, more people (51%) said they were either very or fairly likely to wear one in the next seven days, compared to 40% last week and 36% the week before.

School-age children

21% of adults with children of school age said that they had been asked to send their children back to school. Two-thirds (67%) of these said that their children were now attending school some or all of the time.
59% of adults who have home-schooled their children this week said their children were struggling to continue their education at home. The most common reasons included lack of motivation, limited parent or carer time to support and lack of guidance and support.

Indicators of concern, well-being and loneliness

Fewer people this week (64%) said that they were very or somewhat worried about the effect the virus was having on their life compared to the previous week (68%).
More adults this week said their well-being had been affected by the pandemic in the past seven days, increasing from 42% to 48%.
More people with an underlying health condition also reported that the virus had impacted their well-being compared to last week, increasing from 56% to 60%.
More adults this week reported feeling lonely either often or always, or some of the time (26%) compared to last week (21%).

Source: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/datasets/coronavirusandthesocialimpactsongreatbritaindata

Thursday 18 June

Today's round-up includes:

Daily press briefing
Lords PQ on the implementation of the COVID-19 track and trace system
NHS test and trace statistics (England): 28 May to 10 June 2020
COVID-19 infection survey pilot: England (18 June 2020)

1. Daily press briefing

Matt Hancock, secretary of state for health and social care was joined by Dido Harding, executive chair of NHS test and trace.

Slides and datasets

Daily figures

As of 9am 18 June, there have been 7,259,555 tests, with 136,516 tests on 17 June.
300,469 people have tested positive, 1,218 positive tests on 17 June, around 4500 new cases each day.
As of 5pm on 17 June, of those tested positive for coronavirus, across all settings, 42,288 have died, an increase of 135.
490 admissions with COVID-19 on 15 June
Number of people in hospitals with COVID-19 5193
Hancock says there were no excess deaths in England last week (ie, overall deaths were in line with the seasonal average). He says this is the first time this happened since mid March.

Vaccines

Imperial College London vaccine is entering human clinical trials
AstraZeneca is beginning to manufacture the treatment researched by the University of Oxford
should a vaccine become available, the Government will prioritise frontline health and social care workers and those at increased risk of death, including adults over the age of 50 and those with heart and kidney disease

NHS Test and Trace update

testing on the Isle of Wight has uncovered a technical problem that prevents the centrally developed app from working properly on Apple iPhones
Apple's design does not yet estimate distance to a satisfactory standard
NHS Test and Trace and NHSX will collaborate with Google and Apple to find a workable solution

Dido Harding

NHS Test and Trace statistics, 4-10 June

44,894 people have been identified as people who were in contact with people infected with COVID-19
40,690 were reached and asked to self-isolate
the need to copy a sixteen-digit code when booking tests has been removed
laboratory shift patterns have been adjusted to match when samples arrived
testing results will be combined with regular GP records

Q&A:

Hugh Pymm, BBC: When will the app be involved in contact tracing?

Hancock: cannot put a date on it. Asking people to isolate for two weeks is a good thing. But he would not advise people to do that unless he were confident in the technology.

What is going to happen to people in the shielding group? Will the advice to stay at home end from July?

Hancock: Know the advice to shield has been hard. They will be announcing the next steps very, very soon. But it is important to do this properly. There will be a government publication. And everyone in this group will get an individualised letter.

Tom Clark, ITV: 10,000 symptomatic people a week, only a fraction getting through to test and trace – how can we be sure we can stay on top of outbreaks?
Harding: Missing some people with symptoms who are not getting tested. People who have a temperature, they need to get tested. Need to get better of hunting out the virus. 70% won’t have symptoms or very mild symptoms. More work to do.

Could easing of lockdown, be causing the increase of outbreaks in school?
Hancock: seeing a reduction of people dying of coronavirus and fewer people dying overall compared to last year. Doing more to be able to trace individual outbreak. Outbreak in Leicester, that we are working hard to stop, another in Yorkshire. Working closely with the local councils. Putting in mobile testing units. Ave system in place to spot outbreaks and take localised action.

Harding: Our scheme stands comparison with other countries, will get better with each week.

Andy Bell, C5: App is surely more than ‘cherry on cake’ surely if we are to get back to normal the app is vital?

Hancock: Need to get number of infections right down. World class test and trace system as a whole. Importance of human contact tracing was seen on isle of wight, and app does add to that. Will keep working to get an app to work.

Harding: This is a global challenge. Neither app are working well enough. Having an app to identify people you don’t know will obviously help, but also important, social distancing, good hand hygiene, wearing face coverings.

Heather Stewart, guardian: Has it taken too long to realise the app wasn’t working?
Hancock: Took decision in may to build google/apple version as well. Built and tested both apps.

The Sun: People with disabilities have been left behind:

Hancock: kept 80% of schools open for children with special needs. Vital that local authority support is also there.

Why aren’t schools reducing social distancing to 1m like in NI? Hancock: working to get all schools to reopen and there is a review of the current 2m rule. It will have an impact on transmission of disease. Need to make sure virus is under control enough to lower 2m rule.

Yorkshire post: Local leaders don’t know how to implement localised lockdowns.

Hancock: DHSC is working with the Local Action Committee to empower local authorities to impose localised lockdown measures, led by Chief Executive of Leeds City Council Tom Riordan

Other topics:

How to stop the start of university terms spreading coronavirus
Support for people working from home
Indication for shielding people of what the next steps are

2. Lords PQ on the implementation of the COVID-19 track and trace system

There were oral questions in the House of Lords on the implementation of the COVID-19 track and trace system. Full transcript is here - https://hansard.parliament.uk/lords/2020-06-18/debates/8A3CF8B6-16A6-4672-A890-1B9726F8BC3F/Covid-19TrackAndTraceSystem. NHS Providers sent a briefing to Peers ahead of the debate.

Baroness Anelay of St Johns to asked Her Majesty's Government what progress they have made with the implementation of the COVID-19 track and trace system.

The government has successfully increased daily testing from 200 to 200,000 and is working hard to reduce turnaround times.

What impact does the lack of a NHS app and a non-fully operating Joint Biosecurity Centre affect decisions about easing lockdown?

Low level prevalence means reliance on an app is lower. The Biosecurity Centre is already making a big difference.

Test and Trace only tracks symptomatic cases. Will the minister admit Test and Trace will not stop a second wave and only tracks a small number of cases?

System of Test and Trace will never be ubiquitous. It can, however, help break the chain of transmission.

The emphasis has shifted from app to human contact tracers. What lessons have been learnt from other countries who have launched contact tracing apps?

The opportunity of using automated technologies is enormous but technical challenges are also enormous.
Mass automation delivers a unique advantage if prevalence increases.

When will there be more widespread asymptomatic testing and tracing?

Focus on symptomatic cases does not mean the system does not work. Taking out one-quarter of infected cases is hugely impactful.
Asymptomatic testing is taking place in health and social care settings and the government is learning lessons from these schemes.

What process is in place to prevent community transmission?

Local action is central to an effective response. Working with the Joint Biosecurity Centre to identify local hotspots and to notify and support local authorities.

Have proper mechanisms and budgets been built into the track and trace system, including translators, so no minority group will be excluded?

Working to identify marginalised communities and using resources to ensure the message gets through.

Does the failure to have a system up and running this summer have a huge impact on vital services such as care homes?

Care homes are where the app is least effective as residents are static. Manual test and trace process is most effective in these settings.

3. NHS test and trace statistics (England): 28 May to 10 June 2020

Overall

This week the data is heading in a positive direction. There were fewer positive cases transferred to the system this week (reflecting the drop in cases throughout the country), and there were improvements in the number people reached (both positive cases and close contacts subsequently identified). There is still room for improvement, with 40% of all positive cases not able to give details of their recent close contacts.

Key data headlines from week two

5,949 people who tested positive had their case transferred to the contact tracing system (2,147 fewer than last week, 27% lower)
Of these, 4,366 (73%) were reached by the track and trace system and asked to self-isolate and to provide details of recent contacts. This is a slightly higher proportion than last week (72%)
3,572 (82% of the 4,366 who were reached, or 60% of the 5,949 who tested positive) responded with details of their close contacts. Also slightly higher proportions than last week (73%, 54%)
This week, 78% of positive patients reached were contacted within 24 hours (up slightly from 75% last week)
44,895 close contacts were identified, which I think gives an average of 12.6 per positive patient who responded with details of their close contacts (this seems high, perhaps worth digging into).
Of these close contacts, 40,690 (91%) were reached and advised to self-isolate.(This is up slightly from 90% last week)
86% of the close contacts reached were contacted within 24 hours (up slightly from 85% last week)

In total, since 28 May 2020:

14,045 people who tested positive for coronavirus (COVID-19) had their case transferred to the contact tracing system, of whom 72.6% (10,192 people) were reached and asked to provide details of their recent close contacts.
87,639 people were identified as close contacts and reached through the contract tracing system out of 96,746 reported (90.6%).

Source: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/893172/test_and_trace_bulletin_week_2_28_may_to_10_june.pdf

https://www.gov.uk/government/statistics/nhs-test-and-trace-statistics-england-28-may-to-10-june-2020?utm_source=2e2f65f8-3b8d-4654-b225-985a12ffb638&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate

4. COVID-19 infection survey pilot: England (18 June 2020)

The evidence shows that the proportion of people testing positive with COVID-19 has decreased in the past few weeks and is statistically significant.

Key headlines:

Current estimate of people in England with COVID-19 in the past two weeks is 33,000, the same as last week’s (single-week) estimate, but considerably lower than the weeks before this.
It is estimated that there were 26,900 new infections per week in England, down from 31,600 last week.
5.4% of those who provided blood samples tested positive for antibodies to COVID-19.

Analysis:

ONS do not provide a reason for their switch to a two-week estimate for the number of people in England with COVID-19. It may be because as the number of cases in the survey drops so low, it becomes hard to identify further decreases in the population estimates.

At any given time during 31 May to 13 June 2020, an average of 33,000 people in England had the coronavirus, or 0.06% of the population in England. This is a decrease from 149,000 people infected in the two-week period before (3 May and 16 May).
It is estimated that there were 26,900 new infections per week in private-residential households in England since the study began (approximately 3,800 new infections per day).
Evidence shows that the proportion of people testing positive with COVID-19 has decreased in the past few weeks and is statistically significant. However, the data suggests that the decline may have slowed in recent weeks.
5.4% of those who provided blood samples tested positive for antibodies to COVID-19 (around 1 in 19 people).

Source:

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/18june2020

Wednesday 17 June

Today's round-up includes:

Daily press briefing
PMQs
Urgent Question on coronavirus

1. Daily press briefing

Oliver Dowden, secretary of state for culture, media and sport led today’s briefing. There were no medical / scientific advisers.

7,121,976 tests have been carried out, including 140,359 yesterday.
387 people were admitted to hospital on 14 June, 379 of which in mechanical ventilation beds
5,308 people are currently in hospital with Covid-19.
A further 184 people have died after testing positive for coronavirus – 42,153 have passed away overall.
Dowden spoke about the English Premier League's return, describing it as the "best league in the world".
He pleaded fans to watch the games at home – he pointed out that all of the remaining games would be available on television.
The Minister spoke about the importance of mental health – he said that that the return of elite sport was part of that, but said that early July could potentially see the return of grassroots sport.

Q&A topics:

Theatres
Children returning to schools
Premier League returning
Reopening public toilets
'Air bridges' to other countries
Fears about people congregating outside stadiums

2. Prime Ministers Questions

Today's PMQs focused largely on child poverty and free school meals. The session also covered the Black Lives Matter protests and schools.

Keir Starmer, leader of the opposition questioned the shortfall in funding for councils. The PM said that councils were receiving £3.2bn extra, £1.6bn for the coronavirus pandemic and £600m for social care.

Starmer asked when the changes to the immigration health surcharge would be implemented. The PM said that it is vital frontline health and care works get the support they need. He said health and care workers who had paid the surcharge since May would be refunded.

Other topics:

Brexit and fishing
Child poverty
Economy
Hospitality sector
Furlough scheme
Northern Ireland veterans
NRPF
Online harms whitepaper
Social impact bonds
Food standards

3. Urgent Question on coronavirus

Jon Ashworth, shadow secretary of state for health and social care asked Matt Hancock, the secretary of state for health and social care to make a statement on Coronavirus. Full transcript here - https://hansard.parliament.uk/commons/2020-06-17/debates/DBCB858A-4A0A-422E-859C-490303E79C26/Coronavirus

Hancock – he provided an update on the treatment breakthrough announced yesterday. He said that as part of this clinical trials programme ("Recovery Programme") 11,547 patients in hospital settings across 176 sites across four nations had been recruited so far.
The trial showed that the risk of patients dying who needed oxygen fell by a fifth and for those on mechanical ventilators, a third.
Stockpile – a good stockpile has been built up and as of today there are 240,000 doses and this is readily available for patients.
Seven further drugs are being trialled as part of the recovery trial and 9 are being trialled in the "Accord" programme, which looks at early stage treatments
Anti body testing was announced last month, so far 592,000 have had an antibody test. With every test we are improving our picture of the virus.
Human trials have started on vaccines and should they yield positive results, phase three trail will be rolled out by Imperial
Astra Zeneca have said they will manufacture the vaccine in development at Oxford uni.
Ashworth responded – welcome news on the new treatment. Good news about progress on vaccines – let's make sure that any anti vax issues are dealt with when it is rolled out.
Why are student nurses seeing their placement schemes terminated?
He said that the WHO have said the UK is still in an active phase of the pandemic – can we have an update on the relaxation of some social distancing measures?
When will powers be given to enforce local lockdowns if they are necessary.
Can the house have an update on shielding – understand that support for those shielding is due to come to an end?
Local Authorities say that they are not getting the testing data that they need and why isn’t the government publishing the numbers of people who are being tested?
There are issues with the tracing figures – can govt explain this? Also when will BAME review recommendations be implemented?
Hancock responded – agree that there should be no excuse for anti vaxers – if it is scientifically safe anybody who is recommended to have a vaccine should. He said that the point on student nurses was wrong and that there is funding for them until the end of the summer. Regarding lockdown – he said the govt are moving cautiously. On lockdown powers, he said the coronavirus Act gives him the power to make changes and that there is a chain of command where issues can be sent up and dealt with.
On track and trace he said that some of those who test positive are inpatients in hospitals – test and trace doesn’t apply in the same way because you know they have been in a specific safe setting.
Jeremy Hunt asked when will weekly testing of all frontline NHS and care home staff be introduced – Hancock said they are taking a targeted approach on this, they need to do more and he will write to Hunt with further information.
Phillipa Whitford asked about PPE contracts - £108m for contracts was not advertised and contract has been given to a small pest extermination company – why? Hancock said that they have an enhanced supply of PPE and Lord Deighton is leading on things.
Other issues which came up: social distancing and the 2m rule, cancer and screening programmes, face masks and deaf people, BAME risk assessments, impact on children and young people's mental health.

