public health – Page 45 – The NEN

From Scotland with love

Vital equipment on it’s way to fight Covid-19 crisis in Malawi, Rwanda and Zambia

A grant of more than £270,000 from the Scottish Government’s International Development Fund will fund the supply of 300 items of vital equipment to treat Covid-19 patients in Africa.

The funding will allow Kids Operating Room, a Scottish-based global health charity, to distribute 100 oxygen concentrators each to Malawi, Rwanda, and Zambia.

Covid-19 cases in Malawi, Rwanda and Zambia are rising quickly, with the health system in Zambia especially under severe stress.

One of the biggest impacts of the rise in Covid-19 cases is a shortage of oxygen, and oxygen concentrators are easy to use, are suitable for patients of all ages, and can be used throughout the health service.

External Affairs Secretary Angus Robertson said: “The Covid situation in Malawi, Rwanda and Zambia has become very serious, very quickly, and we know that the pressure on health services are putting great stress on their infrastructure, especially in relation to the delivery of oxygen to patients.

“This funding for oxygen concentrators will go some way to help ease the current stress on the health services in our three African partner countries, and we are delighted to work with Kids Operating Room to make sure this vital equipment is put to use as soon as possible.

“Scotland remains fully committed to playing our part in tackling shared global challenges, and we are committed to increase the International Development Fund (IDF) by 50% to £15 million.

“As the global pandemic continues, we firmly believe this is not the time to turn our back on the poorest and those in dire need – instead, this is precisely the moment when we should be living up to our core values.”

David Cunningham, the chief executive officer of Kids Operating Room, said: “Our model is to listen to doctors, then give them what they need – right now, the message is coming back loud and clear that what they need is access to more oxygen to fight Covid-19.

“Oxygen concentrators are key pieces of equipment that are needed to meet the region’s critical oxygen shortage. They are suitable for all ages and durable for years to come post-Covid, making them incredibly essential to support the health services in the long-term.”

Kids Operating Room is a Scottish global health charity with bases in Edinburgh, Dundee and Nairobi. It works directly with local surgeons and their teams across Africa and South America to transform hospital spaces into dedicated operating rooms for children’s surgery.

Oxygen concentrators provide a sustainable and cost-effective source of medical oxygen – they draw air from the environment and then concentrate that room oxygen to therapeutic levels for delivery to patients.

The charity will coordinate the distribution of the oxygen equipment. They will arrange for delivery to doctors in Lusaka, Lilongwe and Kigali, and have the equipment distributed to the most in-demand hospitals.

First dose phase of vaccination programme nears completion

Health Secretary Humza Yousaf has visited a drop-in vaccination clinic in Arbroath as the national programme nears completion of first doses for all adults who attended their scheduled appointments on Sunday.

The clinic in Arbroath is one of many additional walk-in and pop-up facilities operating across the mainland to encourage people to get Jagged in July and Mr Yousaf urged anyone who is yet to take up their offer of a vaccine for whatever reason to come forward now.

No appointment is necessary at drop-in clinics and people can attend whether they are due a first dose or second dose, if eight weeks have passed. Anyone who wishes to book an appointment can do so at NHS Inform.

Mr Yousaf said: “I am pleased to see people making use of the vaccination clinic in Arbroath and urge others to do the same at their local drop-in venues if they haven’t yet come forward to be vaccinated.

“Getting vaccinated has never been easier. Simply head to a drop-in or pop-up clinic – the most up-to-date details of clinics near you can be found on your local NHS board’s social media posts or book an appointment online in a location which suits.

“The vaccination programme is working – evidence shows vaccination is weakening the link between case numbers and severe acute illness. However, case numbers are still high and vaccination continues to be the best way to protect yourself and those around you.

“We are currently working through the final group on the JCVI priority list – those aged between 18 and 29 – and we know that the extra drop-in clinics being operated by mainland health boards until Sunday make it easier for them to fit getting vaccinated into their busy lives. Walk-ins will still be available after this week but now is the time to take advantage of all the additional facilities on offer.

