Dominic Harrison column: NHS Winter Crisis Risk & Face Masks

I think we may all need to start wearing facemasks again very soon in schools and enclosed public spaces. This is why.

The largest spike in excess winter mortality in England since the Second World War occurred in January 2015. In 2017 I, together with academic public health colleagues from the London School of Hygiene & Tropical Medicine and Oxford University, published a research paper looking at the probable causes. We found that the most likely explanation for the surge in deaths in that month was that those who required urgent lifesaving treatment suffered significantly delayed access to treatment due to an inability of the whole system to manage ‘surge demand’.  The system struggled because of the double-whammy of high NHS staff vacancies compounded by high NHS staff sickness absences.  This arose from significant underfunding of the NHS and care system in previous years which limited the system’s capacity to build staff capacity to meet surge demand with an appropriate surge response.

All of the red light indicators which flashed in January 2015 are flashing now across the health and care system. The NHS in England is showing all the early warning signs of a likely winter crisis which could be accompanied by a high rate of avoidable winter mortality.

For Lancashire and the North West, following a slight reduction in Covid cases during the school half term week, rates of school-aged Covid cases look like they have re-ignited again. The local NHS has seen a surge in Covid hospital admissions in the last seven days, with now over 70 in-patients in East Lancashire Hospitals Trust. Cases had been fairly steady at around 35-45 since early August.

Ambulance Service Trusts across the country are struggling with very high demand with some patients often waiting almost twice as long for a paramedic as they were at the height of the pandemic.

NHS vacancies are also now at a very high level. Even in June this year, data from NHS England and NHS Improvement showed a vacancy rate of 10.3% for nurses. The NHS staff sickness absence rate across the North West Region is the highest in England with a sickness absence rate in June 2021 at 5.7% of all staff, and now at around 7%.

NHS 111 has significant delays in response times due to high demand and parts of Lancashire now have the lowest number of GPs per 100,000 of the population in England – causing access problems for both patients and GPs. As Lancashire has had the biggest overall displacement of routine treatments during the 19 months of the pandemic,  it now has both long waiting lists for treatment and higher than average numbers of Long Covid cases, many of which have not yet been diagnosed. Hospital attendances to most A&E departments – for all causes not just Covid – are running at previous ‘peak winter rates’, even though the winter virus season of flu has not yet started. Many people with high blood pressure and a consequent risk of stroke and heart attacks over the next six months have not had their blood pressure monitored during the 19 months of the pandemic and may now be on sub-optimal medication. Many new cases of high blood pressure arising over the pandemic have not been diagnosed due to pandemic related delays to routine health checks. For those on low income experiencing rocketing fuel costs over the coming months, there is a very real risk we will see a surge in avoidable heart attacks and strokes. Moving from a single heated room to a cold bedroom for instance is often a trigger point.

We urgently need to mitigate some of these emerging risks of avoidable mortality and allow the NHS and care system to focus on those most at risk over the coming months.

The UK Health Security Agency (formerly Public Health England) has just published a further review of face masks which says, “The evidence predominantly now suggests that face coverings reduce the spread of COVID-19 in the community”. So one thing we can immediately do to reduce the Covid burden of high winter demand on the NHS and care system is to immediately reinstate mask-wearing in schools and enclosed public spaces. If implemented now, this would save lives and reduce winter pressures on the health and care system. It may also reduce the risks of stricter Covid control measures having to be reintroduced later in the year. I will issue further local advice on this by Monday 15^th November.