Tuesday 16 June

Daily press briefing
Summary - Health and Social Care Committee - Delivering Core NHS and Care Services during the Pandemic and Beyond
Deaths registered weekly in England and Wales, provisional: week ending 5 June 2020 (week 23)
Update from Michael Gove on EU/UK negotiations

1. Daily press briefing

The Prime Minister Boris Johnson was joined by Sir Patrick Vallance and Professor Peter Horby,

Slides, datasets and transcript

Boris Johnson, Prime Minister

29,8136 positive tests and increase of 1279 since yesterday.
410 people were admitted to hospital on 13 ^th June, 385 of which in mechanical ventilation beds
5,254 people are currently in hospital with Covid-19.
A further 233 people sadly lost their lives after testing positive for coronavirus – 41,969 have passed away overall.
Johnson said he is "all too aware" that the two-metre rule has implications for schools and other sectors, and he will do everything in his power to get life back to normal. But he will proceed carefully and will only act in a way that minimises the risk to life.
Reaffirmed commitment for the next steps to be made no earlier than July 4 ^th .
Said he was proud of UK scientists to find the first treatment which reduces the risk of death from Covid-19, Dexamethasone, which will be made available on the NHS and ensured there is a enough supply for a second wave.
Whilst this drug reduces the risk of dying from coronavirus the possibility is still too high.

Sir Patrick Vallance, Chief Scientific Adviser

Thanked the investigators who put the trial together, the NHS for helping it to happen and the funders for allowing it to happen as well as Jonathan Van Tam and the patients who volunteered.

Professor Peter Horby, Nuffield Department of Medicine.

Said there were11,500 trial patients and it was the biggest trial in the world.
Dexamethasone is very cheap and costs pounds in the UK and pennies abroad.
The results were "remarkable."
The drug reduces the risk of death on ventilated patients by 35%
It reduces the risk of death on patients requiring oxygen by 20%
It is of no improvement to other patients.
It will save the life of 1 in 8 patients for the cost of £40.
This a common drug, which has been around for many years and which is very cheap

Q&A:
BBC: If there is a second wave, might we not have to take such extreme measures now we have this drug?

Vallance: Doesn’t stop people going into hospital, but will help people once already in hospital. Will not reduce spread of infection.

SKY: How quickly can people in the NHS use this drug

Vallance: The drug is inexpensive and widely available. The chief medical officer will issue guidance soon saying this should be used for clinical practice.

Other topics:
reducing the 2m rule

Rashford campaign for free school meals over the summer

Merger of DfID and FCO

Travel corridors

Is Wales being sidelined

2. Summary - Health and Social Care Committee - Delivering Core NHS and Care Services during the Pandemic and Beyond

The Health and Social Care Committee had an oral evidence session as part of the inquiry into Delivering Core NHS and Care Services during the Pandemic and Beyond.

The first session heard from Dr Katherine Henderson, President, Royal College of Emergency Medicine; Professor Derek Alderson, President, Royal College of Surgeons; Mick Armstrong, Chair, British Dental Association; and Rob Martinez, joint replacement patient.

Lack of communication following cancellation of surgery – need clarity on waiting times, hospitals should have provided updates rather than complete silence.
Surgeons saw 1m less people this April than the previous April.
One quarter of surgeons do not have access to COVID-light facilities.
Primary care has functioned incredibly well during the pandemic.
Large backlog of patients in category of patients who require surgery within one month – delays may lead to death for this group. Urgent need for COVID-light sites.
Independent sector important to reducing backlog.
Need to restore confidence in the public for safe elective surgery which may require extra safety procedures. Need realistic expectations for dealing with the backlog which will take months and years.
Need to ensure that trainee receive their normal training.
Productivity drops due to need for PPE, infection controls etc.
Expecting increase in workforce in August as trainee’s international plans are curtailed. Concerns of losing staff in February, clinicians retiring etc.
Previously underutilised of NHS 111, did not fully appreciate use of clinicians for service.
A&E seems less busy due to more staff, more space and less presentations – does not mean staff have not been working.
Lessons to be learnt: use of technology, no longer working in silos, working from home.
Need an honest conversation with the public on public health matters and when to seek health and care.
Dental care has largely been overlooked and viability is uncertain – a Cinderella service.

The second session heard from Daloni Carlisle, cancer treatment patient; Charlotte Augst, Chief Executive, National Voices; Sir Robert Francis, Chair, Healthwatch England; and Dr Layla McCay, Director at NHS Confederation.

Patients left in limbo with lack of communication of when their treatment will resume.
The public have largely been very understanding with the NHS but many also feel that they have been left in the lurch.
Better conversations are needed about what services are available and how it can be accessed.
Concerns that patient safety has taken a back seat – patients are being patronised and not being allowed to participate in conversations on their own safety.
Not at a point for self-regulation where CQC inspections can be done away with but room for improvement.
Pre-COVID, hospitals running at 90% capacity, now expect to run at 60% due to social distancing and extra safety measures.
A perfect storm is brewing – exhausted workforce, Brexit, upcoming demand in all services, potential second wave.
Rapid discharge of patients – concerns about a lack of communication with families of patients who are left unaware whether relative has had COVID.
Lack of communication has been an issue even before COVID – need tailored communication to change how people use emergency care, primary care etc., to reassure patients over COVID concerns.
80% of patients with severe mental health issues feel that they have not been supported at all.
Shielded population highlights need for good wrap around care – anxiety in this group has been exacerbated by poor communications.

3. Deaths registered weekly in England and Wales, provisional: week ending 5 June 2020 (week 23)

Key findings

The number of deaths registered in England and Wales in week 23 (ending 5 June 2020) was 10,709. This is 885 more deaths than the previous week and 7.3% higher (732 more deaths) than the five-year average (although the increase is likely to be due to the Late May Bank Holiday, which occurred in Week 22).
Of the deaths registered in week 23, 1,588 mentioned "novel coronavirus (COVID-19)”. This is the lowest number of deaths involving COVID-19 in the last nine weeks and accounts for 14.8% of all deaths in week 23.
The number of deaths in London falls below the five-year average while the number of deaths involving COVID-19 continued to decrease across all regions in England.
Care home and private home deaths continue to be above the five-year average.
This week, of all COVID-19 deaths, 57.2% occurred in hospitals while 35.5% occurred in care homes.

The number of COVID-19 deaths is the lowest for nine weeks

The number of deaths registered in England and Wales in week 23 (ending 5 June 2020) was 10,709. While there were 885 more deaths than the previous week, this is likely to be due to the Late May Bank Holiday, which occurred in the previous week. The total for week 23 is 7.3% higher than the five-year average (732 more deaths).
Of the deaths registered in week 23, 1,588 mentioned "novel coronavirus (COVID-19)”. This is the lowest number of deaths involving COVID-19 in the last nine weeks and account for 14.8% of all deaths in week 23. There were 12.8% fewer COVID-19 related deaths than in week 22 (234 fewer).

A total of 47,387 deaths involving COVID-19 have been registered in England and Wales between 28 December 2019 and 5 June 2020 (year to date).

Location – The North West continues to have the highest number of COVID-19 deaths

The number of deaths involving COVID-19 continued to decrease across all English regions whilst the number of deaths in London falls below the five-year average.
The North West had the highest number of COVID-19 deaths in Week 23 at 250 deaths, but this is down from 282 last week.
The North East region had the highest proportion of COVID-19 deaths, with 19.6% of all deaths being COVID-19-related.

Setting – Care home deaths continue to be above the five year average

In Week 23, hospital deaths and deaths in other communal establishments remained below the five-year average, while deaths in care homes and private homes continued to be above the five-year average.
Of all deaths involving COVID-19, the proportion occurring in hospitals increased to 57.2% in Week 23 (up from 55.1% in Week 22) but the proportion occurring in care homes decreased from 38.7% last week to 35.5% this week.
Looking at deaths from all causes in the last week, the proportion that occurred in care homes continued to decrease and is now at 22.6% (down from 25.5% last week). 23.4% of all deaths in care homes involved COVID-19 in Week 23, compared with 28.2% in the week before.

People aged 90 years and over continue to have the highest number of COVID-19 deaths

The highest number of deaths and the highest proportion of COVID-19 deaths were in those aged 90 years and over, where 18.2% of deaths involved COVID-19 (404 deaths).

Gender

For the sixth week running, more females aged 85 years and over than males have died from COVID-19. Year to date figures show that 10,753 females in this age bracket have died compared to 9,193 males. This could be because due to there being more females (939,000) than males (564,000) in this age group.

Source:

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/articles/comparisonofweeklydeathoccurrencesinenglandandwales/latest

5. Update from Michael Gove on EU/UK negotiations

Boris Johnson met EU leaders yesterday via video conference to take stock of the progress of negotiations
The UK wants to accelerate the pace of progress. Boris Johnson called on the EU to put a “tiger in the tank” of Brexit talks.
The tempo of talks has accelerate. Talks will start at the end of June and every week of July.
Gove said that the faster we can get this done the better – the govt do not want this going on to the autumn
He stressed that the protocol on NI is a priority for the UK govt
Assurances were sought on UK nationals living in the EU and stressed that UK citizens rights need to be protected.
It is still the case that differences of principle remain. The UK wants a comprehensive FTA, and is ready to be flexible.
Gove said that the UK has been clear that a deal must reflect UK sovereignty and independence and stressed that the ECJ cannot have any say over UK laws. Another key area of concern is fishing waters.
He said that there must be movement and the clock is ticking. At the end of the transition UK will leave the customs union and the single market and that the end of the transition period will be managed in a flexible and pragmatic way.
Extending the tranisiton period isn’t going to happen. Neither side want it to happen and if we did that we would be paying into the EU budget etc.
He said that a deal can be reached if political will is there – govt political will is there.

Monday 15 June

Daily press briefing
ONS data:

a. Coronavirus and anxiety
b. Shielding of clinically extremely vulnerable people in England

1. Daily press briefing

Dominic Raab delivered the daily briefing on his own today.

He gave an update on the data:

As of 9am 15 June, there have been 6,866,481 tests, with 93,163 tests on 14 June.
296,857 people have tested positive.
As of 5pm on 14 June, of those tested positive for coronavirus, across all settings, 41,736 have died, a further 38 deaths.
430 admitted to hospital on 12 June, down from 515 on 5^th June.
395 on mechanical ventilators, down from 585 on 5^th June.
5,507 people in hospital with COVID-19

Q&A:

Public:

When will the alert level be at or below 1? Raab - Keep close eye on the virus, the alert level is not up to politicians.

Provisions for children of key workers over the summer holidays? Raab – working with schools and have provided extra money for school holiday programmes.

Journalists:

Mark Easton, BBC: Wouldn’t it be more helpful to see official findings of why BAME people are more likely to die from COVID-19:

Raab - Important to set up new commission. Don’t accept it’s another review. Have made progress. significant increase in BAME pupils going to university. Acting on Lammy review into criminal justice. When the government can release further information, it will do so.

Beth Rigby, Sky: Why not implementing 250 recommendations we already had? PM is clear on direction of travel. Want to bring actionable policies. The commission is about providing a framework for change. Raab reiterated the positive numbers of black pupils across the UK recently taking core subjects at GCSE. Raab reiterated what he stated earlier on what recommendations the Government were making progress on.

2m rule – review will strike right balance between public health and business – is that how the government is now proceeding?

Jane Merrick, i: Why the scientists and medics were not present today at the press conference, and why their presence had reduced significantly from the first press conference. Raab stated the medical advisers were still very important, but ultimately the politicians need to make the policy calls on the science provided. He said they may not appear every day because ‘they’ve got a huge amount of work to do’.

On relaxing the 2m rule: Raab stated the science would lead the results, but that ultimately people should aim to stay two metres away when they can at all times. With progress however, the economy would hopefully be able to get back on track with more easings of lockdown coming on July 4^th

Other topics:

BA treatment of workforce
Relationship with China and Huawei review.

2. ONS data

Coronavirus and anxiety and Coronavirus and Shielding of clinically extremely vulnerable people in England

Coronavirus and anxiety, Great Britain: 3 April 2020 to 10 May 2020

This dataset provides insights into which socio-demographic and economic factors were most associated with high levels of anxiety during the first weeks of lockdown.

Key findings:

Average anxiety scores dropped between 30 April and 10 May with 37% of people reporting high levels of anxiety and average anxiety scores were 4.0 out of 10 compared to 49.6% between 20 and 30 March.
The percentage who reported high levels of anxiety significantly increased for people who are married or in a civil partnership during lockdown to 39%, up from 19% at the end of 2019.

Change in well-being up to and during the pandemic

The factors most strongly associated with high anxiety during lockdown include loneliness, marital status, sex, disability, whether someone feels safe at home or not and work being affected by coronavirus.
Between 20 and 30 March, 49.6% of people reported high anxiety and average anxiety scores were 5.2 out of 10, an increase from 3.0 out of 10 at the end of 2019. Average anxiety scores dropped between 30 April and 10 May with 37% of people reporting high levels of anxiety and average anxiety scores were 4.0 out of 10.

Personal circumstances associated with high anxiety

Average anxiety ratings for those who often or always felt lonely were 6.4 out of 10 compared to anxiety ratings of 3.1 out of 10 for those who never felt lonely.
Those who are married or in a civil partnership were 2.1 times as likely to report high anxiety than those who are widowed during the first weeks of lockdown. Those who are single or separated/divorces were more likely to report high anxiety than those who are widowed (1.8 and 1.2 times as likely, respectively).
The percentage of people who are married or in a civil partnership reporting high levels of anxiety significantly increased to 39%, up from 19% at the end of 2019.
People in Scotland were 28% less likely to report high anxiety than people in England. The difference between England and Wales was not statistically significant.