“I want to thank all those involved in setting up these clinics and of course, everyone involved in the national vaccination programme. It has been a huge success and without doubt, represents our best way out of the pandemic.”

NHS Tayside Director of Public Health Dr Emma Fletcher said: “Drop-in vaccination clinics are running at venues right across Tayside to make it as easy as possible for people to get vaccinated. No appointment is necessary and anyone over 18 can drop-in.

“So far, uptake of vaccinations in Tayside has been very good. We have delivered over 532,500 vaccines in Tayside with 300,000 people, 86% of the adult population, having one dose and around 232,500 people, 66%, having had both doses but we need that uptake to be higher to stop the spread of the virus.

“We know that getting both doses of the vaccine offers maximum protection against the virus and we are particularly encouraging people aged 18-29 to come forward as early as they can. So if you have not yet had your first jab, or you are longer than eight weeks from your first jab and are due your second jab, come along to your nearest clinic and we will get you vaccinated.”

Freedom … with a warning

The Prime Minister will host a press conference this afternoon (Monday 12th July) to confirm whether England can move to step 4 of the Roadmap.

Step 4 is expected to begin next Monday – so-called ‘Freedom Day’ (19th July) – if the UK government’s “four tests” for easing Covid restrictions in England have been met.

The Health and Social Care Secretary will announce the plans to parliament.

England’s four tests are:

The vaccine deployment programme continues successfully
Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated
Infection rates do not risk a surge in hospitalisations which would put unsustainable pressure on the NHS
Our assessment of the risks is not fundamentally changed by new Variants of Concern

The Prime Minister is expected to urge the public to remain vigilant and exercise caution, praising the efforts of the country for the progress made so far while warning that the pandemic is not over and that caution will be key in the coming weeks.

The latest data will be presented, with current modelling suggesting that Covid cases will continue to rise as restrictions are eased. Hospitalisations, serious illness and deaths will also continue, albeit at a much lower level than before the vaccination programme.

As of 10th July, a total of 80.3 million vaccine doses have been administered in the UK, with 45.7 million adults receiving a first dose (86.9%) and 34.5 million adults receiving both doses (65.6%).

The move to step 4 was delayed by up to four weeks so every adult could be offered a vaccine. 6.8 million first and second doses have already been administered in England during the delay so far.

The delay has also moved the probable end of restrictions to a point closer to the school summer holidays in England, when transmission is expected to be lower. Reopening at a point later in the year may increase pressure on the NHS because of winter illnesses such as flu

Analysis from Public Health England (PHE) and the University of Cambridge suggests that vaccines have so far prevented an estimated 8.5 million infections and 30,000 deaths in England alone.

Wherever you live, it is vital that people keep coming forward to get both jabs when called, with data from PHE showing COVID-19 vaccines are highly effective against hospitalisation from the Delta variant.

The analysis suggests the Pfizer-BioNTech vaccine is 96% effective and the Oxford-AstraZeneca vaccine is 92% effective against hospitalisation after two doses.

The vaccination rollout will continue to accelerate by bringing forward second doses for under 40s to eight weeks – meaning the entire population will benefit from maximum protection more quickly.

Prime Minister Boris Johnson said: “We are tantalisingly close to the final milestone in our roadmap out of lockdown, but the plan to restore our freedoms must come with a warning.

“While the phenomenal vaccine rollout has offered every adult some protection against the virus, and the crucial link between cases, hospitalisations and deaths is weakened, the global pandemic is not over yet.

“Cases will rise as we unlock, so as we confirm our plans today, our message will be clear. Caution is absolutely vital, and we must all take responsibility so we don’t undo our progress, ensuring we continue to protect our NHS.”

The Scottish Cabinet will meet tomorrow to discuss the latest situation in Scotland and First Minister Nicola Sturgeon will update parliament on our next steps in the afternoon.

