The BDA fully supports community water fluoridation as a safe and effective public health intervention, as part of a package of measures to improve dental health, where technically feasible and appropriate for local needs. The Health and Care Bill, currently before Parliament, is set to simplify the rollout of the policy in England. Dentist leaders are now urging all 4 UK administrations to restate their positions on water fluoridation in light of the statement.
Public Health England modelling shows water fluoridation more than pays for itself in medium term, owing to reduction in treatment need. £1 spent equates to £12.71 savings in five years, rising to £21.98 in ten. The BDA has stressed that upfront investment by Government is vital to unlock these benefits.
In their statement, the four UK CMOs recognise water fluoridation should be seen as a complementary strategy, and not a substitute for regular dental check-ups and other effective methods of increasing fluoride use.
The BDA backs a joined-up approach in which tried and tested policies like water fluoridation and supervised tooth brushing in early years settings are expanded, with parallel effort applied to rebuilding high street dental services.
Oral health inequality is anticipated to widen, given combination of unprecedented access problems, the suspension and ongoing disruption to public health programmes and changes to dietary habits since the start of the pandemic. Over 30 million appointments have been lost in NHS dentistry since lockdown, in England alone.
Around 5.8 million people in England receive fluoridated water, the lion’s share artificially added, but in some locations the appropriate level exists naturally within local water supplies.
British Dental Association Chair Eddie Crouch said: “Every dentist will thank the CMOs for recognising the lasting benefits water fluoridation could bring to the nation’s oral health.
“However, these gains are purely theoretical without upfront investment. Spending here will pay for itself, and Ministers need to show they are willing to seize the moment.
“We need a joined-up approach. COVID has left millions unable to access care, and deep inequalities are now set to widen. The four Governments must double down on tried and tested policies while rebuilding the services millions depend on.”
More than 10 million COVID-19 PCR tests have now been carried out in Scotland over the past 19 months since testing got underway.
The tests, which include those processed at the three NHS regional hubs set up around Scotland, have now reached 10,017,000. They also include the four-nations network of Lighthouse laboratories, partner laboratories and testing sites.
More than one million tests have also been conducted by the Scottish Ambulance service at mobile testing units around the country.
Health Secretary Humza Yousaf said: “Reaching ten million tests is a major milestone and recognition of the hard work and dedication of our testing teams across the country.
“Testing has a vital role to play as restrictions are phased out and we learn to live with the virus.
“It may be tempting to think as vaccinations increase and cases drop, that testing will become less important. In fact, this will only make it more important to spot and prevent new outbreaks as cases emerge. We know from our experience just how quickly one outbreak can lead to another.
“The ability to quickly identify new outbreaks and put appropriate measures in place will remain at the heart of our strategy to help break chains of transmission.”
All adults are encouraged to take a PCR test if they have any one of the three symptoms of coronavirus. These are a high temperature or fever, a new continuous cough, as well as any loss of, or change in sense of smell or taste.
People are also encouraged to take two rapid (lateral flow) tests a week, regardless of whether they have symptoms.
https://youtu.be/X0Kj8dD_X_M
Three regional hubs were established this year at Gartnavel hospital in Glasgow (West) operated by NHS Greater Glasgow and Clyde, Foresterhill in Aberdeen (North) operated by NHS Grampian and Lauriston Place in Edinburgh (East), operated by NHS Lothian, to increase capacity.
The 10,017,000 figure for tests comprises those processed through to midnight on September 20.
– Covid-19 booster vaccinations get underway today
– Lothian launches drop-in clinics for 12 to 15-year-olds
Residents in care homes for older people are the first to be offered coronavirus (COVID-19) booster vaccinations from today (Monday).
This group will be offered both flu and COVID-19 booster vaccines after the Joint Committee on Vaccination and Immunisation advised that they could be given alongside one another.
From tomorrow (Tuesday 21 September) frontline health and social care workers are able to book an appointment for a booster jab online at NHS Inform. The portal can be used by all health and social care workers to book a flu vaccine.
Adults aged 70 years and over and those 16 years and over who are on the highest risk list (previously known as the shielding list) will begin to be contacted by letter or by their GP from the end of September.
People on the highest risk list who were severely immunosuppressed at the time of their last COVID-19 vaccination will be offered a third primary dose instead.
Other eligible groups – including all those aged 16 to 49 years with underlying health conditions, adult carers, unpaid and young carers, adult household contacts of immunosuppressed individuals and all adults over 50 – will be able to book an appointment online from October.
Meanwhile, also from today (Monday) children and young people aged 12 -15 years old can go to drop-in clinics for a vaccination if they wish to get their jab before they receive their letter inviting them for a scheduled appointment. Everyone in this age group will be invited for vaccination at a community based clinic or a school delivery session from 27 September.
Heath Secretary Humza Yousaf said: “I am pleased to see the booster programme getting underway for residents in care homes for older people, offering longer lasting protection against severe COVID-19 illness.
“The booster programme will run alongside our biggest ever flu vaccine programme as both of these programmes are important for individual and for public health and wherever possible, those eligible will be offered COVID-19 booster and flu vaccines together.
“We are also starting vaccination of 12-15 year olds after Scottish Ministers accepted advice from the four UK Chief Medical Officers. This group can now head to drop-in clinics for their jabs or wait for a letter offering them a scheduled appointment.”
NHS Lothian launches drop-in clinics for 12 to 15-year-olds
Young people aged 12 to 15 will be able to get a COVID-19 vaccine at drop-in clinics across Lothian from today (September 20).
Mass clinics in West Lothian, Edinburgh and Midlothian will open their doors to young people as part of the latest phase of the national vaccination programme.
Pyramids, Gorebridge and Lowland Hall vaccination clinics will be the first in Lothian to administer the lifesaving vaccine, before more clinics are added to the list over coming days.
Pat Wynne, Director of Nursing for Primary and Community Care, NHS Lothian said: “We are delighted to offer drop-in clinics for young people aged 12-15.
“These clinics will enable young people to attend, without a prior appointment to receive their vaccination.
“We recognise that young people, as well as their parents and guardians may have questions regarding the COVID vaccination and we encourage them to visit the pages on NHS Inform where there is a range of information available.
“Alongside this, our teams at Pyramids, Gorebridge and Lowland Hall are one hand to answer any questions people may have.
“Vaccination remains critically important in the continued fight against COVID-19 and we welcome the further expansion of the vaccination programme across Lothian.”
The clinics are opening their doors following the publication and government acceptance of the advice of the four Chief Medical Officers (CMOs) to offer a single dose of the COVID vaccine to all healthy 12-15-year-olds.
Young people do not need to be registered with a GP to attend, however it is requested that they are accompanied by their parent or guardian.
As well as the drop-in clinics for 12-15’s, NHS Lothian continues to operate a range of COVID vaccination clinics in locations across Lothian.