Personal characteristics associated with high anxiety

Women are 1.6 times as likely to report high anxiety scores (between 6 to 10 out of 10) than men. Between 3 April and 10 May, average anxiety scores for women were 4.7 out of 10 compared with 3.9 out of 10 for men. Reasons for this gender difference include women finding working from home more difficult, being more concerned about health and safety at work, spending significantly more time doing unpaid housework (excluding travel and childcare) and spending less time doing gardening or DIY than men.
Average anxiety levels were 24% higher for those who are disabled (5.0 out of 10) than non-disabled people (4.0 out of 10). However, these results are consistent with reported anxiety levels for disabled people at the end of 2019.
Those aged 75 years and over were 2.0 times more likely to report high anxiety than those aged 16 to 24 years. Prior to the pandemic, anxiety levels tended to be highest in mid-life, declining as people reach their early to mid-60s and dropping their lowest levels in the mid to late 60s.
Average anxiety scores were considerably higher for those who said the coronavirus was affecting their work (4.8 out of 10) compared with those that did not say that their work was being affected (4.0 out of 10).

Source: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/coronavirusandanxietygreatbritain/3april2020to10may2020

Coronavirus and shielding of clinically extremely vulnerable people in England: 28 May to 3 June 2020

These findings look at the impact of the virus on those people who are shielding (clinically extremely vulnerable people) in England including their behaviours and mental and physical well-being. The Shielding Behavioural Survey was put together to discover whether the population who had been advised to shield were following the guidance issued by the government.

Key findings

2.2 million (4% of the England population) clinically extremely vulnerable (CEV) people were advised to shield.
Despite 62% of clinically extremely vulnerable (CEV) people saying that were completely following government shielding advice, 49% of those surveyed and who were CEV said they had left the house at least once and had received visitors who were not a nurse, support or care worker since being told to shield. The findings below suggest that the need for normality, maintaining one’s health and mental well-being and maintaining financial obligations may be the drivers behind CEV people not sticking to shielding guidance.

Following government shielding advice

2.2 million (4% of the England population) clinically extremely vulnerable (CEV) people were advised to shield.
95% of these said that they either completely or mostly followed the government’s guidance on shielding.
Of the 95% mostly or completing following the government’s shielding advice, 62% of CEV people reported that they are completely following shielding advice while 33% reported mostly following the shielding guidance.
However, 49% also reported leaving the house at least once since they received shielding guidance and 13% of CEV individuals reported they had received visitors in the last seven days who were not a nurse, support or care worker. This suggests that less than 62% of people are completely following shielding guidance.

Extra support

Those who were advised to shield were given the opportunity to register to receive extra support to help them shield e.g. receiving grocery deliveries. 46% of CEV people had not registered for support, 54% had registered for support, 15% are currently registered and receiving support and 38% are currently registered but not currently requiring government support (this means they are likely getting support elsewhere or need support not easily provided by the government).

Leaving the house

49% of people advised to shield (around 1,106,000) had left the house even though they had been advised to shield and 40% had left home at least once in the previous seven days.
The most popular reasons for leaving the home were for exercise (53%), GP/hospital appointment (26%) and to shop for essentials (24%).

Employment

28% of CEV people (627,000) were in employment before being advised to shield.

36% of these are now working from home, 5% are continuing to work outside the home (32,000). Of those who are still working outside the home, 19,000 would be unable to meet their financial obligations if they stopped working.
Of those CEV people who are now not working, 31% have been furloughed and cannot work from home, 5% have been furloughed but could still work from home, 17% have stopped working and 6% have received self-employment income support as they cannot work from home (6%)

Mental health

More than a third of CEV individuals (35%, around 785,000 people) reported that their mental health and well-being was worsening during the coronavirus pandemic whilst 29% said that their mental health and well-being was becoming slightly worse and 6% reported that their mental health was much worse.
Those aged under 50 years (46%) and those aged 50-59 years old (45%) were more likely to report worsening mental health than those aged 70-74 years (26%) and over 75 (23%).
More females reported a worsening of mental health (40%) compared with males (28%).

Physical health

20% of CEV people said they were unable to access certain types of care (e.g. tests, scans) and 10% report being unable to access any care since receiving shielding advice.
20% of CEV people state that their existing condition has got worse whilst shielding.

Data note:

CEV people in these findings include children, those over state pension age and those unable to work for health reasons.
In the case of minors or those who are unable to answer the survey themselves, other people answered on their behalf.

Source: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronavirusandshieldingofclinicallyextremelyvulnerablepeopleinengland/28mayto3june2020

Friday 12 June

Daily press briefing
R numbers by region

1. Daily press briefing

Grant Shapps, Secretary of State for Transport, led today’s briefing with Prof. Stephen Powis, national medical director for NHS England and Sir Peter Hendy, chair of Network Rail.

Slides are here.

33,0000 people with COVID-19 in community, down from 152,000
SAGE estimate for the R rate is unchanged from last week: 0.7-0.9
6,434,713 tests have been carried out in total
193,253 tests were carried out yesterday
1541 cases confirmed yesterday
535 people admitted on 9 June
392 patients are on mechanical ventilators
202 people have died yesterday

Face coverings on public transport are mandatory from Monday. Transport operators are able refuse travel if people refuse to wear a face covering.

Q&A

Public question: What work is being done to establish if antibodies mean less risk of infection or possible immunity?

Powis: possible to measure antibodies and working to understand antibody response. NHS has set up SIREN to study healthcare staff to study antibodies.

Catherine Burns, BBC: How can it be that where you live can double your risk of dying? Does more need to be done about health inequalities?

Shapps: government levelling up programme includes health inequalities.

Powis: NHS is tackling on health inequalities, taking a targeted approach towards most deprived areas.

Is the CNO refusing to attend the press conferences due to Dominic Cummings?

Shapps: not the case, she has previously contributed and may do so again.

Tom Clarke, ITV: Would it be sensible to mandate wearing mask everywhere, not just on public transport? R number is still near to 1, especially in hospitals - does it show that hospital infection control is not working?

Shapps: social distancing is the most important thing, along with washing hands. Public transport is an enclosed area which is not the case on the streets.

Hendy: mandating face coverings now as more and more people return to work.

Powis: the evidence is weak but some evidence shows face coverings are better for enclosed spaces than open air. More infections in hospitals, infection control is critical and NHS is used to managing infections. Working with hospitals and healthcare settings to ensure policies and processes are in place to minimise transmission including increasing testing of all patients and all staff.

Ashish Joshi, Sky: Regional breakdown shows SW is 0.8-1.1, are we moving towards regional lockdowns?

Shapps: nationwide R rate is 0.7-0.9, SW figure may not be as high as being reported due to high and low projections within the range.

Powis: SAGE takes data from a number of academic groups, important that the central range is below 1.

Natasha Clark, The Sun: What extra arrangements are the NHS and the government putting in place for a second wave given how poorly prepared it was?

Powis: NHS did a magnificent job, lessons have been learnt. Thinking hard about how to get back to normal for the NHS. Ensuring we have capacity to deal with a possible second wave.

Gemma Mitchell, Nursing Times: What action is being taking to ensure NHS and social cares system is safe for nurses, especially those from BAME backgrounds? Is it acceptable that student nurses are being asked to carry out duties beyond their capabilities?

Shapps: Equalities Minister is working with PHE report to come up with recommendations. Providing test and trace to BAME communities.

Powis: ensuring NHS organisations understand BAME staff need additional support including redeployment and risk assessments. People should be working in areas in which they are competent.

When will nursing students have clarity on their courses?

Powis: higher education are rethinking ways of delivering teaching, HEE is working with providers of nurse training.

Other questions:

Employment
Air bridges
Brexit

2. R numbers by region

Across the UK, R remains between 0.7 to 0.9, but this week they have released it for England separately and it is between 0.8 to 1.0, and also by region (table below – highest: South West – 0.8 to 1.1; lowest: East of England – 0.7 to 0.9).

Region	R
England	0.8-1.0
East of England	0.7-0.9
London	0.8-1.0
Midlands	0.8-1.0
North East and Yorkshire	0.7-1.0
North West	0.8-1.0
South East	0.8-1.0
South West	0.8-1.1

https://www.gov.uk/guidance/the-r-number-in-the-uk

Thursday 11 June

Daily press briefing
COVID-19 Test and Trace statistics release
COVID outbreaks in care homes

Other things to note:

Local authority funding update - the Government has today confirmed how £300 million of funding will be allocated to Local Authorities across England to support test and trace services in their local communities. This includes additional funding for communities with lower incomes and higher demand for local healthcare settings. This funding is in addition to the £3.2bn package of support the Government has provided to councils. A new National Local Government Advisory Board has been established to work with NHS Test and Trace. This will include sharing best practice between communities across the country.

1. Daily press briefing

Matt Hancock, secretary of state for health and social care, was joined by Baroness Dido Harding, executive chair of NHS Test and Trace.

Matt Hancock went through the data slides:

testing and new cases

as of 9am 11 June, there have been 6,240,801 tests, with 197,007 tests on 10 June
291,409 people have tested positive
as of 5pm on 10 June, of those tested positive for coronavirus, across all settings, 41,279 have died
that equals an increase of 151 COVID-19 positive deaths

data from hospitals

462 admissions with COVID-19
440 COVID-19 patients occupying mechanical ventilator beds
5,911 patients in hospital with COVID-19

Baroness Dido Harding

NHS Test and Trace (week one)

31,794 contacts were identified through the Test and Trace service
26,986 (85 per cent) were reached and agreed to self-isolate
to summarise, “the system is working well at scale”

Q&A

Hugh Pym, BBC: are you concerned that couldn’t get details from 1/3 of people?

Hancock: 2/3 in the first week of operation beat my expectations.

Harding: Can and needs and will get better. Why we haven’t got 100% - all have a part to play, give correct details when have a test, learning when it is most convenient to reach people. Feedback from people – pleased with service. Can we do better, yes of course and will continue to improve.

What is the situation with the app?

Hancock: It will help and will bring it in when it is right to do so.

ITV: This is not yet a world-class system. Isn’t it too early to relax lockdown?

Hancock: the PM promised there would be a world-class system, and we will get one. Confident that the measures announced for this weekend - the social measures at the weekend (support bubbles), retail measures on Sunday - are being introduced safely.

When will you tell us how quickly people are being tested?

Harding: the turnaround time for testing has not yet been published. Working with the UK Statistics Authority to make sure the data is robust. They want to make sure the data is reliable.

Andy Bell: Channel 5: will there be an enforcement mechanism? Hancock: not ruling it out but don’t need it at the moment. Harding: Want to encourage people to get a test if they have symptoms. Getting as many people into the test and trace system who have symptoms is really important.

FT: there are some people who don’t have symptoms but don’t have virus. 70-80% who test positive don’t have symptoms in ONS study. 14 day isolation will help break spread.

Harding: In the NHS and social care are routinely testing staff to see if have virus. Looking to find people who have virus but don’t have symptoms. Rolling that approach out to other high risk professions – taxi drivers, security guards.

Antibody test:

Harding: At the moment all the test will tell you is that you have antibodies, we don’t know yet whether this gives you immunity. Antibody testing in health and care is allowing us to build up scientific base.

Daily Express: What reasons are people giving for not isolating / providing contacts:

Harding: 4807 contacts, significant proportion we haven’t reached yet. Doesn’t mean they aren’t self-isolating. We are overstating the number who are choosing to ignore the advice.

2. COVID-19 Test and Trace statistics release

Data was released today by DHSC from the first week of operation of the contact tracing element of NHS Test and Trace following its launch on 28 May. This has rightly been identified as a key tool to control the pandemic and we’ve supported the drive to get it up and running, and will continue to do so as it is rolled out.

Key headlines

8,117 people who tested positive had their case transferred to the contact tracing system.
Of these, 5,407 (67%) were reached by the track and trace system and asked to self-isolate and to provide details of recent contacts.
4,216 (52%) responded with details of their contacts.
31,794 contacts were identified, an average of 5.88 per positive patient.
Of these contacts, 26,985 (85%) were reached and advised to self-isolate.

Analysis

Positive cases:

Two-thirds of people testing positive were reached by the system between 28 May and 3 June and told to self-isolate. 2,710 could not be reached (33%).
Of the people reached, 4,216 (78%) responded with details of their contacts, with 3,336 of these (79%) responding within 24 hours.

Taking into account those who could not be reached, 3,901 of the 8,117 positive cases (48%) provided no details of contacts to trace.

Contacts:

The 4,216 positive patients who did respond gave details of 31,794 contacts, almost six per person.
85% of these were reached and instructed to self-isolate (26,985 people).
The breakdown given for the amount of time taken to reach these contacts appears to consider only a small proportion of the total, but of those included the majority were reached within 24 hours.

3. COVID outbreaks in care homes

The data which tell us how many confirmed or suspected COVID outbreaks in care homes there has been was published today.

Findings:

There are 15,507 care homes in England. This week there were 102 confirmed or suspected outbreaks in care homes. This figure is the lowest its has been since the second week in March. This would support other evidence that suggests we are nearly over the first wave ad in
The cumulative data shows there has been 6,329 outbreaks in care homes - this means that 41% of all care homes have had a suspected or confirmed COVID outbreak.
There is variation by region. Below are the cumulative figures:

Region	Outbreaks	Coverage of outbreaks in area (%)
East of England	761	44.2%
East Midlands	536	34.9%
London	638	45.8%
North East	392	52.5%
North West	886	46.2%
South West	591	28.9%
West Midlands	667	39.3%
Yorkshire and Humber	665	44.6%

Source: https://www.gov.uk/government/statistical-data-sets/covid-19-number-of-outbreaks-in-care-homes-management-information?utm_source=f575366e-4468-4dcd-bbae-b1298302586b&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate

Wednesday 10 June

Today’s round-up includes:

Daily press briefing
PMQs
Lords Public Services Committee summary
House of Lords oral question: COVID-19: Cancelled Medical Operations
Key points from Science and Technology committee session
Daily testing figures

1. Daily press briefing

Prime minister Boris Johnson was joined by chief medical officer, Professor Chris Whitty and chief scientific adviser, Sir Patrick Vallance.

Slides and data sets

PM’s statement

The prime minister highlighted the 5 tests for adjusting the lockdown and said the government is still confident all 5 tests are being met.

He announced easing measures including:

All shops can open from Monday
Places of worship can reopen for individual worship
"single adult households" may form a "support bubble" with one other household, starting this weekend.
Zoos will reopen

Sir Patrick Vallance

R is still between 0.7-0.9
Epidemic is shrinking but not fast.
Numbers coming down
39,000 new infections every week in the community
Vast majority of population remains susceptible to this infection - 15 per cent of Londoners have had it, but across the UK that is as a whole only around six per cent

Q&A:

Laura Keunssberg, BBC: Neil Ferguson said the death toll would be reduced by a half if lockdown had come a week earlier. Was he right?
Vallance: Ferguson also told the committee this afternoon that now was not the time to second guess. There will be a time to look back, and do that analysis. It is very important to address that.
Whitty: it is routine for medics to look back at what happened and consider what could have been done better. At the time they had limited information about the virus. What counts is what measures have the most impact on the virus, but the least impact on society. That is a “very complicated balancing act”. There are three scenarios: It could take off again soon, there is a reasonable chance it could come back in the autumn or winter, there is a risk of a second wave after the virus has been around the world.