Study finds COVID-19 vaccines are ‘highly effective’ in most people in clinical risk groups

Those used in the UK as effective at preventing symptomatic disease in the majority of people with underlying health conditions as the rest of the population

The study from Public Health England (PHE) included more than 1 million people in at-risk groups.

Within these clinical risk groups, there will be people with more severe forms of illness – particularly in the immunosuppressed group – who may not respond as well to the vaccines, and we recommend they seek advice from their specialists.

The study found:

overall vaccine effectiveness against symptomatic disease in risk groups is approximately 60% after one dose of either AstraZeneca or Pfizer-BioNTech, with little variation by age
after 2 doses, vaccine effectiveness is 81% with AstraZeneca in people in risk groups aged 16 to 64. No data is available for Pfizer-BioNTech
in people in risk groups aged 65 and over, vaccine effectiveness with Pfizer-BioNTech is 89% and 80% with AstraZeneca
for those who are immunosuppressed, vaccine effectiveness after a second dose is 74%, with similar protection to those who are not in a risk group. This rises from 4% after a first dose

Although age is the greatest risk factor for adverse outcomes following coronavirus (COVID-19) infection, certain health conditions also increase the risk of severe disease.

Diabetes, severe asthma, chronic heart disease, chronic kidney disease, chronic liver disease, neurological disease, and diseases or therapies that weaken the immune system – such as blood cancer, HIV or chemotherapy – have all been linked to an increased risk of hospitalisation or death with COVID-19.

People with these conditions who are at highest risk were initially advised to shield during the peak of the pandemic and all risk groups were then prioritised for vaccination. The government announced the dose interval would be brought forward from 12 to 8 weeks for the clinically vulnerable on 14 May, and everyone in these groups should now have been offered a second dose.

Data on vaccine effectiveness among people in clinical risk groups was previously limited. Though more data is needed, protection against hospitalisation and death in risk groups is expected to be greater than protection against symptomatic disease, as has been seen in studies of the general population.

Dr Mary Ramsay, Head of Immunisation at PHE, said: “This real-world data shows for the first time that most people who are clinically vulnerable to COVID-19 still receive high levels of protection after 2 doses of vaccine.

“It is vital that anyone with an underlying condition gets both doses, especially people with weakened immune systems as they gain so much more benefit from the second dose.”

The Joint Committee on Vaccination and Immunisation (JCVI) advised that those living with immunosuppressed adults should be prioritised for vaccination to help limit the spread of the virus to people in this group.

If the planned booster programme goes ahead, the JCVI has recommended that immunosuppressed adults and their household contacts should also be among the first to be offered a third dose of vaccine in September.

PHE estimates that 30,300 deaths and 8,151,000 infections have been prevented as a result of the COVID-19 vaccination programme, up to 25 June. This is based on modelling analysis from PHE and Cambridge University’s MRC Biostatistics Unit.

PHE also estimates that 46,300 hospitalisations have been prevented in people aged 65 or older in England up to 27 June (approximately 7,000 admissions in those aged 65 to 74, 18,000 in those aged 75 to 84, and 21,300 in those aged 85 and over).

RCEM: We have a serious problem in Urgent & Emergency Care

Emergency Department performance figures published by NHS England for June 2021 show the highest number of Type 1 attendances ever recorded, the worst four-hour performance for the month of June, and the highest ever number of total emergency admissions for the month of June.

The data show that in June 2021 1,436,613 patients attended Type 1 Emergency Departments, the highest ever figure since records began.

A total of 400,826 patients were admitted via Type 1 Emergency Departments, the highest ever recorded figure for the month of June.

Four-hour performance in Type 1 departments was 73.2% which is by far the lowest June percentage on record.

1,289 patients were delayed by 12-hours or more in an Emergency Department – almost double the figure of the previous month. It is also the highest ever recorded figure for the month of June, and almost triple the previous highest figure for June recorded in 2019.