Mr Wynne added: “We continue to offer vaccination clinics across Lothian for anyone who requires a first dose of the vaccine, or who is now due their second dose. I would urge anyone who has still to be vaccinated to pop along.”
Thousands of vulnerable NHS patients in hospital due to COVID-19 are set to benefit from a ground-breaking new antibody treatment, the UK government has announced.
Ronapreve, a combination of two monoclonal antibodies, will be targeted initially at those in hospital who have not mounted an antibody response against COVID-19.
This includes people who are immunocompromised, for example those with certain cancers or autoimmune diseases, and therefore have difficulty building up an antibody response to the virus, either through being exposed to COVID-19 or from vaccination.
The government has taken action to secure supply of the new therapeutic for NHS patients across the four nations, buying enough to treat eligible patients in hospital from next week. Guidance will shortly be going out to clinicians so they can begin prescribing the treatment as soon as possible.
Health and Social Care Secretary Sajid Javid said: “We have secured a brand new treatment for our most vulnerable patients in hospitals across the UK and I am thrilled it will be saving lives from as early as next week.
“The UK is leading the world in identifying and rolling out life-saving medicines, particularly for COVID-19, and we will continue our vital work to find the best treatments available to save lives and protect the NHS.”
Ronapreve is the first neutralising antibody medicine specifically designed to treat COVID-19 to be authorised by the Medicines and Healthcare products Regulatory Agency (MHRA) for use in the UK.
It will be used to treat patients without antibodies to SARS CoV-2 who are either aged 50 and over, or are aged 12 to 49 and are considered to be immunocompromised.
Antibody testing will first be used to determine whether patients are seronegative, meaning those who do not have an adequate existing antibody response, and will therefore receive the treatment. The treatment antibodies – casirivimab and imdevimab – will then be administered to patients through a drip and work by binding to the virus’ spike protein, stopping it from being able to infect the body’s cells.
The UK’s world-renowned vaccination programme also continues to provide protection to tens of millions of people across the country, and has so far saved 112,300 lives, prevented 230,800 hospitalisations and stopped over 24 million infections in England alone.
Since the beginning of the pandemic, the UK has proven itself to be a world-leader in identifying and rolling out effective treatments for COVID-19 – including the world’s first treatment dexamethasone, which has since saved at least 22,000 lives in the UK so far and an estimated million worldwide.
The NHS has also rolled out monoclonal immunomodulatory antibody treatments tocilizumab and sarilumab, following clinical trial results from the government-funded REMAP-CAP trial. The treatments were found to reduce the relative risk of death by 24%, when administered to patients within 24 hours of entering intensive care.
Earlier this year, the government also brought together a new Antivirals Taskforce to supercharge the search for new treatments for patients who are exposed to COVID-19 to stop the infection spreading and speed up recovery time.
The UK’s leading research infrastructure and life sciences sector makes it the ideal base for the brightest of global innovators to research and progress cutting-edge treatments for COVID-19 through the clinical trials process here in the UK.
Paul McManus, COVID-19 Lead at Roche Products Ltd, said: “Over the last 18 months, our goal has been to do everything we can to minimise the impact of the pandemic on those affected and the brilliant people who work tirelessly to treat and care for them.
“Ronapreve is the first dedicated medicine developed for COVID-19 to receive marketing authorisation from the MHRA, representing a significant milestone in how the NHS is able to fight this disease.
“This is just another step in our journey to overcome COVID-19, and we will continue to collaborate with partners to identify and investigate multiple options that may help different groups of patients.
“Together with Regeneron, we’re grateful for the collaboration of the vaccine taskforce and NHS England in helping to bring this important antibody cocktail to treat and prevent acute COVID-19 across the UK.”
A strategy to deliver world class cancer care for children and young people has been published by the Scottish Government.
Collaborative and Compassionate Cancer Care, the Cancer Strategy for Children and Young People in Scotland 2021-2026, was launched by Health Secretary Humza Yousaf during an online event yesterday.
The strategy highlights 10 priorities for the next five years, supported by almost £6 million investment, which include:
working towards funding genetic testing to provide personally targeted treatment
expanding Chimeric Antigen Receptor T-Cell therapy (CAR-T) to teenagers and young adults
setting up a national molecular radiotherapy service for children
funding a dedicated health workforce to care for teenagers and young adults
raising the profile of supported care services and holistic care
developing a single centre of excellence to provide radiotherapy treatment to improve survival among children with cancer
Mr Yousaf said: “Receiving a cancer diagnosis is never easy, but receiving one at such a young age is especially difficult.
“We know that diagnosis has come a long way, with survival rates remaining stable for children and young people. However there is still more we can do to support this age group to live long, healthy and happy lives.
“This strategy, backed by almost £6 million, marks an exciting time for children and young people’s cancer services as the first strategy for this age group. It outlines our 10 ambitions to build on previous successes so that, by 2026, we will see improved and enhanced outcomes for patients and ensure equal access to care across Scotland.”
Medical Director of NHS Forth Valley Andrew Murray said: “I am delighted to see the launch of Collaborative and Compassionate Cancer Care, after such a challenging period in the NHS Scotland’s history, and I look forward to working with our clinicians and families to deliver its ambitious objectives over the next five years, improving experiences and outcomes.”
The launch was somewhat overshadowed by news that the Scottish Government is calling in the army to help tackle a crisis in the ambulance service – and a Twitter post of a film of Health Minister Humza Yousaf’s unfortunate accident on a scooter.
Children and young people aged 12 -15 years old will be offered a dose of the coronavirus (COVID-19) vaccination from Monday (20 September) after Scottish Ministers accepted advice from the four UK Chief Medical Officers (CMOs).
As a result, a dose of Pfizer-BioNTech vaccine will be offered to all children and young people aged 12-15 who are not already covered by existing advice from the Joint Committee on Vaccination and Immunisation (JCVI) in a move to reduce the disruption caused to education by COVID-19.
This group will be offered their injections in drop-in clinics and community settings followed by each young person receiving a letter inviting them to attend a community clinic.
For some rural Health Boards, those aged 12 to 15 will first be offered the vaccine at school.
Following the initial phase, vaccines will be offered in both communities and schools so that anyone who hasn’t been vaccinated but would like to be has the opportunity to take up the offer.
Meanwhile, people who received their vaccination during phase one of the national COVID-19 vaccination programme in Scotland will start to receive booster injections from 20 September.
This follows advice from the JCVI which has advised that the booster dose can be given alongside the flu jab and should be offered no earlier than six months after completion of the primary vaccine course.
Frontline health and social care workers will be able to book their appointment online at NHS Inform from 20 September and from that date, residents in care homes for older people will be offered both flu and COVID-19 booster vaccination.