Beth Rigby, SKY: what the biggest regrets were in relation to measures being brought in.
Johnson: there will be a time to look back. But these questions are “premature”. This epidemic has “a long way to go”, especially around the world.
Vallance: we need to have the information to be able to make that judgment.
Whitty: There is a long list. If he were to choose one, he would go for testing very early on in the epidemic. Many of the problems were caused by that.

Do you not regret going into lockdown earlier?
Johnson refers to what Whitty and Vallance said earlier. He says they made the decisions based on advice from Sage, including Prof Ferguson. He repeats that it is premature to think about this now.

Telegraph: Asked about the 2m rule.
Johnson said a balance had to be struck between health and other impacts. Vallance said 2m was not a scientific rule - it was a judgement based on an overall risk assessment.

Other topics:

schools
whether those serving food should wear masks / gloves

2. PMQs

Johnson/Kier exchange

Johnson and Kier began by offering their condolences to the families and victims on the third anniversary of Grenfell Tower tragedy.

Starmer said the PHE report on COVID-19 concluded that the death rate is highest amongst BAME groups and states that the guidance needs to be adapted. Why is the government not already acting? The PM said the Government is already acting and acknowledged that BAME people have been at the forefront of tackling coronavirus with 44% of London NHS workers from BAME backgrounds. He said he had agreed with Dido Harding is to ensure high-contact professions are getting expanded and targeted testing.

Starmer said the Government’s figures show the death count is past 40000, ONS data puts it at 50,000 and excess deaths are over 63,000 – amongst the highest in the world. The PM previously said he was proud of the government’s record. There is no pride in these figures is there? The PM said scientists have advised that we must wait to draw international comparisons. He said there has been astonishing achievements of the NHS and the public following the rules.

Today’s exchange also covered racial injustice and schools.

Health related questions

Vicky Foxcroft (Lab): will the government introduce a time slot for shielded people to go for walks, publish guidance for shielding people, and review the furlough scheme so shielding people are not penalised?

PM: doing as much as we can to ensure shielded people receive guidance and will be taking steps to ensure that people recently told to shield can benefit from the furlough scheme

Ian Blackford (SNP): PM told the Liaison Committee he did not read the scientific papers. Can the PM confirm what science papers he has read on the two metre social distancing rule?

PM: have read many papers on the social distancing rule. These measures will be kept under review.

Ian Blackford (SNP): Chris Whitty said the two metre was going to be necessary for as long as the pandemic continues. Will the PM continue to ignore the advice of the experts?

PM: The public has listened to the advice and tomorrow the public will hear more about test and trace.

Other topics

Hong Kong
Inequality and racism
Science and technology
Beer gardens
Northern Ireland Troubles
Racism
Stop and search
Hospitality and tourism sector
Statutory sick pay
Animal welfare
Infrastructure investment
Economy

3. Lords Public Services Committee summary

The Lords Public Services Committee held an oral evidence session as part of their inquiry into Public services: lessons from coronavirus.

The first session heard from Sarah Pickup, Deputy Chief Executive at Local Government Association; Saffron Cordery, Deputy Chief Executive at NHS Providers; and Kate Terroni, Chief Inspector of Adult Social Care and Care Quality Commission speaking on health and social care.

The second session heard from Ann Longfield OBE, Children’s Commissioner at Children’s Commission for England; Amanda Spielman, Chief Inspector at Ofsted; and Claire Murdoch, National Director for Mental Health Services speaking on children’s services.

Session I

Successes:

Discharge to assess – barriers were removed and relationships improved between health and social care
SC: NHS has done a remarkable job in creating capacity including 30,000 new ICU beds, a 30% increase in ambulance vehicles and 24/7 mental health lines.
Exceptional joint working
Places with better integration and stronger understanding of the local population rose to the challenge.

Challenges:

Lack of focus on care sector, unequal support to NHS
£600m infection control grant is insufficient and difficult to access
Data sharing issues
Government guidance came in ‘dribs and drabs’
SC: lack of a successful testing regime
SC: issues around distribution and guidance for PPE
SC: care homes
Significant challenges pre-COVID including variations joined up working across the country, workforce shortages and high turnover rates in social care.

Lessons:

Health inequalities have become more apparent, stronger focus on public health and prevention needed.
Need for social care reform.
SC: need better strategy and planning with better consultation and engagement with those actually rolling out the plans e.g. changes to masks and visiting times came with no prior consultation.

SC: COVID-19 has accelerated collaboration (e.g. discharge to assess led to a speedy discharge of medically fit patients to the care sector). Not having financial considerations as the first priority allowed effective and efficient decisions. Appropriate checks remain in place throughout this crisis. Some changes cannot be undone which may have benefitted from local consultation – need to ensure these decisions are reviewed.
Need to look at personalisation and safeguarding – focus on individual choice has fallen during pandemic.
Crisis has shown local areas are able to collaborate when needed.
LGA is not in favour of a top-down approach, local leaders need the space, power and funding to develop local services.
Discussion with ICSs/STPs show need to continue moving towards system by default approach with joint decision making and joint commissioning.
SC: difference between targets and accountability, targets are top down and trusts have been able to speed up ways of working free from the shackle of targets. Targets skew behaviours and priorities but can be a helpful measure. Need to look at target vs outcomes (e.g. target of 100,000 tests per day did not show value of the target).
Need to ensure national targets are not conflicting, local targets are better.
SC: need for alignment, difficult for organisations to work within multi-regulatory fremworks.
SC: lot of providers are working with all institutions across their patch. Commissioning plays a critical role and organisations are dealing with commission decisions. Need to be clear about the role of commissioning in inspections/targets.
Two-thirds of people receive care in their own homes but focus has been on care homes. Need to redesign services around people and what they need.
Voluntary sector has been important and must not lose focus on building community infrastructure.
SC: there has been an overreliance on voluntary services providing statutory services. Charities have lost a lot of income and this demonstrates need to shore up health and care services and local authority funding.
SC: regional structures are incredibly important, need to learn what powers are appropriate at each level. Prevention and population planning work best locally rather than regionally.
ICSs need to be empowered and not always overruled by the national system. They need to integrated with local government on an equal partnership basis.
Report shows 4.5m people have been taking on informal care roles during lockdown – a lot of unmet need.

Session II

Model of mental health services was radically changed. 35% of contact with children was done digitally.
Concerned about loss of referral routes for young people. Keeping a close eye on under 18s group and is central to Help Us, Help You campaign.
Plan to introduce mental health teams in schools with mental health support practitioners. Aim to cover 1.5m children by 2023.
Local transformation plans are best to tackle inequality.
NHS looking at freedom of choice and accessibility.

4. House of Lords oral question: COVID-19: Cancelled Medical Operations

Full transcript

Baroness Kennedy of Cradley asked an oral question on what assessment they have made of the impact of cancelled medical operations due to the COVID-19 pandemic.

The Parliamentary Under-Secretary of State, Department of Health and Social Care, Lord Bethell, responded:
NHS trusts were rightly asked to postpone elective activity to free up capacity to support the response to Covid-19. The latest data shows that there was a 30% reduction in the number of completed admitted patient pathways in March 2020 compared to the same month last year. Data for April is due to be published by NHS England tomorrow. The NHS is safely restoring urgent non-Covid services, catching up on the backlog, and ensuring that surge capacity can be stood up again should it be needed.

We prepared a briefing ahead of this debate.

5. Key points from Science and Technology committee session

We will share a full summary tomorrow, however I wanted to highlight a couple of things that are getting pick up in the media.

On care homes:

The policy has always been to protect care homes and to protect the elderly. The policy has been clear in that sense. This is not unique to this country. The policy has simply failed to be enacted until very recently, and there are multiple causes for that.

On the number of deaths:

The epidemic was doubling every three to four days before lockdown interventions were introduced. So had we introduced lockdown measures a week earlier, we would have reduced the final death toll by at least a half.
Whilst I think the measures, given what we knew about this virus then, in terms of its transmission and its lethality, were warranted, I’m second guessing at this point, certainly had we introduced them earlier we would have seen many fewer deaths.

6. Daily testing figures

As of 9am 10 June, there have been 6,042,622 tests, with 170,379 tests on 9 June.

290,143 people have tested positive.

As of 5pm on 9 June, of those tested positive for coronavirus, across all settings, 41,128 have died, an increase of 245.

Tuesday 9 June

Today's update includes:

1. Daily press briefing

2. Lords oral question on Exercise Cygnus and preparations for responding to a major pandemic by the UK

3. Office of National Statistics weekly data

1. Daily press briefing

Alok Sharma MP, business secretary delivered today’s briefing alongside Sarah Albon, the chief executive of the Health and Safety Executive

Slides and datasets

There have been 5,870,506 tests, with 102,930 tests on 8 June. 289,140 people have tested positive. As of 5pm on 8 June, of those tested positive for coronavirus, across all settings, 40,883 have died.
446 admitted to hospital on 6 June, down from 624 on 30 May
513 critically ill patients still require mechanical ventilation, a decrease of 140 since June 1

Sharma set out the measures that had been taken to allow the government to reopen non-essential shops in England on 15 June if they comply with social distancing guidelines.

Q&A:

BBC: 2m rule, WHO says it should be 1m: Sharma: 2m rule is based on advice from SAGE, will keep under review

Victoria McDonald, C4: highlights PHE report, community engagement section was missing. Why was it missing, who decided not to publish, and can you guarantee it will be published? Sharma: The report was published and the equalities minister is continuing work on this.

The Times: 2m rule – is that about number of infections or R? Will continue to keep this under review. Only make changes if its safe to do so.

What metrics? CMP wants it until the end of epidemic? Sharma: other countries have looked at infection rates before they have made decisions. Infection rates and R will be key determinants.

Albon: have to take into account science – chances of passing on at 2m is significantly less at 1m or 1.5m. Prevalence in society combined with safe distance gives you the probability of it being passed on.

2. Lords Oral Question on Exercise Cygnus and preparations for responding to a major pandemic by the UK.

The Lords were critical of the government’s response to the COVID-19 outbreak. Issues raised included:

the lack of protections for the care sector
whether the recommendations from Exercise Cygnus had actually been implemented
request for reports from Exercise Iris (Scotland) and the National Security Risk Assessment to be published
impact of cost cutting measures and privatisation on the UK’s resilience
lack of PPE in the stockpile including gowns and masks
whether Exercise Cygnus reported a shortage of ventilators and PPE.

Lord Hunt asked why was the care sector so neglected and quoted Martin Green of Care England saying “PPE was redirected away from care homes and the NHS was given clear instruction in March to send people to care homes despite not testing for infection available.”

Lord Bethel responded:

Exercise Cygnus planned for a flu pandemic but did inform measures for current pandemic
ADASS did have input into EC but again did not anticipate demands of COVID-19
Nothing could have prepared the UK for COVID-19 and EC did not anticipate a pneumonia response or a global shortage of equipment and break down of global supply chains
No plans to publish findings from Exercise Iris and National Security Risk Assessment, not in the public interest

3. Office of National Statistics weekly data

Deaths registered weekly in England and Wales, provisional: week ending 29 May 2020 (week 22)

Key findings

The number of deaths registered in England and Wales for week 22 (week ending 29 May) was 9,824. While this is 2,464 fewer than the previous week, this is still 20.2% higher than the five-year average (1,653 more deaths).

1,822 of the deaths registered in week 22 were due to COVID-19 (18.5%). This is down from 21.1% the previous week (767 fewer COVID-19 deaths), and is the lowest number of COVID-19 deaths in the last eight weeks.
Although overall excess deaths continue to decrease, excess deaths in care homes are still occurring while hospital deaths are now below the five-year average.
- This week, 55.1% of all hospital deaths were due to COVID-19, an increase from last week (51%), while 38.7% of all care home deaths were due to COVID-19, down from 42.1% in the previous week.
The number of total deaths registered continues to decrease and the number of deaths involving COVID-19 is the lowest for eight weeks
The number of deaths registered in England and Wales for the week ending 29 May 2020 (week 22) was 9,824. This is 2,464 fewer than in Week 21, but remains 20.2% higher than the five-year average (1,653 more deaths).
1,822 of the deaths registered in week 22 were due to COVID-19, accounting for 18.5% of all deaths registered. This is down from 21.1% the previous week (767 fewer COVID-19 deaths), and is the lowest number of COVID-19 deaths in the last eight week
Overall, a total of 45,748 deaths involving COVID-19 were registered in England and Wales between 28 December 2019 and 29 May 2020

Location – The North West has the highest number of COVID-19 deaths

The percentage of deaths involving COVID-19 continued to decrease or remain steady across all English regions.
In week 22, the number of deaths involving COVID-19 was highest in the North West at 282 deaths.
The North East had the highest proportion of COVID-19 deaths, where 25.6% of all deaths were related to COVID-19.

Setting – Excess deaths in care homes are still occurring while in hospitals deaths are now below the five-year average

The total number of excess deaths is decreasing, but the number of deaths in care homes this week remains 48.6% higher than the five-year average (819 excess deaths). The number of deaths in private homes this week also remains 45.5% higher than the five-year average (869 excess deaths), while in hospitals the number of deaths was 0.8% lower than the five-year average (30 fewer deaths).
The proportion of all hospital deaths that involved COVID-19 increased to 55.1% in week 22 (up from 51.0% in the previous week), while the proportion of COVID-19 deaths occurring in care homes decreased to 38.7% (from 42.1% in the previous week).
In Week 22, the proportion of all deaths occurring in care homes decreased to 25.5%, while deaths involving COVID-19 as a percentage of all deaths in care homes decreased to 28.2%.

People aged 90 years and over continue to have the highest number of COVID-19 deaths in Week 22

The largest number of COVID-19 deaths was in those aged 90 years and over, where there were 468 deaths.
The highest proportion of coronavirus (COVID-19) deaths was in the 80 to 84 year age group, where 23.3% of deaths involved COVID-19 (381 deaths).

Gender

For the fifth week running, more females aged 85 years and over died from COVID-19. Year to date figures show that 10,299 females in this age group have died from the virus compared to 8,889 males, in part due to there being a higher a female population in this age group (939,000) than male (564,000).