Dr Katherine Henderson, President of the Royal College of Emergency Medicine, said: “We have a serious problem in urgent and emergency care. We are deeply concerned. We are facing record breaking figures in the high summer. We can only begin to imagine what this winter may bring.

“We are facing record breaking attendances with a tired workforce and fewer beds; it is seriously challenging. Busy departments are a threat to patient safety, it increases the chance of crowding and corridor care, this risk is significantly increased if covid and non-covid patients are sharing the space for long periods of time.

“We ask that there is a transparent discussion about how the whole of the health service deals with the current levels of demand. Emergency care does not happen in a vacuum but is often the canary of the system. Managing demand in Primary care, the elective backlog and what is happening at the front doors of hospitals is all connected and there is urgent need for a plan that balances these needs in a way everyone can understand.

“The data show what is happening on the ground, and it is likely that things will worsen in the coming months, especially as we enter the winter. The government must realize there is a looming crisis and take swift and urgent action – this is critical ahead of Winter.

“Hospitals can only do all they can to boost capacity, in the face of serious resourcing constraints. And we would ask patients to only attend Emergency Department if they need urgent and emergency care, and seek alternative care, like from their GP or NHS 111, if they have a minor injury or mild condition.

“Despite now being in the middle of summer, our Summer to Recover: Winter-Proofing Urgent and Emergency Care for 2021 contains the necessary actions the government and the NHS can take ahead of Winter.

“If no action is taken, we may soon be in the middle of a crisis worse than any previous winter.”

Edinburgh Park mass vaccination centre welcomes final patients

Edinburgh Park’s mass vaccination centre will welcome its final patients this weekend as the site prepares for closure on Sunday.

The mass vaccination centre, based within the Royal Bank of Scotland’s former Younger Building, will close this weekend, having seen thousands of patients come through its doors.

Over the last four months, since the site opened on Monday 1 March, the vaccination team has administered 82,595 doses of the lifesaving vaccine.

NHS Lothian is now in the process of moving to a more flexible delivery model and will utilise more mobile and surge vaccination clinics. This will allow the board to target people who are still to receive their jab by making it as easy as possible to be vaccinated.

The decommissioning of the site will begin on Monday (12 July). Those in the west Edinburgh area wishing to visit a drop-in clinic at a mass vaccination centre can do so at the Royal Highland Showground.

Airport buses have been temporarily diverted to allow passengers to be dropped off directly outside Lowland Hall.

The Edinburgh Park site will still welcome both appointments and drop-ins until closure.

Pat Wynne, Nurse Director of Primary and Community Care, NHS Lothian, said: “The site at RBS has played a key role in the vaccination programme so far and we are really thankful to our team who made it work so well. I would also say thank you to Royal Bank of Scotland for cooperation throughout the site’s operation.

“Anyone wishing to be vaccinated from Monday can do so visiting one of our four mass vaccination drop-in clinics across the region, which are continuing to operate.

“This weekend (10 and 11 July), we will be running our mobile vaccination clinics with the Scottish Ambulance Service at The Centre, Livingston (Sat), and Fort Kinnaird Shopping Centre (Sun).

“These are open to everyone over the age of 18 for first vaccination, and for those who are due their second vaccination having waited eight weeks.”

Do not ease COVID restrictions, warn doctors

The British Medical Association (BMA) has urged the UK Government this week to rethink its plan to relax all restrictions owing to the surge in COVID-19 infection rates.

The association has been a leading voice in the debate on the issue on the national and international media.

Senior BMA members including chair of council Chaand Nagpaul and co-chairs of the BMA’s public health committee Penelope Toff and Richard Jarvis co-signed a letter in The Lancet published on Thursday – which described the easing of restrictions as ‘reckless’.

Dr Nagpaul also appeared on the BBC’s Newsnight last night (9 July) saying it was ‘folly’ for the UK Government to press ahead with easing all restrictions on 19 July. He pointed to the growing evidence of spiralling infections leading to growing hospitalisations as well as wider effects on public health.