Adults aged 70 years and over and adults aged 16 years and over who are on the highest risk list (previously known as the shielding list) will be contacted soon, either by letter or by their GP.
People on the highest risk list who were severely immunosuppressed at the time of their last COVID-19 vaccination will be offered a third primary dose instead. Other eligible groups – including all those aged 16 to 49 years with underlying health conditions, adult carers, unpaid and young carers, adult household contacts of immunosuppressed individuals and all adults over 50 – will be able to book online from October.
Health Secretary Humza Yousaf said: “I want to thank Dr Gregor Smith and the other three UK CMOs who have taken the time to consider the benefits of offering a first dose of the COVID-19 vaccination to 12-15 year olds.
“I recognise the impact disruption to education can have and am keen that we do all we can to reduce this so I am happy to accept the recommendation to proceed.
“As the CMOs recommended, informed consent must be at the heart of decision making so we will ensure that there is clear communication with this age group and their parents so they understand the potential benefits, potential side effects and the balance between them.
“A new leaflet from Public Health Scotland will be circulated to ensure parents, carers and young people have all the information they need. Individual choice is central to this, and the decisions of parents, carers and children will be respected.
“Alongside the booster programme this will be a busy period for our largest ever vaccination programme but work has been underway for some time to plan for this and I am confident our roll-out will continue to be a huge success.”
Statement given by the First Minister Nicola Sturgeon to the Scottish Parliament on Tuesday 14 September 2021
Thanks, Presiding Officer,
I will give an update today on the latest COVID situation.
I can confirm that the Cabinet met this morning, and decided not to make any immediate changes to the current regulations in place.
I will also give an update on certain other issues, most notably the mitigations in place for schools, including of course our approach to vaccination of 12 to 15 year olds, and the issue of a vaccine booster programme, which we have received final JVCI advice on this morning.
Firstly, though, to recap on today’s statistics.
3,375 positive cases were reported yesterday – 11.4% of all tests.
1,064 people are currently in hospital with COVID – 16 more than yesterday.
And 89 people are receiving intensive care – that is one fewer than yesterday.
Sadly, a further 21 deaths have been reported in the past 24 hours, and the total number of deaths under the daily definition is now 8,263.
And, as always, I send my condolences to everyone who has lost a loved one.
Good progress continues to be made in the vaccination programme.
As of this morning, 4,144,904 people have had a first dose and 3,788,551 have now had both doses.
95% of people over 40 are fully vaccinated with two doses now, as are 73% of 30-39 year olds, and 60% of 18 to 29 year olds.
Around 76% of 18-29 year olds have, though, had a first dose, so the proportion in that age group who become fully vaccinated will continue to increase in the weeks ahead.
In addition, 65% of 16 and 17 year olds have now had the first jag – which is five percentage points higher than at this time last week.
Presiding Officer,
Although the level of infection in Scotland remains too high, there are continuing signs that the recent spike in cases is now slowing down.
Indeed, we are now seeing early signs – not just that the rate of increase is slowing – but that cases are now actually starting to fall slightly.
This can be seen in the last three weeks’ data
In the week to 28 August, there were an average of 5,651 new cases a day – which was an increase of more than 80% on the previous week.
In the week to 4 September, average daily cases were 6,290 – still an increase, but one of just 11%.
However, in the seven days to 11 September – so the most recent seven-day period – cases have fallen to an average of 5,506 per day – which is 12% lower than last week.
It might also be worth providing some detail on the age breakdown of cases.
In the past week, more than 70% of cases have been in the under 45s.
And that’s consistent with the pattern we’ve seen throughout this latest wave.
However, the picture varies across different age groups – that said, there are broadly positive signs now in all of them.
Two weeks ago – in the week to 4 September – the number of cases in the 0-14 year old band rose by 51%. However in the past week, cases in that age group have fallen by 5%.
Amongst 15-24 year olds, cases fell by 16% two weeks ago, and have now fallen even further – by 34% – in the most recent week.
Two weeks ago, cases in the 25-44 year old age group rose by 7%, and last week, they fell by 14%.
Finally, the number of cases amongst the over 65s has risen slightly, but again the rate of increase has slowed down over the past week.
This most recent data underpinned Cabinet’s decision earlier today not to reintroduce any restrictions.
I am very grateful to everyone – organisations, businesses and individuals – who has taken extra care in recent weeks to try to stop this spike.
It does seem that these efforts are making a difference.
That said, of course, our position does remain challenging.
Even though new cases have fallen, they remain five times higher than at the start of August.
Universities are now returning for a new term. That is very welcome – but it also creates some additional risk, and I will say more shortly about how we are working to mitigate that risk.
Overall, though, the key point is this – the recent fall in cases is very welcome, but we cannot take it for granted. We must continue efforts to keep cases on a downward track.
The NHS is already under considerable pressure and any further rise in cases would intensify that.
As we know, vaccination has significantly weakened the link between cases of COVID and serious health harm from COVID.
The proportion of people with the virus who end up in hospital remains much lower now than before the vaccine programme started.
But current case numbers reflect how transmissible the Delta variant is.
So as we can see already – even a lower percentage of a large number of cases results in a high number of hospitalisations.
To illustrate that, on 20 August, there were 312 people in hospital with COVID. Today, there are 1,064.
The number in intensive care has also increased – from 34 on 20 August to 89 today.
Of course, these figures do not include people who don’t need hospital care, but nevertheless suffer long COVID.
It is also important to remember that the pressure that the NHS is experiencing falls on staff who have in many cases been working flat-out since the start of this pandemic.
And it comes at a time when the NHS is working to catch up on a backlog and care for everyone who needs it, not just COVID patients.
The Government continues to work closely with health boards to help manage these pressures.
But – as has been the case throughout the pandemic – everyone has a role to play.
At the start of the pandemic, we constantly emphasised the need to “protect our NHS”.
That is still necessary, and should give all of us even more incentive to get vaccinated, test regularly, and take all the basic precautions that we know can slow down transmission.
An additional reason for continued caution is that it helps protect those most at risk.
The UK Government announced earlier today that it will no longer use its Shielding Patient List.
In light of that – and to avoid any mistaken assumption – it’s important for us to confirm that the Scottish Government is not following suit at this stage. We will continue to use our equivalent list – which is the Highest Risk List.
We have used this throughout the pandemic to communicate with all those at highest risk and ensure that they have advice and support.
We will continue to keep this under review, but for the moment we believe it is important to retain it.
I will now provide a brief update on some specific strands of work.
Firstly, I can confirm that Cabinet Secretaries are continuing to engage with representatives from business, the public sector and wider civic society to encourage maximum compliance with the mitigations still in place.
I will be taking part in a roundtable meeting with a range of stakeholders immediately after this statement to underline the importance of this work.