Source:

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregisteredweeklyinenglandandwalesprovisional/latest

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/causesofdeath/articles/comparisonofweeklydeathoccurrencesinenglandandwales/latest

Coronavirus and loneliness (3 April – 3 May)

5.0% of people in Great Britain reported that they felt lonely “often” or “always” between 3 April and 3 May 2020. This equates to 2.6 million adults when scaled up to the whole Great Britain population.
30.9% reported their well-being had been affected through their feeling lonely in the past seven days (7.4 million adults).
Working-age adults living alone, those in bad health, in rented accommodation, or those who were single, divorced or separated were more likely to report loneliness.
Those feeling most lonely had lower personal well-being scores (including higher anxiety scores than the Great Britain average).
Those feeling most lonely were more likely to say they were struggling to find things that help them cope during lockdown.
Around 7 in 10 of those feeling lonely “often” or “always” agreed that they had people who would be there for them, compared with 9 in 10 of the Great Britain average.

Source: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/bulletins/coronavirusandlonelinessgreatbritain/3aprilto3may2020

Business impact of coronavirus, analysis over time

This data relates to the period 23 March 2020 to 17 May 2020. Out of a sample of approximately 18,000 businesses, 9,036 unique businesses have responded to BICS over this period and 3,521 of those businesses have responded to every survey.

Over the first part of this period, 5% of businesses reported turnover was within the normal range and 95% said turnover was outside the normal range. By the end of this period, only 2% of businesses reported turnover was within the normal range and 97% reported turnover was outside the normal range.
Over the first part of this period, 30% of businesses who continued to trade expected their workforce to decrease, compared with 9% by the end.
One-fifth (19%) of businesses that expected their workforce to decrease in size at the beginning of this period still expected their workforce to decrease by the end of this period. Three-fifths (62%) now expected their workforce to stay the same, while 12% expected it now to increase.
Of the businesses who continued to trade and whose financial performance were outside normal expectations, 15% responded that they had not been able to get the materials, goods or services they needed at the beginning of this period but this had fallen to only 7% by the end of this period.

Source: https://www.ons.gov.uk/businessindustryandtrade/business/businessservices/articles/businessimpactofcoronavirusanalysisovertimeuk/waves2to5panel

Monday 8 June

Today's update includes:

Daily press briefing
Daily testing figures

1. Daily press briefing

Matt Hancock, Secretary of State for Health and Social Care joined by David Pearson, Chair of National COVID-19 Social Care Support Taskforce

Matt Hancock

Number of confirmed cases, lowest since end of March. 7 day rolling average continuing to fall.
Number of admissions with COVID-19 has fallen again to 519, down from 661 a week ago.
516 people on mechanical ventilators.
R is below 1 in all regions. In all areas number of people in hospital with COVID is falling in all regions.
Number of deaths with a positive test was 55 yesterday. Lowest since 21 March. Data could rise again, because of weekend effect.
Total deaths 40,597
Deaths in social care are 12,739 – 29.1 percent of all registered deaths.
The Govt have prioritised testing for care homes and provided funding. They have asked local councils to conduct daily reviews.
The Social Care Support Taskforce will be responsible for drawing up a plan to keep residents and staff safe as the lockdown begins to ease.
On testing: over 1m test kits have been sent to 9,000 care homes. The test results "so far do not show a significant rise in positive cases."
The Government will now roll out testing in "all remaining adult care homes" and staff and residents in adult social care will be able to get access to testing.
He concluded by thanking all carers "especially in this time of crisis."

David Pearson, Chair of the National Covid-19 Social Care Support Taskforce

Residents of care homes, and those in need of social care, have been particularly affected by this virus
The organisations and voluntary sector deserve "our gratitude"
The staff and those in need of adult social care must be protected, and he has read through care home recovery plans that have been submitted. From this, he knows the enormous efforts that are happening locally.
Work is now focussed on supporting people in social care and staff. He has reviewed care home resilience plans, infection control, PPE supplies, and what additional support is needed.
Says taskforce will bring together actions of central and local government for care providers
The taskforce will bring together central and local government with care providers.
Social care has a "crucial role to play" and "our job is to harness our efforts…to support social care."

Q&A:

Hugh Pymm, BBC: Why are you confident that COVID is on the retreat? Hancock:important to look at all the figures and scientific advice. Whilst clearly not over, there is progress on all of the figures. Number of new infections is lowest in months. Figures in care homes show a decrease in number of new infections. Total number of excess deaths has come right down as well.

Care homes have reported feeling abandoned, what lessons have been learnt? Pearson: evidence from resilience plans shows the amount of energy at local level to ensure care homes get support they need. Taking account of all international evidence, level of asymptomatic infection, etc. Making sure work with care homes to ensure staff are trained in infection prevention.

Paul Brand, ITV: is it safe to send people into care homes? Hancock: Yes, with all of the measures and extra funding, clear that epidemic in care homes is coming under control. Pearson: Have been keeping eye on international evidence, have to be vigilant, make sure continue to learn. Things we are putting into place today are the right measures to bring the virus under control.

Beth Rigby, Sky: What mortality rate will we have to live with to open up economy more? Hancock: there isn’t a trade-off. If we don’t have control of virus the economy will suffer more. Task of government is to get infection rate down and keep it down whilst reopening things. Things are moving in the right direction, which is why we have been able to lift and target locally.

Why did the crisis in care homes happen here? Pearson: Other countries have had the same difficulties as us in care homes. Focus is to continue to learn. Other countries didn’t have levels of community transmission we have

Jason Groves, Daily Mail: why is the distance 2m if other countries think it is safe to stand 1m apart? Hancock: have to take into account all social distancing measures, keep the 2m rule under review. SAGE have been looking at this,

The Guardian: Why are BAME people disproportionately dying from COVID and being fined disproportionately under lockdown rules. Hancock: critical work following on from PHE report last week, will take into account all factors - comorbidities, housing, occupation.

Echo: Non-clinical NHS staff will have to quarantine, but clinical staff wont: Hancock: Basis for this being introduced is to stop spread. Hope that we will be able to get to a position where people will be able to go on holiday.

2. Daily testing figures

As of 9am 8 June, there have been 5,731,576 tests, with 138,183 tests on 7 June. 287,399 people have tested positive.

As of 5pm on 7 June, of those tested positive for coronavirus, across all settings, 40,597 have died.

Friday 5 June

Today's round-up includes:

Daily press briefing
Update to the process for communicating changes to the list of people identified as ‘clinically extremely vulnerable’ (‘Shielded Patient List’ or SPL).
ONS Data releases

1. Daily press briefing

Matt Hancock delivered the daily press briefing on his own today.

He announced that from 15 June, all hospital and outpatient visitors should wear face coverings / masks. Face coverings for all patients, face masks for all staff. NHS staff will be required to wear level 1 or 2 surgical face masks.
He urged health and care staff to follow the isolation advise to ensure the virus doesn’t spread.
He went through the latest slides:

As of 9am 5 June, there have been 5,214,277 tests, with 207,231 tests on 4 June.
283,311 people have tested positive. As of 5pm on 4 June, of those tested positive for coronavirus, across all settings,
40,261 have died.

Q&A:
Hugh Pymm, BBC: Death toll is above 40,000 how to you assess that and the regional variations in R – is that a concern, is there a concern for more regional restrictions?

Hancock: Way to get incidence down and keep R below one. Increasingly getting better regional data, advice sage is that R is below 1 in all regions, but increasingly want to have regional approach to tackle flare ups. New Joint Bio Security centre has been tasked to look at this. Need to get more focused information on outbreak.

Chances of no deal Brexit? Position is reasonable, working very hard and will accelerate work to make progress in talks. Any agreement must reflect that the UK is an independent sovereign state.

Sam Coates, Sky: seem to be cherry picking most positive data, PHE said today the regional R level is rising and above 1 in some areas.

Hancock: Everyone should exercise caution. Discussion of higher R in SW and NW is an important part of moving to localised approach to lockdown. Study is important, but overall assessment of SAGE is that R is between 0.7 and 0.9.

Is the infrastructure in place to enact a local lockdown should one happen tomorrow? Hancock: Yes, as they have done in Weston-super-Mare.

ITV: When can we expect guidance on what localised lockdowns will look like?

Hancock: As part of the overall test and trace programme have been engaging with local authorities and regional mayors and devolved administrations. Tom Riordan is ensuring we have that local perspective.

At what point do you stop easing off on lockdown? Hancock: all of the studies are brought together by SAGE, which highlights that R level is still below 1. Challenge in NW which needs to be addressed. In SW overall incidence is lower, but R is a little bit higher.

Telegraph:

Difference between R in community and in healthcare settings

Hancock: Higher incidence of new cases amongst health and social care staff. But that is not rising as a proportion. There isn’t a different R in health and social care. Hugh package of measures in health settings to bring the incidence of virus down. Different to those in the community.

Why are facemasks only now being made mandatory? Hancock: As we bring the over all incidence of disease down,

I: Timetable from July 4 onwards, isn’t that unrealistic given rates of infection.

Hancock: Important that people look at all reports in the round. Overall view of SAGE is that R remains between 0.7 and 0.9.

Muslim news:

PHE need to look into the structural issues that lead to inequality which may have an impact on BAME people: Hancock: taking forward this point of why and what we can do about this issue. Higher proportion of BAME people working in customer focused and health and social care roles, which may have an impact. Measure of introducing face coverings in hospitals and on public transport will hopefully help this.

Will you look at the structural issues? Hancock: Yes will be taking a rigorous scientific approach looking at the root causes, including comorbidities and economic background. As we go we will do whatever we can to help these situations.

2. Update to the process for communicating changes to the list of people identified as 'clinically extremely vulnerable' ('Shielded Patient List' or SPL).

The Department of Health and Social care has announced the changes to how updates to the SPL are communicated.

Communication to the NHS on removing a patient from the SPL

A letter has been sent from NHSE to NHS Trust Medical Directors, GPs and CCGs to reinforce the guidance for clinicians on removing people from the Shielded Patient List. This reinforces the need to discuss any changes in their advice before making any changes to their medical records, because this will trigger a change in the individual’s access to the Government support service. The letter also emphasises the importance of communication between clinicians, and the need for specialists to communicate their decision to the their patient’s GP when removing anyone from the SPL. The letter can be found here.

Communication to patients removed from the Shielded Patient List in receipt of support

letters will be sent out next week to a small number of patients who have recently been removed from the Shielded Patient List and were receiving food boxes from the National Shielding Service. We are doing this to ensure that these patients receive the information that they do not need to shield and to signpost other avenues for support.

The details of these individuals will also be sent to GP practices so they are aware the letters have been sent.

Communication to patients shielding

the government will review the shielding policy the week commencing 15 June, after which the department will write to all individuals on the Shielded Patient List with information about next steps on shielding advice and the support that will be available to them after this review point. Decisions taken on the shielding policy will be based on clinical advice from medical experts and the best data available about the prevalence of Covid-19 in the community. Patients identified as clinically extremely vulnerable between now and the review will receive a letter advising them to shield and encouraging them to register their support needs. The letter has been updated to reflect the current Government guidance and clarifies that they should shield until 30 June, awaiting the outcome of the review. The updated version of the letter can also be found here.

3. ONS data releases

It covers:

COVID-19 infection survey pilot weekly update
Death registrations not involving coronavirus data
Coronavirus social impacts survey

Key headlines

COVID-19 infection survey pilot

Current estimate of people in the community in England with COVID-19 is 53,000, significantly lower than previous weeks.
The survey estimates that 39,000 new infections occurred per week in England, or 5,600 per day - also less than previous estimates.
Latest SAGE estimate for R remains similar to previous weeks - between 0.7 and 0.9. An estimate picked up today in the media from the London School of Hygiene and Tropical Medicine puts R between 0.9-1.
Seven out of ten survey respondents with positive tests were asymptomatic.

Death registrations not involving coronavirus

There were 46,380 excess deaths between 7 March and 1 May, of which 12,900 were non-COVID-19 (28%).
Undiagnosed COVID-19 could help explain the rise in these deaths, with non-COVID-19 excess deaths seen predominantly in older age groups, and especially for the frail elderly with underlying conditions.
The largest increases in non-COVID-19 excess deaths are due to "dementia and Alzheimer disease" (5,404 excess deaths, 52.2% higher than the five-year average) and "symptoms, signs and ill-defined conditions" (mostly indicating old age and frailty) (1,567 excess deaths, 77.8% higher).
Many of the non-COVID-19 excess deaths appear to have been displaced from hospitals to care homes and private homes, but this may well be because we know with more certainty whether deaths in hospitals are a result of COVID-19.

Coronavirus social impacts

More people are feeling safe outside the home, but this varies by nation.
More people are expecting to start using face coverings than currently use them.
Fewer people are self-isolating, but social distancing still strongly supported.
More people are finding working from home difficult, and two thirds of parents are not confident about sending children back to school.
Anxiety levels continue to reduce

COVID-19 infection survey pilot: England (5 June 2020)

Population estimates are falling, R is steady

At any given time between 17 May and 30 May 2020, it is estimated 0.10% of the community population had COVID-19.
This equates to an average of 53,000 people having COVID-19 in England at any given time; a significant drop from previous weeks where the estimate has been above 130,000.
As more data is collected in the survey, the trend of declining cases in the community can be reported with more certainty (smaller error bars in the figure 1 below).
There were an estimated 39,000 new COVID-19 infections per week in England, or 5,600 per day. This is also significantly down on previous weeks where the estimate has been over 50,000 per week or 8,000 per day.
The latest estimate of R remains very similar to previous weeks, between 0.7 and 0.9(5 June). The London School of Hygiene and Tropical Medicine’s modelling team estimate R to be between 0.9 and 1, although this should be treated with caution as “estimates of R can vary slightly because different research groups use different sources to calculate the number in slightly different ways.”

As the infection survey collects more data, we can start to comment on the characteristics of the people testing positive with more confidence.

- Individuals working outside the home show higher rates of positive tests (0.72%) than those who work from home (0.22%).

- Patient-facing healthcare workers and resident-facing social care workers show higher rates of positive tests (1.87%) than people not working in these roles (0.32%) (figure 2).

Of everyone who tested positive at any time in the survey, only 29% reported having symptoms, meaning seven out of ten remained asymptomatic.

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/5june2020

b) Analysis of death registrations not involving coronavirus (COVID-19), England and Wales: 28 December 2019 to 1 May 2020

· Between 7 March and 1 May 2020, a total of 130,009 deaths were registered across England and Wales; this is 46,380 more than the five-year average, of which 12,900 (28%) did not involve COVID-19

· Non-COVID-19 excess deaths occur predominantly in older age groups, and especially for the frail elderly with underlying conditions - undiagnosed COVID-19 could help explain the rise in these deaths.