‘We need to dispel the idea we’ve broken the link with hospitalisations. It’s diluted but we have about three times as many people on ventilators than this time last month and two and a half times more people in hospital than last month,’ he said and added that if the trends continue this will further increase the pressures on the NHS.

Dr Nagpaul added that this was not simply a secondary care issue but there were now growing numbers of the population suffering from the condition not going to hospital many of whom will go on to have long COVID.

The BMA is arguing for the UK Government to maintain some targeted control measure in place after 19 July including the requirement to continue wearing face coverings in indoor public settings and improved messaging on social distancing and meeting outdoors where possible.

Dr Nagpaul (above) said full easing on the timescale proposed ‘defied public health logic’ – further unlocking of restrictions was a matter of timings rather than ‘indefinite restrictions’. Dr Nagpaul also appeared on CNN on Thursday arguing for targeted restrictions to remain.

Following Monday’s press conference by the prime minister, the chief medical officer and the chief scientific adviser,  the BMA issued a statement describing the proposed easing of restriction as ‘incredibly concerning’.

‘There is a clear disconnect with the actions the Government is planning to take and the data and views of the scientific community and medical profession,’ it says.

On Monday evening deputy council chair David Wrigley appeared on Channel 5 News  to reflect on the announcement and said getting rid of restrictions was ‘reckless’ and was a ‘recipe for seeing an increase in infections which is not good for the NHS and not good for patients’.

The BMA believes targeted measures and support are needed beyond 19 July

The situation in Scotland remains concerning, where Covid levels are among the highest in Europe and hospitals are coming under increasing pressure.

The Scottish Cabinet meets on Tuesday morning and First Minister Nicola Sturgeon will update Holyrood on Scotland’s plans for moving to Level 0 on Tuesday afternoon.

The Scottish Government had originally planned that all parts of Scotland woud be in level zero from 19 July, allowing some additional relaxation to rules on physical distancing and outdoor gatherings.

Following these initial easings in July, the plan is that more restrictions will be removed on 9 August, including lifting the legal requirement to physically distance indoors.

However the Scottish Government has repeatedly said it will be driven by ‘data not dates’ and First Minister Nicola Sturgeon said earlier this week that these dates are not written in ‘tablets of stone’.

More staff to bolster Scotland’s Test and Protect system

Changes are working, insists Health Secretary

Scotland’s Test and Protect contact tracing system will see its workforce bolstered with the deployment of additional staff over the coming week to help address a rising number of coronavirus (COVID-19) cases.

Health Secretary Humza Yousaf said recent changes to the system are helping its performance and the way it operates will continue to evolve as vaccination levels rise.

Ascensos, one of Test and Protect’s existing commercial partners, has agreed an arrangement with Barrhead Travel to accelerate and augment the capacity they are providing to the contact tracing system by 100 staff. Additional contact tracing bank staff continue to be brought on board and existing bank staff mobilised.

Recent changes to the system have also been implemented aimed at ensuring a growing number of cases are closed by contact tracers and that high risk cases are prioritised. These include greater use of text messaging to contact lower risk index cases and digital self-tracing forms.

Mr Yousaf said: “Our Test and Protect workforce have played a vital role in the battle against this pandemic. We owe these contact tracing teams a huge debt of gratitude for all their efforts over the past year.

“The Test and Protect system has continued to operate well as case numbers have increased in recent weeks, contacting unprecedented numbers of people.

“This agreement to bring in additional staff follows our ongoing efforts this year to ensure commercial partners were on board in preparation for potential increases in demand on the contact tracing system.

“This extra workforce is important, but the success of the system going forward will not simply be about staffing numbers.

“Test and Protect will change as the population becomes more protected by vaccination and it will still play a key role in mitigating clusters and outbreaks in high risk settings, slowing infection spread and protecting populations at risk.