I am, again, grateful to all businesses and organisations for the efforts being made to follow and promote measures like the wearing of face coverings; good ventilation and hygiene; and wherever possible, continued home working.
In addition, as I mentioned earlier the university term is now starting – colleges began their return a few weeks ago. And we have been working closely with universities, colleges and the wider sector to make the return as safe as possible.
As a precaution at this stage, colleges and universities won’t be holding large in-person lectures for now.
Instead, there will be a mix of online and in-person learning – with institutions themselves deciding the level of in-person teaching that they will offer during this term.
In addition, physical distancing will remain in place on campuses and face coverings will be required in indoor public spaces.
We are also – of course – encouraging students to get tested regularly. Test kits are available on campuses, and students who are moving to term-time accommodation should book a PCR test before making that move.
Above all, we are strongly encouraging students to get vaccinated if they haven’t done so already.
Mobile vaccination units are being deployed in universities and colleges during freshers’ weeks, and vaccination will continue to be made available throughout the term.
Health Board web pages will contain details of local drop-in clinics and also clinics operating within colleges or universities.
We are also continuing to work with local authorities to make schools and childcare centres as safe as possible – for example, though support for the use of carbon dioxide monitors and improved ventilation.
We have also received further advice from the Advisory sub-group on Education, and I want to take the opportunity today to highlight two points arising from that advice.
First, we indicated at the start of term that secondary schools pupils would need to wear face coverings in class for the first six weeks of term, subject to a review at that point.
Given the continuing high levels of infection still being experienced at this stage, the Advisory sub-group has advised that this requirement should remain in place until the October holidays, and be reviewed again then.
I know how unpopular this is with many pupils and I completely understand why.
But for now, it remains a prudent and a necessary precaution.
Second, we intend to clarify an aspect of guidance on contact tracing in schools, to help ensure fuller understanding of the process.
There is no change in advice for close contacts thought to be at high risk of having COVID. They will continue to be advised to self-isolate until they have returned a negative PCR test. For children and young people, a high-risk contact is most likely to be a household member, or someone they have stayed overnight with.
However, we will clarify guidance on the letters that schools send to lower-risk contacts. These letters should be sent on a targeted basis to those who are most likely to have had low risk contact with someone who has tested positive. They ensure that parents, staff and pupils are aware of those cases – and the letters offer advice on issues like looking out for symptoms, and using lateral flow testing.
Our updated guidance may mean, for example, that it is appropriate to send letters to the classmates of a pupil who has tested positive, but not necessarily to everyone in their year group.
We hope that better targeting will help reinforce the importance of the messages in these letters while minimising undue anxiety.
In addition, the advice in the letters will be strengthened in one respect.
They will recommend – to primary and secondary school pupils and staff who receive them – that a lateral flow test is taken before they next return to school. That test should be in addition to the regular twice weekly lateral flow testing which is recommended for all secondary school pupils and staff.
Presiding Officer,
All of these measures reflect our commitment to prioritising the wellbeing of children and young people – and our determination to minimise disruption to education.
That consideration was also, of course, central to the advice that the Scottish, Welsh, and UK Governments – and the Northern Irish Executive – received yesterday from our Chief Medical Officers.
Members will recall that the JCVI had concluded that the benefit of vaccination – the health benefit – for 12-15 year olds did outweigh any risks, but that because this was marginal they could not recommend a universal offer of vaccine to this age group on health grounds alone.
However, they indicated that it would be appropriate for Chief Medical Officers to consider whether any wider issues might tip the balance in the other direction.
The CMOs have now done so and concluded that vaccination could reduce disruption to education and that, taken together with the health benefits previously identified in the JCVI advice, extending the offer of vaccination to all 12 to 15 year olds is justified.
Taking this broader view of the benefits and risks of vaccination, the CMOs are recommending that 12 to 15 year olds should be offered one dose of the Pfizer vaccine.
This advice has been broadly endorsed by the Royal College of Paediatrics and Child Health.
I am very grateful to all of the four Chief Medical Officers for assessing the evidence on this issue with such pace and also with such rigour.
I can confirm to Parliament today that the Scottish Government welcomes and accepts this recommendation. We believe that vaccination of 12-15 year olds is important and we will therefore move to implement the advice as quickly as possible.
Our supplies of vaccine are adequate to allow us to do this.
It is, of course, important to stress how important informed consent is.
I know that many young people and their parents will have questions.
Material will be made available online later this week.
It will be appropriate to both young people and adults. It will seek to answer questions and provide balanced information to help young people and their parents make informed choices.
And I can confirm that from Monday 20 September, so Monday coming, drop in clinics will be open for any 12 – 15 year old who has read the information and – in discussion with parents and carers – decided that they do wish to be vaccinated.
It will of course be appropriate for parents or carers to accompany their children to clinics, and vaccinators will be on hand to answer any further questions or address any concerns.
And then, starting in the following week – so week beginning 27 September – letters will be sent to all 12 to 15 year olds inviting them to an appointment at a drop-in centre or vaccination clinic.
Again, parents and carers will be invited to accompany their children. And again the appointment will include an opportunity to ask questions and discuss concerns.
Finally, after the scheduled community sessions, there will be a programme of vaccination in schools, to ensure that anyone who hasn’t been vaccinated, and who decides that they want to be, gets a further opportunity.
Presiding Officer,
I know that these are important decisions for young people and their parents, and that many will have questions. I would encourage everyone to read the information that will be provided, and do not hesitate to visit a drop in clinic to ask any questions or raise any concerns.
Vaccination is a vital part of our overall protection against this virus. That is why it is important to support people – perhaps especially young people – to make informed choices that they feel comfortable with.
In addition to the CMO advice on 12-15 year olds, we have received this morning the final JCVI advice on a vaccine booster programme.
This is in addition to the third doses already being offered to people who were severely immunosuppressed or immunocompromised at the time of their first or second vaccination.
I can confirm that the Scottish Government is also accepting this advice, and again we have adequate supplies to move ahead with this.
The booster programme is intended to prolong the protection that vaccines provide against severe COVID illness.
It will run alongside our biggest ever flu vaccine programme – since, of course, both of these programmes are important for individual and for public health. Wherever possible, eligible people will be offered COVID and flu vaccines together.
Booster vaccines will be offered to all adults over 50; to frontline health and care workers; and to younger adults with certain health conditions that put them at higher risk; and to adult household contacts of people with suppressed immune systems. The JCVI has also advised that there should be an interval of at least six months between a second dose and a booster dose.
So let me now give a broad outline of the order in which we will now move to implement the booster programme. And of course we will set out more details shortly.
Frontline health and social care workers will be able to book their booster appointment online through NHS Inform from Monday 20 September – so that again is Monday coming.
Also from next week, residents in care homes for older people will be offered both flu and COVID booster vaccines.
