Covid-19 update: 5 March

Funding for the Department of Health and Social Care in 2021/22 will actually fall substantially as specific Covid-19 funding reduces. This is based on the expectation that the peaks of the pandemic are now in the past and that the vaccination programme will be effective. Planned funding of £199bn in 2020/21 will fall to £169bn. NHS England’s own additional Covid-19 funding will drop from the £18bn allocated in the current year to £3bn for 2021/22. While its core funding increases by £6.4bn, in overall terms, the NHS England budget will fall from £148bn to £139bn.

The NHS Confederation said chancellor Rishi Sunak’s promise last year to give the NHS whatever resources it needed to get through the crisis ‘appeared to have evaporated’.

‘The NHS has faced an unprecedented and almighty battle over the past year and has at times come very close to breaking point, so to continually under-resource and underfund both the health service and social care sector when they are facing the biggest challenge they have ever seen is of huge concern,’ said chief executive Danny Mortimer.

He welcomed the additional £1.65bn for the vaccination programme. However, the £3bn, previously announced in the autumn spending review, ‘fell far short’ of the £10bn investment in the NHS believed to be needed to deal with the pressures caused by the coronavirus.

Just a day after the Budget, the government’s recommendation of a 1% pay rise for NHS staff next year was met with a concerted outcry from unions, NHS representative bodies and Labour. Labour leader Keir Starmer said the recommendation amounted to a real-terms pay cut, given forecast levels of inflation. ‘You can't rebuild a country by cutting nurses' pay,’ he tweeted.

The failure to tackle the long-term funding of social care in the Budget was widely seen as another missed opportunity. Care homes struggle to survive on current funding levels and there are major workforce shortages, compounded by low pay in the sector. There have been multiple reviews and government pledges of future reform. Prime minister Boris Johnson promised in January 2020 to ‘get it done this year’ and there was a commitment in the autumn spending review to bring forward proposals in 2021.

Mr Sunak told BBC Radio 4’s Today programme that there needed to be a cross-party consensus to ensure any solution was sustainable. ‘Right now our focus is the pandemic, but the health secretary has started that work and if we can find consensus we will bring that forward,’ he said.

James Jamieson (pictured), chair of the Local Government Association said further action was ‘desperately needed to immediately shore up social care services, and to secure the long-term future of care and support’. ‘The government must urgently bring forward its proposals, including a clear timetable for reform,’ he said, ‘so that we can finally put social care on a sustainable footing and enable people to live the lives they want to lead.’

Away from the Budget, the government published guidance on workforce movement between care homes and other care settings. Its winter plan for social care, published last September, made it clear that stopping staff movement was critical to minimise the risk of infection. The new guidance underlines that movement between settings should continue to be limited unless absolutely necessary.

Staffing requirements should be planned so routine movement is not necessary to maintain safe staffing levels, with block bookings used where agency or other temporary staff are needed. Where someone does need to be deployed across two settings, the guidance calls for a 10-day interval plus a negative test result prior to the individual entering the home.

Guidance has also been updated on allowing a single named visitor for residents in care homes in England. Visits from 8 March should be supported wherever they can happen safely. The named visitor will need to take a lateral flow test on every visit and wear personal protective equipment. Physical contact will still be discouraged.

NI pathway

Northern Ireland set out its roadmap to easing restrictions this week, following similar plans published by England and Scotland last week. Wales had previously extended its lockdown rules by three weeks, although it has said that further easing of restrictions is being considered. The Northern Ireland executive’s Pathway out of restrictions confirms that the phased return of children to school will begin on 8 March , with a second phase on 22 March and the remaining students returning after Easter.

There will be four-weekly reviews of restrictions, with lockdown eased if metrics continue to show the pandemic moving in the right direction. It has set out possible relaxations across nine areas including hospitality, sports and leisure, and home and community.

The government’s Covid-19 dashboard continues to offer encouragement – as does the falling number of occupied critical care beds reported in the winter sitrep statistics. Daily positive cases across the UK are now around 6,500, with a seven-day average close to half the level a fortnight ago. Daily admissions to hospital are below the thousand mark (757 on Sunday) and the numbers in hospital continue to fall. There were still 12,136 Covid patients in hospital beds early in the week. But this represented a 25% fall compared with just seven days previously and a more than 60% reduction on the numbers at the beginning of February.

There have been a few days of relatively low vaccination numbers – ranging from 186,000 to 279,000 first doses, compared with some days in recent weeks when more than 500,000 vaccinations have been delivered. However, the number of second dose vaccinations being delivered is ramping up with Wednesday’s more than 68,000 being the highest daily total yet for second dose delivery.