ONS suggest that many of the non-COVID-19 excess deaths appear to have been displaced from hospitals to care homes and private homes. In reality this is likely because we are more certain of whether deaths in hospitals are a result of COVID-19.

- Age-standardised mortality rates (ASMRs) for non-COVID-19 deaths were generally higher in regions with higher COVID-19 ASMRs.

Excess deaths where COVID-19 was not mentioned were predominantly in the very eldest.
Men accounted for more excess non-COVID-19 deaths at first, but from mid-April this switched to women
Analysis by leading underlying causes of death shows all leading causes are above or at their 5-year averages.

· The largest increases in non-COVID-19 excess deaths are due to "dementia and Alzheimer disease" (5,404 excess deaths, 52.2% higher than the five-year average) and "symptoms, signs and ill-defined conditions" (mostly indicating old age and frailty) (1,567 excess deaths, 77.8% higher than the five-year average). Together these comprise two thirds of total non-COVID-19 excess deaths in this period.

Dementia increases are so sharp it’s implausible that they are unrelated to COVID-19.
People with dementia are more likely to have communication problems describing symptoms.
They generally affect the very old, and would tend to impact women to a greater extent than men due to population structure, particularly once the virus was took hold in care homes with limited testing.

· The balance of evidence so far points to undiagnosed COVID-19 in the elderly being the most likely explanation for a majority of excess deaths that did not mention COVID-19 on death certificates.

· There is some evidence for deaths involving, for example, cancers and renal failure being displaced from hospitals https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/analysisofdeathregistrationsnotinvolvingcoronaviruscovid19englandandwales28december2019to1may2020/technicalannex

c) Coronavirus and the social impacts on Great Britain: 5 June 2020

Feeling safe outside the home is improving, but varies by nation

91% of adults said that they had left their house for any reason during the period, similar to the previous week (90%). Figures across countries were England (92%), Scotland (88%) and Wales (84%).
Essential shopping, exercise, work and running errands were the most common reasons for leaving the house in Great Britain. Meeting with others in a public place has continued to increase this week, as has travelling to and from work (30% up from 24%).
Almost half of adults in all countries (49%) had visited a park or public green space this week, and 39% of these had met with family or friends from outside of their household – an increase compared to last week.
In England, 52% said they had visited a park or public green space, and 40% of these had done so meeting others. In Wales, a smaller proportion had visited a park or public green pace at 34%, and 41% had met others. In Scotland, about a quarter (25%) had visited a park or public green pace, and 24% had met others.
41% of adults in all countries said that they felt safe outside of their home this week, up from 33% last week. A higher proportion of those living in Scotland said they felt safe outside the home (51%), 40% of adults in England felt safe, while only 26% of adults in Wales felt safe outside the home this week (figure 6).
87% of adults in Great Britain said they had enough information about how to protect themselves from the coronavirus, this is an increase from 79% last week

Face coverings and handwashing stable but likely to increase

A similar proportion of adults (28%) had used face coverings when outside of their home this week compared to 29% last week. People were most likely to wear face coverings whilst shopping (76%), while 23% wore face coverings for exercise and 20% for running errands.
36% of adults said that they were very likely or likely to wear a face covering over the next seven days.
94% of respondents said they either always or often washed their hands with soap and water straight away after returning home from a public place.

Fewer people self-isolating

13% of adults said they had self-isolated in the past seven days, which is a decrease from last week at 19% and is the lowest level across all the weeks data have been collected for. For those aged 70 years and over, 28% said they had self-isolated, while for those with an underlying health condition (all ages) it was 19%. These are both lower than reported last week (36% and 33% respectively).
10% of adults were in households where everyone had self-isolated over the past seven days, which is a decrease from 17% last week and is the lowest proportion across the weeks.

Social distancing still strongly supported

98% of adults said they had tried to stay at least two metres away from other people when outside their home.
88% of adults said that they were avoiding contact with older or vulnerable adults. 10% said those that they are avoiding are people that they care for.

More people finding working from home difficult

41% of adults said that the virus was having an impact on their work. With some of the most common impacts were being furloughed, finding working from home difficult and needing to work from home.
This week, more adults (24%) said they were finding working from home difficult compared to 14% last week.
A similar proportion of employed adults in Great Britain said that they had worked from home at some point this week (41%) compared to last week (39%).

Two thirds of parents not confident about sending children back to school

Almost two thirds of adults (65%) with dependent children said their children had been home-schooled this week. This is similar to previous weeks.
Home-schooled children spent on average 11 hours learning this week.
39% of adults said their children were struggling to continue their education. Lack of motivation, lack of guidance and support, and limited parent or carer knowledge to support were the most common reasons for children to be struggling.
In England, almost two thirds of parents (63%) felt unconfident in sending their children back to school in June.
70% said a vaccine available for the virus would make them feel more confident to send their child or children back to school, and 67% said that reassurance that their school was fully prepared would also make them feel more confident.

Indicators of concern, well-being and loneliness

69% of adults said they were worried about the effect that the virus was having on their life. This is similar to last week (67%) but reflects a downward trend overall since data collection began.
For the third week running, the most common impact of the virus was a lack of freedom and independence with 58% reporting this. Other common issues were an inability to make plans (52%) and personal travel plans being affected (50%).
44% of adults said their well-being was affected by the virus in the past seven days, a decrease from 47% last week. The proportion of those aged 70 years and over who reported their well-being had been affected (36%) continued to be lower than the general population but for those with an underlying health condition it was similar at 47%.
The most common issue affecting well-being continues to be feeling worried about the future (63%), followed by feeling stressed or anxious (56%), and feeling bored (49%).
Anxiety levels have seen the largest change over the lockdown period, falling to an average score of 3.7 this week, from 5.2 at the start of the period (figure 7).
This week, 25% reported feeling lonely either often or always, or some of the time, similar to last week at 27%.

Thursday 4 June

Today's update includes:

Daily press briefing
No.10 Lobby briefing
Summary of an Urgent Question to the Minister for Women and Equalities on Public Health England's review of disparities in risks and outcomes related to the COVID-19 outbreak
Summary of Lords Public Services Committee oral evidence session (Saffron giving evidence next week)

1. Daily press briefing

Grant Shapps, Secretary of State for Transport, was joined by Sir Peter Hendy, chair of Network Rail and is working to restart the transport network.

Slides are available here.

Number of test carried out and posted out has more than 5m.
1805 people tested positive yesterday.
39,904 total COVID-19 deaths, increase of 176 yesterday.
Average daily deaths now stands at 241.
Avoiding public transport has worked well so far, crowding has been avoided as public transport users has increased.
Next easing of lockdown on 15 June will increase demand on public transport.
Face coverings will become mandatory on public transport in England from 15 June – people may be refused travel if they do not wear a face covering and may be fined.

Public questions

How are renters going to be protected once ban on eviction ends?

GS: government is working to strengthen the economy and protect jobs to help renters pay rent.

What is the government doing to ensure holiday companies give refunds?

GS: holiday companies must offer refunds, redress exists through existing scheme such as Trading Standards.

Media questions

Tom Burridge, BBC

Will rail workers responsible for policing mandatory face coverings?

GS: face covering will be a condition to use public transport, volunteer journey makers will assist in reminding people to wear face coverings.

PH: rail workers will also be expected to use face coverings, people need to be sensible, not expecting a huge upsurge in policing as there wasn’t when alcohol was banned on TfL.

Has the government lost the confidence of the aviation industry?

GS: looking into various measures including travel corridors.

Harry Horton, ITV Yorkshire

What specific advice is there to protect BAME communities?

GS: government is turning PHE report into recommendations. Terms of references are here.

Phil Hornby, ITV

Has the case of Alok Sharma shown the folly of returning to parliament and will the PM need to self-isolate?

GS: parliament has come back because it needs to work on behalf of the nation and strict social distancing remains in place.

Sharon Barber, BBC Look North

Care homes were pressured to accept hospital patients who have not been tested and care homes in Derbyshire have seen high levels of deaths. Who’s responsible for these deaths?

GS: government has stepped in to provide PPE to care homes, care homes have been incredible and there will be time to look back.

Dominic Yeatman, Metro

Has agreement with Scotland been reached on face coverings? Should the government be encouraging people to holiday in the UK?

GS: face coverings is a decision for Scotland, need to see how the disease tracks before allowing international travel.

PH: need to respect devolution but would expect passengers to wear a face covering when they get on the train and when they get off – it would be sensible and courteous.

Darren Slade, Bournemouth Echo

What message would you give to those visiting the coast (given images from last week)? What help is given to the hospitality industry?

GS: stay alert means to maintain 2m distance and not to risk yourself and others, there are fewer life guards and so swimming poses a greater risk. There has been an enormous economic programme.

Paul Geater, East Anglian Daily Times

Why were hospital patients discharged into care homes only being testing from mid-April? Why has guidance only been changed recently preventing patients being discharged without a test? Why won’t NHS release a trust level break down of patients discharged to care homes without tests?

GS: majority of care homes do not have any cases of COVID, there are questions to be reviewed, increased hospital capacity has helped reduced deaths in care homes which is lower than in Europe.

Paul Faulkner, Lancashire Evening Post

Does it not make sense to Do you expect tourist destinations to face a challenge of keeping the virus in check?

GS: there needs a national picture, need to know path of virus going forward before easing more measures.

2. No. 10 Lobby briefing

The spokesman said 171,829 tests were carried out in the 24 hours to 9am yesterday. But the government had the capacity to carry out 220,213, he said.
The spokesman confirmed the Telegraph story saying that tens of thousands of coronavirus tests were returned void after being sent to a US laboratory for analysis. He said 67,000 tests had been sent to the US, and 29,500 were returned void. The laboratory was not being used again, he said. He said in total 4.2m tests had been carried out.
The spokesman refused to deny a report on Channel 4’s Dispatches last night saying Johnson told his Italian counterpart on 13 March that he wanted “herd immunity”. Asked about the report, the spokesman said: “The position of the government is that herd immunity has never been its policy.”

3. Summary of an Urgent Question to the Minister for Women and Equalities on Public Health England's review of disparities in risks and outcomes related to the COVID-19 outbreak

This morning there was an Urgent Question to the Minister for Women and Equalities on Public Health England's review of disparities in risks and outcomes related to the COVID-19 outbreak, tabled by Gill Furniss MP. Kemi Badenoch, Govt Equalities Minister responded.

She opened by commenting on the recent events in the US and protests taking place in UK regarding the murder of George Floyd, stressing the need for people to work together to improve lives of people from BAME communities.
She said the PHE has completed its review, which confirms that COVID-19 has replicated and in some cases increased existing health inequalities. Coming from a BAME background is a risk factor.
The minister said she is taking forward to the work with the Race Disparity Unit in the Cabinet Office and will keep the house updated.
Gill Furniss said the report confirms what we already know – that those from BAME backgrounds are more likely to die.
She questioned why there are no recommendations in the report and asked when they will be published. She said that structural racism is a factor and that BAME workers are anxious. All employers should risk assess their BAME workforce.
The minister responded by saying that PHE didn’t make recommendations because some of the data needed isn’t routinely collected and some of this data will be needed for recommendations. The review was done in a short space of time and we need to get it disseminated and discussed before deciding what needs to be done.
Caroline Noakes MP urged the minister to make sure that any work on this will be cross departmental.
The SNP said that they have done their own review with Public Health Scotland but are treating it with caution as it doesn’t tally with what is being reported in England and Wales.
There were several questions about the government’s policy of no recourse to public funds. The minister responded to request to scrap the policy with a list of what the government has been providing for those in difficult circumstances because of COVID-19.
A few MPs flagged that it has been ten years since the Marmot report and that nothing has improved.
There were also questions about why the report failed to mention occupational discrimination.
Other issues which were raised included: impact of COVID-19 on older people; why stakeholder submissions had not been published in the report; higher rate of death for men; disproportionate deaths in Welsh prisons; pregnancy discrimination and the impact of COVID-19 on those with learning disabilities.

4. Summary of Lords Public Services Committee oral evidence session

The Lords Public Services Committee held an oral evidence session as part of their inquiry into Public services: lessons from coronavirus.

The first session heard from Nick Davies, Director, Institute for Government; Richard Sloggett, Senior Fellow and Health & Social Care Lead, Policy Exchange; and Professor Nick Pearce, Director, Institute for Policy Research.

The second session focussed on local government and heard from Jessica Studdert, Deputy Director, New Local Government Network; Vicki Sellick, Executive Director of Programmes, NESTA; and Anna Round, Senior Research Fellow, IPPR North.

First session:

Failures include care homes (echoed internationally), divisions between health and social care, lack of robust community test and trace system.
Renewed cross party calls for reform of social care services.
Collapse in public confidence in care homes – 33% less likely to send relatives into care homes.
NHS has held up relatively well, frontline staff have been willing to respond and adapt quickly, but fundamental challenges ahead.
Five categories of health care need: COVID-19 patients, patients with long term conditions, patients with deferred elective surgery, patients with missed care, wider societal health impacts.
Long term underinvestment in buildings and equipment – difficult to maintain social distancing, harder to reorganise older hospitals.
Over centralised response has excluded local ingenuity.
Focus on the NHS came at the expense of social care.
Scotland has more funding settlement and more integration but proportionally higher deaths.
Value on social care has been enhanced – attitudes towards low pay and low skill has changed.
More willingness to pay more tax to fund public services (but may depend on the upcoming recession). Reported that before the crisis the government was 90% towards agreeing social care reform – just had to agree funding.
Will be some difficult communications to the public on waiting times and availability of services.

Rapid adoptions of patient engagement tools – 111, online GP appointments etc.
Public private collaboration has been positive.
Under investment in digital technology – vast majority of remote GP consultation is via telephone not video.

Too much focus on the NHS budget as the ringfenced budget with public health, social care, capital and staff not moving in the same direction. Need to view altogether.
More funding would have allowed public services to respond better.

Prevention needs to be at the heart of redressing health inequalities.
In short term, prevention is unlikely to deliver cashable savings, benefits would be long term.

Second session:

NHS and local government has worked well together but mixed picture of local innovation and disconnect with central government.
Disparity between funding of local government and NHS – NHS has had historic debt written off and funding needs met.
Greater data sharing between relevant local bodies would be beneficial.
Need a shift from model of commissioners and providers of local services – more preventative.