Adults aged 70 or over, and everyone aged over 16 on the highest risk list will be contacted very shortly, either by letter or by their GP.
Other eligible groups – that’s all adults over 50, all those 16 to 49 with underlying health conditions, adult carers, unpaid and young carers, and adult household contacts of people who are immunosuppressed – will be able to book online from October.
These two announcements today, Presiding Officer, represent a very significant, and a very welcome, extension of the vaccine programme – and will help us considerably in our ongoing efforts against this virus.
So – to anyone eligible for vaccination – please do take up the opportunity.
The final point about vaccination I want to touch on very briefly is certification for certain venues – which, of course, Parliament approved in principle last week.
We are now working with businesses, events organisers and sports governing bodies to finalise the detail of the regulations and sector-specific guidance.
COVID certification has of course already been introduced in many countries across Europe. Indeed, many of them have already gone much further than we are proposing.
We know that this is not a magic wand – but we do believe that as part of a package of measures, it can help reduce transmission while keeping our economy and our society open, which is of course what all of us want to see.
Presiding Officer, I will close by emphasising again the key things all of us can do to help, and to ensure that we keep infections on a downward track.
Firstly, as I’ve already been talking extensively about – please get vaccinated if you are eligible and you haven’t yet done so.
Secondly, please continue to test yourself regularly with lateral flow devices. You can order these through NHS inform or collect them from a local test site or pharmacy.
And if you test positive, or you are identified as a close contact, or if you have symptoms of COVID, please self-isolate, and book a PCR test.
And thirdly and finally, please continue to comply with the mitigations still in place.
Please wear face coverings in indoor public places, such as shops, public transport and when moving about in hospitality settings.
Think carefully about the number of contacts you are having – and perhaps reduce any that are not strictly necessary.
Meet outdoors as much as possible.
Indoors, open windows if you can.
And, although it’s not the law anymore, try to keep a safe distance from people in other households – especially when you are indoors.
And remember to continue to wash your hands and surfaces thoroughly.
All of us this – as we can see in the most recent data – really does make a difference. So please stick with it and let’s get cases down even further.
Thank you, Presiding Officer.
Teaching union the EIS has welcomed the decision by the UK’s Chief Medical Officers (CMOs) that young people aged between 12 and 15 should be offered a COVID vaccination.
Infection rates have increased substantially in recent weeks, and we have seen record levels of both pupil and staff Covid related absences particularly amongst young people, as schools have returned. This is having a serious impact on education provision and has been a cause for concern for teachers and other school staff.
EIS General Secretary Larry Flanagan said, “The EIS welcomes this decision by the CMOs as the latest step in the battle against Coronavirus. Offering the vaccine to young people in the 12 to 15 age group will make secondary schools safer by reducing the risk of the virus spreading through school communities and will help reduce the level of disruption to education.
“Whilst we know that young people are less likely to become hospitalised through COVID, offering the vaccine will offer important additional protection against the virus.”
Mr Flanagan added, “In the few short weeks since our schools returned after the summer, we have already seen significant outbreaks in some school communities. This has led to an increase in enforced absences from school, with record numbers of students and staff forced to stay at home due to Coronavirus.
“Rolling out the availability of the vaccines to a wider group of young people will reduce the risk of further outbreaks linked to schools and help ensure that education provision can continue on as normal a basis as possible.”
School Safety Mitigations Extended
Safety mitigations to keep children, young people and staff safe in schools will be extended until at least the October holidays.
Education Secretary Shirley-Anne Somerville confirmed that all current mitigations, including the use of face coverings by pupils in secondary school classrooms, will still be required to help keep schools as safe as possible.
In addition, updated guidance will be provided in the information letters that schools are asked to send to staff and the parents of primary and secondary pupils when they are in low risk contact with positive cases in schools.
These will now include a strengthened recommendation to take a lateral flow test before returning to school. This is in addition to current advice for staff and secondary pupils to take a lateral flow test twice a week, with a few days apart, and record the result before returning to the classroom.
There will be a continued requirement for staff to keep at least a metre distance from each other and from children and young people when they are at schools.
Revised guidance to reflect these changes will be published as soon as possible.
Ms Somerville said: “Throughout this coronavirus pandemic, the safety of school pupils and staff has been my top priority. Every decision is underpinned by our determination to keep children and young people in schools when is safe to do so.
“In light of the latest data and evidence, we have decided to extend the period for these mitigations to remain in place. This decision has been informed by expert medical advice and will be kept under close review to ensure it remains appropriate.
“We owe a debt of gratitude to our young people, for their continued compliance with the public health measures that keep us all safe. I promise that if we can remove the restrictions sooner, we will. For the moment though, we consider this an important protection for them, and for others in the school.”
Move follows unanimous advice to ministers from the four UK Chief Medical Officers
Parental consent will be sought prior to vaccination
People aged 12 to 15 in England will be offered one dose of the Pfizer/BioNTech COVID-19 vaccine, following advice from the four UK Chief Medical Officers (CMOs), the Health and Social Care Secretary has announced. The Scottish Government is expected to make an announcement later today.
In line with the recommendation of the independent Joint Committee on Vaccination and Immunisation (JCVI), the government sought the views of the four UK CMOs on the wider issues that are relevant to the health of children.
The UK Government has accepted the advice of the four UK CMOs and the NHS is preparing to deliver a schools-based vaccination programme, which is the successful model used for vaccinations including for HPV and Diphtheria, Tetanus and Polio (DTP), supported by GPs and community pharmacies. Invitations for vaccination will begin next week.
Parental, guardian or carer consent will be sought by vaccination healthcare staff prior to vaccination in line with existing school vaccination programmes.
Healthy school-aged children aged 12 to 15 will primarily receive their COVID-19 vaccination in their school with alternative provision for those who are home schooled, in secure services or specialist mental health settings.
Health and Social Care Secretary, Sajid Javid said: “I have accepted the recommendation from the Chief Medical Officers to expand vaccination to those aged 12 to 15 – protecting young people from catching COVID-19, reducing transmission in schools and keeping pupils in the classroom.
“I am very grateful for the expert advice I have received from the Joint Committee on Vaccination and Immunisation and UK Chief Medical Officers.
“Our outstanding NHS stands ready to move forward with rolling out the vaccine to this group with the same sense of urgency we’ve had at every point in our vaccination programme.”
THE CHIEF MEDICAL OFFICERS’ LETTER READS:
To: Sajid Javid MP, Secretary of State for Health and Social Care, HM Government Eluned Morgan AS/MS, Minister for Health and Social Services, Welsh Government Humza Yousaf MSP, Cabinet Secretary for Health and Social Care, Scottish Government Robin Swann MLA, Minister of Health Northern Ireland Executive
13 September 2021
Dear Secretary of State, Cabinet Secretary and ministers,
Universal vaccination of children and young people aged 12 to 15 years against COVID-19
Background
The Joint Committee on Vaccination and Immunisation (JCVI) in their advice to you on 2 September 2021 on this subject said: ‘Overall, the committee is of the opinion that the benefits from vaccination are marginally greater than the potential known harms… but acknowledges that there is considerable uncertainty regarding the magnitude of the potential harms.
