Coronavirus: lessons learnt

On 26th January 2021, Sir Simon Stevens, CEO of NHS England, attended the Health Select Committee to answer questions on lessons learnt from the pandemic. The session focused on several topics, including the vaccine rollout, NHS waiting time and a long term plan for social care.

Article written by Louis Holmes, Care England

Witness(es): Sir Simon Stevens, Chief Executive, NHS England

On 26th January 2021, Sir Simon Stevens, CEO of NHS England, attended the Health Select Committee to answer questions on lessons learnt from the pandemic. The session focused on several topics, including the vaccine rollout, NHS waiting time and a long term plan for social care.

The session started with an update on the pandemic. There are currently around 33,000
COVID-19 positive patients in hospitals across England, before Christmas it was around 18,000. Although new admissions are slightly decreasing overall, bed occupancy changes per region. In the midlands, it is increasing, while in London it decreases. There are currently over 4,000 in critical care, with three-quarters being COVID related. Sir Simon confirmed that everyone who needs a ventilator is getting one, but this does not mean that critical care beds and resources are not stretched.

Sir Simon was asked about steps taken to maintain cancer treatment. He reassured that chemotherapy and cancer checks are still being maintained, however, there are concerns over surgery. Efforts are being made to make sure that there is dedicated time for this. Maintaining maternity and mental health services was brought up next. Sir Simon noted that maternity services have continued with the discussion of visitors continuing. On mental health, ONS data suggests that the rate of its use has come down. There is concern over the eating disorder services and their usage.

The session moved onto the increased waiting times for procedures. Nearly one-quarter of a million are waiting a year for their treatment. Sir Simon was asked what the minimum/maximum waiting time was. He stated that overall, the size of the waiting list is slightly lower than a year ago overall. The medium wait for a planned test/operation has been failing since July (19 weeks in July to 10 ¬Ω weeks by November).

The vaccine rollout was the next point of discussion, with the first question referring to the concerns over the recent confrontations with the EU. Sir Simon reassured the committee that he was not worried, due to comments from ministers, however, if there were obstacles put in place then there that would be an issue. There was also further confirmation that the deadline of vaccinating the top four priority groups by 15 Feb was still on target. The next question asked about hospital admissions of patients who had had their first dose. Sir Simon stated that there isn’t any reason to be concerned and that MHRA will be publishing data on this soon.

The session moved to discuss the priority groups and whether the focus should be reducing the pressure on the NHS or vaccinating younger people who are also vulnerable such as people with learning disabilities and those in key public services such teachers. Sir Simon refuted the argument that the sole focus of the vaccine rollout should be on reducing the stress of the NHS and that people with learning disabilities and/or autism need to be factored in post 15 February. He further reiterated that the most important thing is to get the R rate down.
Vaccine hesitancy was raised, especially in reference to the figure that just 28% of BAME communities will get vaccinated. Although the uptake of the vaccine in over 80s was higher than expected (80% when it was expected to be 75%), there is a long-standing mistrust of public services. Tracking data and targeting misinformation channels are some of the things being done to increase the uptake of the vaccine.

When asked about the date of the second dose, Sir Simon confirmed that everyone in the top four priority groups will receive their second dose within 12 weeks of the first. This is despite statements from Pfizer that have made it clear that there should only be a 21 daybreak. In response to the Israel study, where one dose was only 33% effective, Sir Simon said that further studies have rebutted this and there will be constant reviews of the vaccine. Vaccination centres will be issuing cards with the second dose date on it. When it is getting closer to the 12 week deadline, people who have received their first dose will be prioritised for their second, over those who have yet to receive their first. If there were unlimited vaccines, then there wouldn’t be the need for a 12 week gap. Regarding the supply and distribution model for the second dose, the NHS will move into a ‘pull’ model, where regions can contact how many doses they need.

The terminology of the rollout was raised next. This is in reference to the PM referring to people receiving their first dose as being vaccinated rather than having received their first dose. Although MHRA data states that the protection you get after the first jab is significant, the recommendation is two doses and therefore vaccinated isn’t the correct term until both doses have been administered. However, it is unknown how much it reduces transmission. A return to normality for the NHS was the next point raised, where Sir Simon noted that the first half of 2021 will be on the vaccine rollout and the second half of the year and beyond will allow more therapeutic treatments to increase with coronavirus becoming a far more treatable disease.

The session moved onto the workforce and long-term plan in health and social care. Sir Simon stated his support for a 10 year plan in the sector. He stated that the sum needed for the care sector’s sustainability (¬£7 billion, as stated in the Health Select Committee’s report), is less than a third compared to the budget for the test and trace system (¬£45 billion). Making effective use of additional funding will be important; what will be used to make the financial burdens fairer and what proportion will be used to meet unmet needs. There needs to be a set of judgements to be made which gives people more flexible options. People with learning disabilities and/or autism are also a big part of social care and they need proper attention too. Sir Simon said that there needs to be increasing support for this and the wide range of providers in social care, from big to small.

Sir Simon was asked about the discharge to assess model, how family carers have been left. The lack of clarity around unpaid carers in priority group 6 and how they are identified as well was also brought up. Sir Simon said that these will be addressed, referencing the important role these carers have. Post-February 15, there will be a review of what the next stage of the rollout will be. Communication to home care providers has also been difficult, especially with some Local Authorities. Communication has been absent in certain places. Sir Simon responded that this was not the role of the vaccination hospital hubs, but he would feed this back. Asked about the levelling up agenda, Sir Simon said that this should include more minorities. He further stated that there needs to a balance between doing things locally vs centrally.

Testing was raised and the efficacy of LFT tests. Sir Simon said that these were an important tool in keeping staff safe.

The remainder of the session moved onto a discussion about the NHS and its services, including structural change, reduction in treatments, communication, the importance of working together and the integration of healthcare.

To read the full transcript, visit Parliament. For more information or questions, please email info@careengland.org.uk.