Wednesday 3 June

Today’s update includes:

Daily press briefing
PMQs summary
Summary: Health and Social Care Committee oral evidence session: Management of the Coronavirus Outbreak

1. Daily press briefing

Prime minister Boris Johnson was joined by Professor Chris Whitty, chief medical officer and Sir Patrick Vallance, chief scientific adviser.

Slides and data sets
PM’s statement

Prime minister:

called on those with symptoms with COVID-19 to get a test, saying "there is plenty of capacity to take a test"
the government will host the Global Vaccine Summit tomorrow aimed at finding an international solution to the issue, including the immunisation of 300 million people in developing nations
the prime minister urged people not to move gatherings from outside to inside because the risks of transmission were far lower outdoors than indoors.

Sir Patrick Vallance:

Sir Patrick Vallance began by showing a slide on new cases, the trend indicated that around 8,000 people probably had the virus, because the R rate remained near to 1, the rate of reproduction was not coming down fast. However, new cases were coming down fast overall.
Data for hospitals indicated that there was an overall downwards trend.
The number of people in hospitals were declining especially in places such as London.
"The death rate isn't coming down as fast as we want" Sir Vallance added.

Q&A

Most of the questions focused on holidays and the 14 day quarantine being imposed at UK borders.

Sky: The government said the lockdown would not be relaxed until the alert level went down to 3. But it is still at 4. What has happened?
Whitty: Relaxing the lockdown was linked to the government’s five tests. But the alert level is different, he says. It is independently set. It monitors the spread of the disease. (Although it’s worth pointing out that the government’s coronavirus recovery plan specifically said: “The content and timing of the second stage of adjustments will depend on the most up-to-date assessment of the risk posed by the virus. The five tests set out in the first chapter must justify changes, and they must be warranted by the current alert level.” And the government produced a chart saying gradual relaxation of the lockdown would only start when the alert level went down to 3. See here.)

ITV: Point of threat levels was to advise on when to have local lockdowns. Know from Dido Harding that we won’t have that data for another month – has the easing happened too early?
Whitty: This is an infection we will have to live alongside, need a multi-layered defence against it. Will have to go incredibly cautiously. Shouldn’t take the fact that small reductions are happening as the end of lockdown.

Things we need to do to isolate the virus. Can be transmitted before they have symptoms. People they are most likely to pass it on to are their own household, they must isolate for 14 days. New element of test and trace. NHS Test and Trace will allow us to identify contacts.

Things we need to do to reduce transmission at a local level: Coughing – use tissue and dispose, 2m rule and face coverings – this will carry on for as long as this epidemic continues.

Trying to reduce social contacts including friends and family

Sun: Testing capacity is up and running, what capacity is it now at, when do you expect to be running at full capacity?
Whitty: Have now got to a situation where we can test people who have the virus. That allows us to do screening in hospitals and care homes. Not yet at full capacity. No. of tests will increase and ability to use the tests we’ve got will increase.

Antibody testing is also now increasing.
Vallance: Test and trace is not the single answer. We need to make sure we carry on with the distancing. Lowering the number of cases means it is easier to trace the virus.

Other topics:

Are holidays abroad going to happen?
What help is there for parents who need to go back to work but who do not have childcare options
Quarantine
China and security laws with Hong Kong

2. PMQs summary

Johnson/Starmer exchange

Starmer starts by saying how shocked he was by the death of George Floyd – it’s notable that Johnson didn’t start PMQs by mentioning it, as is usually the case with a big event such as this. Starmer then moves onto the Telegraph story that says Johnson is ‘taking back control’ and asks ‘who’s been in control until now?’ Johnson condemns what happened to George Floyd but says people should protest in a peaceful way. He says he takes full responsibility for the government’s coronavirus response to date. He says he is disappointed by Starmer’s tone and asks him to co-operate with the government.

Starmer says he wants to co-operate but highlights a private letter he wrote about the schools reopening offering to help and says Johnson didn’t reply. He then highlight’s a survey which shows a huge fall in trust in the government. Johnson responds that he phoned Starmer (Labour have now published the letter and pointed out that the call was with other Opposition parties) and that the public are following the guidance.

Starmer moves on to test and trace and quotes Dido Harding, who says it will not be fully ready until the end of June. Johnson starts to get angry and says Starmer is casting aspersions on the efforts of people who have set up test and trace. He asserts that thousands have been tested every day. Every person is contact and their contacts are contacts.

And that as a result of test and trace thousands of people are self-isolating to stop the spread of the disease.

Starmer welcomes this news but says the number of people testing positive is only a fraction of those infected every day. And says that assuming there are 5 contacts for every infected person the system needs to reach 45,000 people a day. He highlight’s the UK Stats Authority letter yesterday and again says this is having an impact on people’s trust in the government. Johnson accuses Starmer of undermining trust in the government and says he should give credit to the people involved.

Starmer says the PM is confusing scrutiny for attacks and that Johnson makes it difficult to support this government. He then moves onto the easing of restrictions, and says that on 10 May the PM said, on lifting restrictions, that if the alert level won’t allow – we will wait. He asks Johnson what is the alert level and what the R level is. Johnson responds angrily that Starmer knows that the alert level does allow it, and knows that the 5 tests have been fulfilled. He asks whether Starmer supports the progress we are making?

Finally, Starmer asks about the return to physical voting in the Commons and Scenes of MPs queuing to vote and says it is a clear case of discrimination. Johnson responds that it’s not unreasonable to expect MPs to queue to do their job when members of the public are having to queue for supermarkets. He then makes a concession to allow Proxy voting – which wasn’t announced yesterday.

Health and social care related questions:

Rachel Maskell (Lab): asked about yesterday’s Public Health England report about diversity and the risk from coronavirus. Johnson replies Kemi Badenoch, the equalities minister, will looking further on this.

Jeremy Hunt (Con) chair of health and social care committee: Asked how many tests were being turned around in 24 hours and called on the PM to publish this number regularly. Johnson responds that 90% of tests are being turned around in 48 hours (I think this figure was 95% last week?) He says all the mobile tests are turned around in 24 hours and commits to all tests *except for difficulties with postal tests* being turned around in 24 hours by end of June.

Other topics:

George Floyd and the protests in America
The government’s levelling up agenda
Furlough scheme
Quarantine at airports / borders
Rise in antisocial behaviour
UK steel industry
Brexit
Domestic abuse

3. Summary - health and social care committee oral evidence session: Management of the coronavirus outbreak

The first session heard from Chen Chien-jen, former vice president of the Republic of China (Taiwan) and Professor Fraser, Professor of pathogen dynamics, University of Oxford.

The second session heard from Baroness Dido Harding, executive chair of NHS Test and Trace programme, Department of Health and Social Care, Professor Christophe Fraser, Professor of pathogen dynamics, University of Oxford; Lord Paul Deighton, advisor to secretary of state on PPE, Department of Health and Social Care.

First session

Currently don’t fully understand correlation between number of contacts and transmission rate.
Around 55,000 people have been using the NHS app on Isle of Wight.
NHS app should be better integrated to tracing strategy and wider public health measures to be successful.

Second session

Testing

What proportion of new COVID cases have been contacted by contact tracers within 24 hours? Do not currently have that data, need to ensure data is accurate. Working to have a weekly dashboard for the Test and Trace Programme from next week.
Vast majority contacted are happy to self-isolate.
Most concerned about symptomatic people not seeking a tests – yesterday only 1600 ordered test but estimated 8000 new cases per day.
Poll shows only 44% of adults were aware that all adults are now eligible for a test.
25% of people are entering their own details online and therefore contact tracers are not needed in these cases.
SAGE minutes show that people need to isolate within 48 hours of contracting the virus to be most effective. How many tests are returned within 24 hours? Over 90% are returned within 48 hours. Will only provide further data once it has been validated.
Why are people not offered a second test if tested negative given estimated 20% of false negatives? If people feel unwell after being tested negative, they should order another test after a few days.
Scientists cannot confirm that the presence of antibodies confers immunity.
Learnings from Isle of Wight show that human contact tracing is the bedrock of the system, local engagement is critical. The app is more a ‘cherry on the top’ to speed things up. 8m people do no own a smartphone and service needs to be inclusive.
What proportion of contact tracers are from BAME communities? Will write to the committee on this. 7,500 returner clinicians are contact tracers and likely reflect the diversity of the NHS.
What is being done to prevent fraud given there is no way to confirm a call from a contact tracer is genuine? Contact tracers will never ask for financial details. NHS Test and Trace can send an email or a text to log on to online services if a person is not comfortable talking on the phone.
Who has access to Test and Trace data? All data is compliant with GDPR, PHE holds the data.
Full evaluation of learnings from Isle of Wight will be published very soon.
What does the testing capacity need to be for Test and Trace to be accessible? Currently excess capacity. As we move to winter and more people have flu-like symptoms, will be necessary to expand capacity, speed up time and look at specificity of test.

PPE

Lord Deighton’s role has moved from overseeing manufacturing of PPE to overseeing the whole PPE operation, to stabilise PPE supply and ensure resilience.
Completely met the gap on aprons, largely due to SMEs e.g. bag manufacturers.
How far are we from having a solid supply of PPE (issues still exists with delivery of different FFP3 mask types requiring fit tests, expired PPE etc.)? Distribution in place where any item is resupplied to hospitals with less than 72hours stock. Situation is improving day by day.
Diversifying from reliance on China is key.
System of mutual aid across the four nations works very well.

Tuesday 2 June

Today’s round up includes:

Daily press briefing
Summary of oral Statement from Matt Hancock, secretary of state for health and social care
Office of National Statistics weekly data
Written statement summaries
- Health Protection (Coronavirus, Restrictions) (England) Regulations.
- NHS Test and Trace

1. Daily press briefing

Matt Hancock, secretary of state for health and social care was joined by Professor John Newton.

Hancock went through the slides including new cases, and tests

As of 9am 2 June, there have been 4,615,146 tests, with 135,643 tests on 1 June.
277,985 people have tested positive. 1,613 cases confirmed on 2 June.
As of 5pm on 1 June, of those tested positive for coronavirus, across all settings, 39,369 have sadly died.
436 estimated admissions with COVID – as of 31 May
Number of people in hospital continues to fall

He went on to give an overview of the PHE report published today.

He stated that he values the contribution of everyone who works in the NHS and social care, and extended this across society. He added that he values those who come to the UK to work in the NHS and social care, and loves that this country is one of the most welcoming, tolerant and diverse.
PHE's investigation found age was the biggest risk in terms of catching coronavirus, next gender, living in a city is a risk, and being black or from a minority ethnic background is also a significant factor. And there is more work to be done to understand what is driving these disparities and how the risk factors interact, and the government is determined to get to the bottom of it.
Kemi Badenoch, minister for equalities, will be taking this work forward working with PHE

Q&A

Public:

If R rate increases because of easing how will you identify?

Hancock: Will make changes at a national or local level. At a national level we can look at the measures. Have been clear, will bring in further measures if we need to.
Newton: Will depend on how virus is coming back. Have routine surveillance, and surveys. If it is in individual settings ie care homes, prisons, can make specific changes. Will be in response to how cases are increasing. From other countries, we can see that if it does come back it could be in patches.

When will people be able to have antibody tests?
Newton: In the first instance being used by those in health and social care sector. Delivering 40,000 a day for those in health and social care.
Hancock: Then we will be able to roll them out. Still not clear whether having antibodies mean you are less likely to catch the virus again and less likely to spread it.

Journalists:

BBC: Why has it taken so long to publish the PHE report?
Hancock: Really important report. More work that needs to be done, this report shows that. Have asked equalities minister to look into causes and what further can be done. Number one thing for anyone in a higher risk group is to follow social distancing, including at work.

Newton: weren’t able to look at all areas. This analysis has been produced in a relatively short time, and what they would like to do now is to have a discussion with the various groups involved in responding to it. difficult to turn this report to policy recommendations

Testing: Criticised by UK Statistics Authority:

Hancock: Way we present the stats is the best we can, simplest way of presenting 5 pillars of testing. Hancock working with the Stats authority to ensure we present the data in a way they are happy with and make sure as transparent as possible. Will be working to make sure statistics are constantly improved.
Newton: Purpose is to build capacity – what we do with tests, rather than numbers is what matters. Happy to report numbers in any way we are asked to.

ITV: where are the recommendations in the report?
Hancock: need to go through the next stage and take into all considerations - the effect of occupation, comorbidities or obesity. Need to scientifically rigorously understand the data
Newton: There are recommendations, but there are still some questions to look at. There is more than just ethnicities in the report.

Report emphasises that what COVID has done is emphasise existing health inequalities. We have put forward data that can be used to make recommendations by the Race equalities unit.

Shouldn’t all ethnic minorities be put in at risk category?

Newton: although at risk, it’s not necessarily because of their ethnicity – might be because of occupation. The report emphasises the complexity of what we are seeing.

LBC:

ONS this morning said total excess mortality is 62,000 – what lessons can we learn?

Hancock: didn’t make any prediction other than right at the start. SAGE forecast that with no measures the death toll would have been half a million – that led to the measures we have implemented. Transparent about the impact of the disease and welcome the ONS measuring it. Good news from the stats is that the number of deaths is coming down. Proportion of deaths in care homes is also coming down. Have been learning all way through how to deal with that.

Testing capacity has increased, but 1/3 is being unused - how can it be used?

Newton: 3 priorities: support test and trace programme – keen for anyone with symptoms to come forward. Thousands of contacts who have successfully been don’t recommend testing for people without symptoms, as might be negative. If self-isolating would still need to do so for 14 days even with a negative test.

Numbers of positive tests in care home / hospital settings are coming down, are learning for future.

Daily Express: what are your plans for reform of social care?

Hancock: Absolutely need to make reforms to social care. Made clear commitments in manifesto, have been working on this even during coronavirus. One of the positive things, is that people have recognised social care for how important it is. Need to follow that up with reforms to social care.

Timeframe is clear – have to get done in this parliament. Before coronavirus we were aiming for this year.

The Voice: When will the follow-up report come out?
Hancock: he gets that yearning for action. He needs to speak to Kemi Badenoch about a timeline for her report. But he won’t necessarily wait until it is done before acting.