The margin of benefit, based primarily on a health perspective, is considered too small to support advice on a universal programme of vaccination of otherwise healthy 12 to 15-year-old children at this time…. JCVI is constituted with expertise to allow consideration of the health benefits and risks of vaccination and it is not within its remit to incorporate in-depth considerations on wider societal impacts, including educational benefits. The government may wish to seek further views on the wider societal and educational impacts from the Chief Medical Officers of the 4 nations, with representation from JCVI in these subsequent discussions.‘
You accepted this recommendation from JCVI, and wrote to us on 2 September 2021 stating “We agree with the approach suggested by JCVI, and so we are writing to request that you take forward work (drawing on experts as you see fit) to consider the matter from a broader perspective, as suggested by the JCVI.”
In doing so we have been fortunate to have been informed by the independent expertise of leaders of the clinical and public health profession from across the UK. This has included Presidents and Chairs or their representative of:
Royal College of Paediatrics and Child Health
Royal College of General Practice
Royal College of Psychiatry
Faculty of Public Health
Academy of Medical Royal Colleges representing all the other Royal Colleges and Faculties
Association of Directors of Public Health
Regional Directors of Public Health
national public health specialists
experts in data and modelling
We are very grateful to them for taking considerable time and effort to consult their own colleagues in all 4 nations at short notice to get a comprehensive view of the balance of informed medical opinion and experience across the UK.
The UK’s independent regulator of medicines and vaccines the Medicines and Healthcare products Regulatory Agency (MHRA) is in law the appropriate body to determine whether, based on risk-benefit grounds, a vaccine is safe and effective to use and so grant a licence. They have done so for children and young people aged over 12 years for two vaccines against COVID-19, those manufactured by Pfizer and Moderna. Their assessment is that benefits exceed risks on an individual basis. We take their independent opinion as read. The MHRA position on mRNA vaccines is similar to the relevant regulatory approvals granted in the same age groups in multiple other jurisdictions including but not limited to the USA, the European Union, and Canada.
The independent JCVI is the proper body to give advice on how to deploy a vaccine which has a prior favourable risk-benefit decision and authorisation from MHRA including whether it has a sufficiently large benefit to be worth deploying on a larger, population scale. Like MHRA they consider the benefits of vaccination in this age group exceed the risks (i.e. it is better to be vaccinated than not vaccinated in this age group).
They balanced the risk of COVID-19 against the risks of vaccination, including myocarditis. When forming its advice, the JCVI considered vaccine use according to clinical risk groups, thus identifying different groups according to their potential to benefit from vaccination.
For 12 to 15 year olds who do not have underlying health conditions that place them at higher risk from severe COVID-19, the JCVI considered that the size of both the risk and the benefit are at an individual level very small, and the overall advantage for vaccination, whilst present, is therefore not sufficiently large to recommend universal vaccination on their usual criteria.
They deemed the extent to which vaccination might mitigate the impacts of COVID-19 on education was beyond the usual remit of the JCVI. They recognised however that given the substantial scale of the impact of COVID-19 on all children and young people, which goes beyond normal clinical benefit and risk, wider issues could, exceptionally, be relevant hence their suggestion to consult UK CMOs.
The JCVI have already recommended that children and young people aged 12 to 17 with specific underlying health conditions, and children and young people who are aged 12 years and over who are household contacts of persons who are immunocompromised are offered two doses of a vaccine, normally Pfizer BioNTech BNT162b2. They have recommended all young people 16 to 17 are offered an initial first dose of vaccine.
The UK has benefited from having data from the USA, Canada and Israel, which have already offered vaccines universally to children and young people aged 12 to 15.
The UK CMOs start from the position that the MHRA and JCVI set out on individual benefit-risk calculations for this age group, and have not revisited this. We accept that at an individual level benefit exceeds risk but this advantage is small, and we have taken the JCVI figures as the UK current position on this question.
The Chair of the JCVI Prof. Lim has been a member of our group to ensure that there is no duplication of effort or conflict between the views of UK CMOs and the JCVI. We have been fortunate to have been joined also by the lead Deputy Chief Medical Officers for vaccines Prof. Van Tam (England), Prof. Steedman (Scotland) and Dr. Chada (Northern Ireland) and the DHSC Chief Scientific Adviser, Prof. Chappell. The final advice is that of the Chief Medical Officers, but informed by independent senior clinical and public health input from across the UK.
UK CMOs have decided in their ToR that we will only consider benefits and disbenefits to those aged 12 to 15 from vaccinating this age group, including indirect benefits. Whilst there may be benefits to other age groups, these have not been considered in our advice below.
Issues of vaccine supply were not factors considered in decision making.
The UK CMOs are aware of the extensive range of non-clinical views but this UK CMOs advice is purely clinical and public health derived and has not taken issues outside their clinical and public health remit into account. There is a subsequent political process where wider societal issues may be considered by ministers in deciding how they respond to this advice.
Advice
All drugs, vaccines and surgical procedures have both risks and benefits. If the risks exceed benefits the drug, vaccine or procedure should not be advised, and a drug or vaccine will not be authorised by MHRA. If benefits exceed risks then medical practitioners may advise the drug or vaccine, but the strength of their advice will depend on the degree of benefit over risk.
At an individual level, the view of the MHRA, the JCVI and international regulators is that there is an advantage to someone aged 12 to 15 of being vaccinated over being unvaccinated. The COVID-19 Delta variant is highly infectious and very common, so the great majority of the unvaccinated will get COVID-19. In those aged 12 to 15, COVID-19 rarely, but occasionally, leads to serious illness, hospitalisation and even less commonly death. The risks of vaccination (mainly myocarditis) are also very rare. The absolute advantage to being vaccinated in this age group is therefore small (‘marginal’) in the view of the JCVI. On its own the view of the JCVI is that this advantage, whilst present, is insufficient to justify a universal offer in this age group. Accepting this advice, UK CMOs looked at wider public health benefits and risks of universal vaccination in this age group to determine if this shifts the risk-benefit either way.
Of these, the most important in this age group was impact on education. UK CMOs also considered impact on mental health and operational issues such as any possible negative impact on other vaccine programmes, noting that influenza vaccination and other immunisations of children and young people are well-established, important, and that the annual flu vaccine deployment programme commences imminently.