This week marked 12 weeks since the first vaccination was delivered, with more than 20 million citizens now vaccinated. Health secretary Matt Hancock described this as a ‘phenomenal achievement’. ‘The data confirms that this strategy is working because the vaccines work,’ he said. ‘The number of hospital admissions is falling faster than the number of new cases, whereas in the first peak it fell more slowly, and the fall in hospitalisations is faster among the age groups vaccinated first than in younger age groups yet to get a jab.’

He also pointed at new research that shows a single dose of either the Oxford or the Pfizer vaccine delivers protection against severe infection in the over-70s, with a more than 80% reduction in hospitalisations for the over 80s.

He acknowledged that supply had been lumpy but promised there were ‘bumper weeks ahead later this month’. The programme remained on course to offer all nine priority groups a first vaccine by 15 April and to all adults by the end of July.

Variants and vaccines

This week also saw a hunt intensify for a person who tested positive for variant of the virus that emerged in Brazil. With six cases detected in the UK, five had been located and had quarantined at home. The sixth person had not filled in contact details fully when submitting their test. Experience in Brazil suggested the variant was infecting people who might have expected to be immune following a first bout of Covid and there are concerns about whether existing vaccines would protect against it. Mr Hancock told the Commons ‘there may well be a need for a third vaccination over the autumn against variants’.

The Medicines and Healthcare Products Regulatory Agency (MHRA) said this week that vaccines that are modified in response to new variants will not need a brand-new approval or lengthy clinical studies. Guidance – developed by the agency with regulatory authorities from Australia, Canada, Singapore and Switzerland – makes it clear that manufacturers would need to provide robust evidence that the modified vaccine produces an immune response, but not have to go through time-consuming clinical studies ‘that do not add to the regulatory understanding of a vaccine’s safety, quality or effectiveness’. The approach mirrors that used for seasonal flu vaccines.

MHRA chief scientific officer Christian Schneider said the priority was to get effective vaccines to the public in as short a time as possible, without compromising on safety. ’The public should be confident that no vaccine would be approved unless the expected high standards of safety, quality and effectiveness are met.’

The weekly update on NHS Test and Trace statistics showed that just over 69,000 cases were transferred to the contact tracing system in the week to 24 February – continuing a decreasing trend in line with reducing infections. Some 61,000 (89%) of these were reached and 46,000 of these (75%) collectively provided details of 129,000 close contacts. Some 93% of these close contacts were reached by the service.

More than eight out of 10 results of in-person tests in the community were received within 24 hours. But this falls to just over three in 10 when looking at all test routes. Interim chair of the National Institute for Health Protection Dido Harding (pictured) said it had been ‘another strong reporting week’ for NHS Test and Trace. ‘As the virus becomes less prevalent, the test, trace and isolate system will become ever more important in identifying local outbreaks rapidly, enabling local and national teams to take swift action to manage them and respond to new variants of concern,’ she said.

The final findings from the February Covid-19 React-1 study suggest that one in 204 people had the virus between 4 and 23 February. This broadly confirms the interim findings published a fortnight ago and suggests that infections have fallen by two-thirds since the January report. However, the research, led by Imperial College London and Ipsos Mori, also shows the speed of the decline is slowing. When compared to the interim findings, there has been no change in prevalence in Yorkshire and the Humber and a slight increase in London, the South East, East Midlands and West Midlands, with falls in all other regions.

The halving time for prevalence is now estimated at 31 days with an R number of 0.86.

Paul Elliott, director of the React programme from Imperial’s school of public health, said the fall in infections showed public health measures were working. ‘But these new findings, showing that some areas are experiencing apparent growth, reinforce the need for everyone to continue to stick to the rules and help keep infections down,’ he said.

Layla McCay, director of policy at the NHS Confederation, said that in general it was important to keep track of the changes in the data and the speed of decrease. ‘The latest test and trace figures show another welcome decrease in the number of new infections, falling a further 19% week-on-week, but this has slowed from a 21% decrease in the preceding week, and a 29% decrease the week before that,’ she said. ‘Furthermore, about one in 200 people in England are still believed to have the disease and, with the first stage of the national lockdown easing from next week, it is imperative that decision makers keep a close eye on this data and what experts are saying, including NHS leaders.’

With schools returning next week and other lockdown measures set to relax in coming weeks, the scrutiny of infection and hospitalisation rates is likely to intensify.