Other topics:

Quarantine and airbridges between countries

2. Summary of oral Statement from Matt Hancock, secretary of state for health and social care

Full transcript

Matt Hancock

While the ONS data shows level of excess mortality is lower than at any point since start of lockdown, we are at a sensitive point in the pandemic.
NHS Test and Trace is operational and so public health advice has been updated to reflect a new duty: if you have C-19 symptoms, you must get a test.
The pandemic has exposed huge disparities in the health of the nation. PHE has now completed work on disparities on C-19 and published its report, which found that: age is the biggest risk factor (v high risk for over 80s), working age men are twice as likely to die, and certain occupations at higher risk. The ONS did not find that healthcare/ hospital workers had higher rates of death involving COVID-19 compared with the general population.
PHE report found that being black or from a minority ethnic background is a risk factor.
The SoS said more needed to be done to understand other risk factors e.g. obesity and co-morbidity: further work would be done on disparities in health outcomes.
The SoS confirmed that the Equalities Minister would lead on the next strand of work on understanding the impact of inequalities in health outcomes.

Jon Ashworth

Why is the excess death rate so high in the UK?
What measures is the Government planning to put in places to minimise risk to BME groups?
CQC report that 134% increase in deaths in people with learning disabilities. When will this group be included in testing?
The NHS has not been overwhelmed by Coronavirus but this has been at the expense of cancelled surgical procedures, cancer screening. This has essentially been the ‘biggest rationing exercise in the history of the NHS’. Can the SoS provide a full breakdown of procedures etc that have been cancelled as a result of the pandemic?
Jon Ashworth also raised the UKSA letter to Matt Hancock, ongoing questions over weekly testing of all NHS staff and concerns from Local Directors of Public Health about test and trace.

Matt Hancock

Testing of individuals with LD and autism is already taking place in care homes and is being rolled out further.
He agreed that it was necessary to get core NHS services going again. He acknowledged the pick up in cancer services and noted that while demand for A&E was not as high as in the past, it would be expanded further.
Test and trace is up and running and working well.

Wider questions

Science behind easing lockdown
Impact of Dominic Cummings saga on undermining public health messaging
School reopenings
Qs over timing of publication of PHE report
Care home deaths

3. Office of National Statistics weekly data

The weekly ONS registered deaths data covers all registered deaths in all settings. This update covers week 21, the week ending 22 May.

Key headlines

The total number of deaths (all causes) and the number of deaths involving COVID-19 continued to decrease, but the total is still 24% more than the five-year average for week 21 (2,348 more deaths).
2,589 of all deaths registered in week 21 mentioned COVID-19, which is 21.1% of the total. This is down from 26.1% last week, or 1,221 fewer COVID-19 deaths this week.
By setting, total deaths in care homes remain significantly higher than the five-year average, while in hospitals this is back to expected levels. The proportion of COVID-19 deaths in hospitals and care homes remained similar this week.
By region, the South East had the highest number of COVID-19 deaths this week, while the North East had the highest proportion of COVID-19 deaths. London is now near the bottom of the proportion list.
Over the year-to-date, there have been 43,837 deaths registered as COVID-19 related. This has resulted in 51,466 deaths above the five-year average (22% higher).

1. The total number of deaths (all causes) and the number of deaths involving COVID-19 continued to decrease:

The provisional number of deaths registered in England and Wales decreased from 14,573 in week 20 to 12,288 in week 21. This was 2,348 more deaths than the five-year average (Figure 1).
The number COVID-19 deaths also decreased from 3,810 in week 20 to 2,589 in week 21. Of all deaths registered in week 21, 21.1% mentioned COVID-19; this is down from 26.1% in week 20.
Looking at the year-to-date, the number of deaths up to 22 May was 286,759, which is 51,466 more than the five-year average (22% higher). Of the deaths registered by 22 May 2020, 43,837 were COVID-19 related, which is 15.3% of all deaths.
Week 21 showed a continuation of the decreasing trend in excess deaths above the five-year average (Figure 2). ONS are continuing to investigate the number of non-COVID-19 related deaths and will publish detailed analysis on this on 5 June 2020.

2. By setting, total deaths in care homes remain significantly higher than the five-year average, while in hospitals this is back to expected levels. The proportion of COVID-19 deaths in hospitals and care homes remained similar this week:

While excess deaths fell in all settings this week, the number of deaths in care homes was 1,289 higher than the five-year average, and there were also over a thousand excess deaths in homes. In hospitals the number of deaths was 24 fewer than the five-year average (Figure 3).
In Week 21, the proportion of deaths occurring in care homes decreased to 27.3% while deaths involving COVID-19 as a percentage of all deaths in care homes decreased to 32.5%.
The proportion of COVID-19 deaths in hospital rose slightly this week to 51.0% (up from 50.1%), while the proportion of COVID-19 deaths in care homes fell slightly to 42.1% (down from 43.6%).
By 29 May, the CQC had been notified of 11,186 COVID-19 deaths in care homes in England (Figure 4).

3. By region, the number of deaths involving COVID-19 was highest in the South East, while the North East had the highest proportion of COVID-19 deaths:

The number of deaths (all causes) and deaths involving COVID-19 continued to decrease across all English regions and Wales (figure 5).
The region with the largest number of deaths involving COVID-19 was the South East (409 deaths).
The North East saw 28.1% of all deaths being COVID-19 related. London only saw 19.6% of deaths being COVID-19 related this week, with only the South West (10.7%) and Wales (19.4%) having a lower proportion.

4. By age, people aged 90 years and over continued to have the highest number of COVID-19 deaths in week 21, while the age group with the highest proportion of COVID-19 deaths was 85-89 years.

The largest number of COVID-19 deaths was in those aged 90 years and over with 693 deaths.
The highest proportion of coronavirus (COVID-19) deaths was in age group 85 to 85 years where 26.0% of deaths involved COVID-19 (593 deaths).
There were again more COVID-19 deaths in women than men in the 85 years and over age bracket this week. This is likely because the over-85 years female population (939,000) is larger than the over-85 male population (564,000).

4. Written statement summaries

1. Health Protection (Coronavirus, Restrictions) (England) Regulations.

This written statement outlines the amendments to the Health Protection (Coronavirus, Restrictions) (England) Regulations.

The changes include:

allowing for increased social contact outdoors (both public and private places) in groups of up to 6 people from different households.
opening some outdoor retail (e.g. vehicle showrooms and outdoor markets).
confirming in law what people cannot do rather than the reasons for which someone can leave the home.
the maximum review period will change from 21 days to 28 days (every 4 weeks instead of every 3 – which takes the next review point to 25 June).

The full statement can be found here.

2. NHS Test and Trace update

The statement outlines the announcement on Test and Trace made last week.

Key points:

The NHS Test and Trace service uses a combination of 25,000 dedicated contact tracing staff, local public health experts and an online service to trace the contacts of anyone who tests positive for COVID-19. The NHS COVID-19 App, which will further extend the speed and reach of contact tracing, will be rolled out nationally in the coming weeks as part of the NHS Test and Trace service.
On 22 May the government announced £300m of new funding for local authorities in England to work with NHS Test and Trace to develop local outbreak control plans. These plans will focus on identifying and containing potential outbreaks in places such as workplaces, housing complexes, care homes and schools, ensuring testing capacity is deployed effectively and helping vulnerable people who are self-isolating access essential services in their area.
Anyone who tests positive for coronavirus is contacted by NHS Test and Trace and asked to share information about their recent interactions. This could include household members and people with whom they have been in direct contact or within 2 metres for more than 15 minutes. People identified as having been in close contact with someone who has had a positive test must stay at home for 14 days, even if they do not have symptoms, to stop unknowingly spreading the virus.

Full statement here

Monday 1 June

Daily press briefing
No.10 Lobby briefing

1. Daily press briefing

Matt Hancock, the Secretary of State for Health and Social Care was joined by Professor John Newton, Director of Health Improvement at Public Health England who is coordinating the test and trace programme.

Slides can be found here

126,437 tests yesterday.
206,444 testing capacity.
Tests are available on the NHS website or by calling 119.
1570 confirmed cases yesterday – the lowest number since lockdown began on 23 March.
39,045 people have sadly died.
111 died yesterday – the lowest number since 23 March.

Data shows that we are beating coronavirus and therefore the government can make some cautious changes to the lockdown.
People should not step too far and should take their responsibility seriously.
People should get a test if they show symptoms and self-isolate if requested to do.

Public questions

The impending recession will affect school leavers and young people. What action is the government taking?

MH: Taking measures with unprecedented economic support to protect jobs. The economy will need to change.

What changed to make it safe for the extremely vulnerable to go outside?

MH: Clinical advice said it was safe to advise the shielded to go outside as long as they remain 2m away from others, it is a small but positive step. Rate of incidents of disease is back down to the levels before the shielding policy was introduced.

Media questions

Hugh Pym, BBC

Government has said test and trace is vital to stopping the virus. Why are contact tracers saying there is very little to do? Do you know how many contacts have been made?

MH: As the rate of incidents comes down, there are fewer cases to track. 25,000 contact tracers were hired which means there is more capacity than needed. Rightly erring on the side of having too many contact tracers. The number of contacts is lower than expected suggesting people are complying with social distancing rules.

Tom Clarke, ITV

How many of the 9000 people tested positive for COVID-19 since the test and trace system began have been contacted? Does the biosecurity centre for local lockdown exist yet?

JN: Figures will be available soon. Not all new cases need to go through contact tracing process, e.g. those in care homes.

MH: Work is being done to set up the Joint Biosecurity Centre.

Sam Coates, Sky

If the R rate goes up, how likely is it that some blanket lockdown measures will be reimposed?

MH: Attempting to move the system to a more targeted approach but prepared to reintroduced measures whether nationally or locally if necessary.

Will data on contact tracers be available this week? Why can’t we have them now?

JN: Don’t want to produce inaccurate data.

Peter Walker, Guardian

How would localised lockdowns work in practice?

MH: It may involve shutting new admissions to a A&E at a local hospital. The Joint Biosecurity Centre will advise the CMOs who will advise local bodies. The toolkit is broad.

JN: Extension of normal processes.

Pulse Magazine

Why has new shielding advice been rushed through?

MH: It has not been rushed through and these are small cautious changes to benefit people in a safe way.

Dumfriesshire

Should we have a more UK wide measures including a UK contact tracing system?

MH: Minor differences but major principles are the same. Legally powers to implement lockdown are devolved.

Shielding people in Scotlannd still cannot go outside. Who is right?

JN: Trying to ensure guidance is the same across the UK. Differences are ironed out over time.

2. No.10 Lobby briefing

The prime minister’s spokesman suggested that the government is backing away from its plan for all primary school pupils in England to spend at least a month in school before the start of the summer holidays.
The spokesman indicated that the government backed a call from Anne Longfield, the children’s commissioner for England, for children to get catch-up tuition during the summer holidays. “We are [looking at] what additional measures may be required to ensure every child has the support they need, including over the summer.”

No.10 rejected calls for the easing of lockdown to be paused. The spokesman said the changes being made were “limited and...cautious” and “the consensus from the scientists is if test and trace is up and running and the public follow the social distancing guidance then it’s unlikely the measures will push the R above one.”
The spokesman defended the government’s decision to issue new advice to the 2.5m people in the ‘shielding’ category (extremely clinically vulnerable) at the weekend. He said it was a “very cautious change”, issued in accordance with medical and scientific advice. But he refused to say the move had been explicitly authorised by SAGE.
The spokesman said there was no requirement for MPs to vote on the move to impose quarantine on people arriving in the UK. There has been speculation that, if there were a vote, the government might be at risk of losing because so many Tory MPs oppose the plan.
The spokesman was unable to say how many people with coronavirus have had their contacts traced through the new test and trace system that went live last week. But he confirmed that the system was not yet operating at full capacity.

Tuesday 30 June

Monday 29 June

Friday 26 June

Thursday 25 June

Yesterday

Wednesday 24 June

1. PMQs summary

2. Opposition day debate on testing NHS Staff

3. Written ministerial statement on testing of NHS staff

Tuesday 23 June

1. Daily press briefing

2. Prime Minister’s statement to the House of Commons

3. Health and Social Care oral questions

Monday 22 June

1. Daily press briefing

2. Summary of Public Accounts Committee oral evidence session on Readying the NHS and social care for the COVID-19 peak – with Simon Stevens, chief executive at NHS England and Improvement and Amanda Pritchard, chief operating officer at NHS England

Friday 19 June

1. Daily press briefing

2. Coronavirus related deaths by religious group, England and Wales: 2 March to 15 May

3. Coronavirus and the social impacts on Great Britain data

Thursday 18 June

1. Daily press briefing

2. Lords PQ on the implementation of the COVID-19 track and trace system

3. NHS test and trace statistics (England): 28 May to 10 June 2020

4. COVID-19 infection survey pilot: England (18 June 2020)

Wednesday 17 June

1. Daily press briefing

2. Prime Ministers Questions

3. Urgent Question on coronavirus

Tuesday 16 June

1. Daily press briefing

2. Summary - Health and Social Care Committee - Delivering Core NHS and Care Services during the Pandemic and Beyond

3. Deaths registered weekly in England and Wales, provisional: week ending 5 June 2020 (week 23)

5. Update from Michael Gove on EU/UK negotiations

Monday 15 June

1. Daily press briefing

2. ONS data

Friday 12 June

1. Daily press briefing

2. R numbers by region

Thursday 11 June

1. Daily press briefing

2. COVID-19 Test and Trace statistics release

3. COVID outbreaks in care homes

Wednesday 10 June

1. Daily press briefing

2. PMQs

3. Lords Public Services Committee summary

4. House of Lords oral question: COVID-19: Cancelled Medical Operations

5. Key points from Science and Technology committee session

6. Daily testing figures

Tuesday 9 June

1. Daily press briefing

2. Lords Oral Question on Exercise Cygnus and preparations for responding to a major pandemic by the UK.

3. Office of National Statistics weekly data

Monday 8 June

1. Daily press briefing

2. Daily testing figures

Friday 5 June

1. Daily press briefing

2. Update to the process for communicating changes to the list of people identified as 'clinically extremely vulnerable' ('Shielded Patient List' or SPL).

3. ONS data releases

Thursday 4 June

1. Daily press briefing

2. No. 10 Lobby briefing

3. Summary of an Urgent Question to the Minister for Women and Equalities on Public Health England's review of disparities in risks and outcomes related to the COVID-19 outbreak

4. Summary of Lords Public Services Committee oral evidence session

Wednesday 3 June

1. Daily press briefing

2. PMQs summary

3. Summary - health and social care committee oral evidence session: Management of the coronavirus outbreak

Tuesday 2 June

1. Daily press briefing

2. Summary of oral Statement from Matt Hancock, secretary of state for health and social care

3. Office of National Statistics weekly data

4. Written statement summaries

Monday 1 June

1. Daily press briefing

2. No.10 Lobby briefing

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