The UK CMOs, in common with the clinical and wider public health community, consider education one of the most important drivers of improved public health and mental health, and have laid this out in their advice to parents and teachers in a previous joint statement. Evidence from clinical and public health colleagues, general practice, child health and mental health consistently makes clear the massive impact that absent, or disrupted, face-to-face education has had on the welfare and mental health of many children and young people. This is despite remarkable efforts by parents and teachers to maintain education in the face of disruption.
The negative impact has been especially great in areas of relative deprivation which have been particularly badly affected by COVID-19. The effects of missed or disrupted education are even more apparent and enduring in these areas. The effects of disrupted education, or uncertainty, on mental health are well recognised. There can be lifelong effects on health if extended disruption to education leads to reduced life chances.
Whilst full closures of schools due to lockdowns is much less likely to be necessary in the next stages of the COVID-19 epidemic, UK CMOs expect the epidemic to continue to be prolonged and unpredictable. Local surges of infection, including in schools, should be anticipated for some time. Where they occur, they are likely to be disruptive.
Every effort should be taken to minimise school disruption in policy decisions and local actions. Vaccination, if deployed, should only be seen as an adjunct to other actions to maintain children and young people in secondary school and minimise further education disruption and therefore medium and longer term public health harm.
On balance however, UK CMOs judge that it is likely vaccination will help reduce transmission of COVID-19 in schools which are attended by children and young people aged 12 to 15 years. COVID-19 is a disease which can be very effectively transmitted by mass spreading events, especially with Delta variant. Having a significant proportion of pupils vaccinated is likely to reduce the probability of such events which are likely to cause local outbreaks in, or associated with, schools. They will also reduce the chance an individual child gets COVID-19. This means vaccination is likely to reduce (but not eliminate) education disruption.
Set against this there are operational risks that COVID-19 vaccination could interfere with other, important, vaccination programmes in schools including flu vaccines.
Overall however the view of the UK CMOs is that the additional likely benefits of reducing educational disruption, and the consequent reduction in public health harm from educational disruption, on balance provide sufficient extra advantage in addition to the marginal advantage at an individual level identified by the JCVI to recommend in favour of vaccinating this group.
They therefore recommend on public health grounds that ministers extend the offer of universal vaccination with a first dose of Pfizer-BioNTech COVID-19 vaccine to all children and young people aged 12 to 15 not already covered by existing JCVI advice.
If ministers accept this advice, UK CMOs would want the JCVI to give a view on whether, and what, second doses to give to children and young people aged 12 to 15 once more data on second doses in this age group has accrued internationally. This will not be before the spring term.
In recommending this to ministers, UK CMOs recognise that the overwhelming benefits of vaccination for adults, where risk-benefit is very strongly in favour of vaccination for almost all groups, are not as clear-cut for children and young people aged 12 to 15. Children, young people and their parents will need to understand potential benefits, potential side effects and the balance between them.
If ministers accept this advice, issues of consent need to take this much more balanced risk-benefit into account. UK CMOs recommend that the Royal Colleges and other professional groups are consulted in how best to present the risk-benefit decisions in a way that is accessible to children and young people as well as their parents. A child-centred approach to communication and deployment of the vaccine should be the primary objective.
If ministers accept this advice, it is essential that children and young people aged 12 to 15 and their parents are supported in their decisions, whatever decisions they take, and are not stigmatised either for accepting, or not accepting, the vaccination offer. Individual choice should be respected.
Chief Medical Officer for England Prof. Christopher Whitty
Chief Medical Officer for Northern Ireland Sir Michael McBride
Chief Medical Officer for Scotland Dr. Gregor Smith
Chief Medical Officer for Wales Dr. Frank Atherton
Over four in five adults across the UK have received both COVID-19 vaccine doses, with over half of all 16 and 17 year olds coming forward for their first jab.
However COVID numbers continue to rise across the UK. 28,856 new cases were reported yesterday, with 4241 of these in Scotland. The daily Scottish figure is likely to be considerably higher due to an IT problem.
Responding to the advice from the Chief Medical Officers regarding the vaccination of all 12-15 year olds, Bruce Adamson, the Children and Young People’s Commissioner Scotland, said: “We welcome the advice to offer the vaccine to children between the age of 12 and 15. It is important to give them that choice.
“Children and young people have a right to the best possible health, that’s not just about protection from the Covid virus itself, but also the impact on their mental health due to isolation and other factors. The pandemic has impacted their right to education, their right to play, their right to see wider family and friends which is so essential to their development. Their education has been disrupted with two long periods of school closures.
“It is important that children are supported to make informed decisions about their own health. Children of this age group have told me over the last few months that they are in favour of having the choice to be vaccinated. That is not to say that all of them had made a decision about whether they would get a vaccine, but they wanted the option to be available to them. Of course, there have been some children who are concerned about vaccination, or who told me about parental concerns. It is important that there is no stigma attached to the choices that children make about vaccination.
“It is essential that this advice is communicated directly to 12 to 15 year olds in a child-friendly way so they can understand why they are now being offered the vaccine, and can have any questions they might have answered in a way they can understand. Children have the right to access appropriate information on decisions affecting them.
“Parents and carers will play an important role in supporting the decision-making around whether a child chooses to get vaccinated so it is important that they have all of the necessary information to support that choice.”
Health Secretary Humza Yousaf has announced a new £10 million Long COVID Support Fund to help health boards respond to the condition.
The announcement follows Mr Yousaf meeting with a range of healthcare professionals at Eastwood Health and Care Centre in East Renfrewshire and speaking with patient Pamela Bell who has been receiving support for long COVID since she contracted the virus almost a year ago.
The Long COVID Support Fund is designed to maximise and improve the co-ordination of a broad range of existing services across the health and social care system and Third Sector in response to the condition. It will be a flexible fund that will be tailored to local needs. It will strengthen the range of information and advice available, and ensure the right support is available within primary care, providing a response focused on each patient’s needs, with referrals to secondary care where necessary.
Mr Yousaf said:
“We know that long COVID can’t be handled with a one-size-fits-all approach. It can be complex and involve an array of diverse symptoms and combinations of those symptoms.
“The new Long COVID Support Fund will give our NHS Boards the flexibility to design and deliver the best care for those with long COVID, tailored to the specific needs of their populations.
“It’s been great to meet Pamela and hear how she has benefited from care and rehabilitation in a setting close to home. Long COVID patients are being supported by the full range of NHS services – primary care teams and community-based rehabilitation services with referrals to secondary care where necessary – and I want to thank our dedicated staff for their hard work.”
Mrs Bell, 62, from Glasgow, met with the Health Secretary to discuss her experience since testing positive for COVID last September. She has a mild chest condition – bronchiectasis – which meant she had to shield at the start of the pandemic. After contracting the virus she was admitted to hospital where she ended up in intensive care and intubated for almost three months.
By the time she was transferred to a respiratory ward on Hogmanay, she could not move and ultimately went to a Physical Disability Rehabilitation Unit for intensive physiotherapy and Occupational Therapy.
She also received intervention and oxygen therapy in a respiratory ward, and returned home with long-term oxygen at the beginning of June, where she receives ongoing care from a Community Rehabilitation Team to support her to regain her independence, function and mobility. Mrs Bell, who previously worked in a children’s nursery, has had to retire due to ill health.
Mrs Bell, a mother-of-two who is due to become a grandmother next Spring, said:
“Recently I was able to walk for two minutes and 40 seconds – which is a huge achievement for me.
“Before COVID, I was a senior child development officer, which involved outdoor play. I’d be in the playground or taking the children on forest walks, doing at least 15,000 steps a day. I’d help out in my community. I was there for everybody.
“This last year has been a challenge, when I’ve had to let other people take care of me. But I’m blown away by everything I’ve been given by the NHS. They are just amazing. Some of them visit me weekly, some are at the end of the phone, they deliver my oxygen and really look after me.”
Details of the new Long COVID Support Fund will be shared with NHS Boards in due course.
Scotland’s largest ever vaccination programme will complete second doses for all over 18s who have attended their scheduled appointments by close of play on Sunday 12 September.
Some of those eligible have rearranged their appointment for health or work reasons and will get their second dose shortly. Vaccination Clinics will remain open and anyone who has not yet received their vaccination, for whatever reason is reminded that it is never too late to get vaccinated and is urged to go to a local drop-in clinic or go to NHS Inform to book a convenient appointment.
The second dose of the vaccine offers greater and longer lasting protection and can be given from eight weeks after the first, either at a drop-in clinic or by requesting an appointment through the NHS Inform website.
Evidence shows that after two doses the vaccines are more than 90% effective against hospital admissions from the effects of the virus.
Students from the UK and abroad are included in the national programme and are encouraged to come forward for vaccination regardless of whether they require their first, second or both doses.
Health Secretary Humza Yousaf said: “Today is a significant day because every single adult in Scotland has now been given the opportunity to be fully vaccinated against COVID-19.
“I want to pass on my thanks to all those who have helped make this possible – from the scientists who developed the vaccine, to the hard-working staff delivering the programme on the ground. I also want to thank everyone who has taken up their offer of a vaccine, and rolled up their sleeves to help tackle coronavirus.
“To all those who haven’t yet had their second doses, please don’t leave the job half done. Even if the time since the first dose is more than eight weeks, people can still be vaccinated and I encourage them to come forward.
“We have made getting a vaccination easier than ever – head to one of the drop-in clinics being offered across the country or, if you prefer, book an appointment online at NHS Inform. Please check your NHS board’s social media posts for the latest information on where you can attend.
“Students heading to university or college from anywhere in the UK or abroad are reminded they too are urged to take up this offer if it’s relevant to them – indeed, in addition to drop-in clinics around the country, mobile vaccination units are visiting several further education campuses.
“Recent increases in case numbers mean it remains crucial everyone who is offered a vaccination takes up the invitation.”
The latest Emergency Department performance figures for August 2021 show the worst four-hour performance since records began, the worst performance for an August, and the fourth highest number of 12-hour stays ever.
The data show there were 1,342,250 attendances to Type 1 Emergency Departments in England in August 2021, a decrease of 6% compared to the previous month. Despite the decrease in attendances, four-hour performance deteriorated for the fifth consecutive month while the number of 12-hour stays increased for the fourth consecutive month.
In Type 1 Emergency Departments, 66.2% of patients were seen in four-hours or less, the worst four-hour performance on record and equal to over one-third of patients staying in a Type 1 Emergency Departments for over four-hours.
2,794 patients stayed in an Emergency Department for 12-hours or more, this is a 26% increase on the previous month and is the highest ever for August, it is also the fourth highest figure on record.
Data also show there were a total of 71,894 booked appointment attendances, with 34,787 of these booked at Type 1 Emergency Departments. Four-hour performance was at its lowest since records began, with 91.6% of all attendances seen within four-hours, and 82.5% of Type 1 attendances seen withing four-hours.
Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “These figures come as no surprise, but they are no less appalling. The health service has been severely struggling in recent months and the College has been vocal in its warnings about this trajectory. We are now in autumn and the workforce is seriously apprehensive about this winter and what it might bring.
“The pandemic has highlighted stark inequalities; different parts of the country have been affected to different degrees of severity – and the continued impact and recovery has been harder in more deprived areas. In particular, the urgent and emergency care systems in the North East and North West are facing particularly extreme pressures.
“Average four-hour performance in the both the North East and North West is 63% while in the South East it is 73%. As part of levelling up, it is vital that these inequalities are properly addressed and not overlooked, and that support is given to those areas and to those patients that need it most.
“Departments also need clarity of focus in terms of priorities, and the priority must be long stays – this month’s fourth worst ever number of 12-hour stays shows the desperate need to improve the flow of patients through hospitals. But England continues to only publish 12-hour data measuring from decision to admit. Good statistics that accurately measure performance are essential in improving systems and publishing 12-hour data from time of arrival would show the true scale of the problem of long stays.
“The data also show that performance against booked appointments has sharply deteriorated. We must properly evaluate the efficacy of NHS 111 ‘talk first’ approach, so we can begin to improve it. There must be an adequate range of services available that NHS 111 to which call handlers are able to direct patients. Patients must be able to be directed to the right place for their care, and any patient booking an appointment at A&E through 111 must not be left waiting for a long period of time.
“At the same time there must be a renewed focus on the workforce. Our survey from July 2021 showed that half of all respondents said they were considering reducing their hours, while a large proportion are thinking of taking a career break or even changing specialty.
“The workforce cannot afford to lose any Emergency Department staff, we must do all we can to retain existing workers. To tackle this there must be a recruitment drive for Emergency Departments, in England 2,500 more consultants are needed – alongside sufficient numbers of nurses, trainees, allied health professionals and SAS doctors.
“To reduce crowding in hospitals, there must be investment in alternative care pathways including same day emergency care and discharge to assess, these will help prevent unnecessary admission.
“The vision for urgent and emergency care must be implemented and Emergency Medicine staff need to be assured that progress is being made. The College has laid out what needs to be done in RCEM CARES, and reports including; Summer to Recover; and Retain, Recruit, Recover.
“Patient safety is at risk and on this trajectory, winter will be far worse than previously forecast – it is a looming crisis – and the health service is on the brink. The cost will be huge. Funding is welcome, but a comprehensive, joined-up plan, that must include short-term actions for the winter ahead together with a long-term strategy is vital.
“We are at a crucial point; Emergency Department performance continues to deteriorate while elective care waiting lists continue to rise steeply. The government must see the iceberg ahead and steer the health and social care service to safety.”