“As we announced last week, we are now using a variety of methods to contact people, including using digital methods like SMS messages for lower risk cases and prioritising calls for higher risk cases. These changes, along with extra staffing, will ensure that people are contact traced, and begin self-isolation, as quickly as possible. I’m confident that the performance of Test and Protect has started to improve in recent days.

“The majority of people comply when asked to self-isolate and we are thankful for the important role they are continue to play in stopping transmission of COVID-19.

“We will have to manage living with COVID-19 for some time to come, even when we are able to move beyond Level 0. While we hope we are in the process of emerging from the pandemic, case rates at the moment underline the fact that this virus is still with us.”

Recently announced measures have been implemented to streamline the contact tracing system to manage pressure on the system and ensure it is more efficient.

These include greater use of text messaging to contact lower risk index cases and digital self-tracing forms.

The new approach ensures that the contact tracing system is using its resource appropriately and proportionate to public health risks: Test and Protect to prioritise high risk cases – gov.scot (www.gov.scot)

Test and Protect is an NHS-led service which works with commercial partners to help augment capacity when required.

Contact tracing capacity in Scotland is split between the National Contact Centre operated by National Services Scotland (NSS) and the daily contact tracing workforce provided by territorial Health Boards.

All mainland health boards offer drop-in coronavirus (COVID-19) vaccination clinics: Drop-in vaccine clinics in every mainland health board – gov.scot (www.gov.scot)

Scotland’s Emergency Departments experience worst ever May performance

The latest data released yesterday by the Scottish Government for May 2021 show that attendances at Emergency Departments have risen significantly.

In May 2021 there were 112,563 attendances to major Emergency Departments across Scotland. This is a 12% increase compared to April 2021, a 24% increase when compared to March 2021, and a 45% increase compared to May 2020.

Following this increase, four-hour performance deteriorated, 86% of attendances to major Emergency Departments in Scotland were seen within four hours. 15,706 patients were delayed by four-hours or more in an Emergency Department, this is the highest figure since January 2020, and it is the highest figure ever recorded for the month of May. This means one in seven patients were delayed by four hours or more before being seen.

In May 2021, 393 patients spent 12 hours or more in an Emergency Department, this is double the figure for April 2021. This is the highest number of 12-hour delays for the month of May ever recorded, and it is more than double the previous highest May figure of 189 12-hour delays that was recorded in 2019.

Data also show that 1,680 patients spent eight hours or more in a major Emergency Department, this is an increase of nearly 50% compared to April 2021 and it is the highest figure ever recorded for the month of May.

Dr John Thomson, Vice President of the Royal College of Emergency Medicine, said: “The data is deeply concerning and very much reflects what is happening on the ground. Departments are busier than ever, especially for the summer period with some record-breaking figures for the month of May, and it is becoming increasingly challenging.

“These figures come at a time when reports suggest Scotland has the highest covid infection rate in Europe. We are battling community admissions, elective care patients seeking treatment, as well as increasing covid patients attending our departments, all within the context of reduced bed-stock.

“Departments are filled with patients, some who may have covid, waiting to be seen. While long-stays alone can put patient safety at risk. This risk is increased as some patients could contract the disease in a busy Emergency Department.

“The College’s recent Emergency Medicine workforce census in Scotland revealed an Emergency Medicine workforce that was not adequately staffed to deliver the highest quality patient care in Emergency Departments in Scotland.

“We have shortages across the board, but particularly among consultants and senior decision-making clinicians. These shortages are currently exacerbated by the soaring covid infection rate, meaning there are a large number of absent NHS staff due to covid in Scotland.

“We are doing all we can to maintain flow and maximise patient safety, but the pressures are increasingly intense and are faced by the existing but short-staffed workforce that are facing continued burnout and exhaustion.

“The data show the growing demand for urgent and emergency care, Emergency Departments are where people turn to for treatment when there is nowhere else to go, so they must be adequately staffed with trained Emergency Medicine staff, properly funded, and equipped with enough capacity and resources to cope with severe demand.”

“We urgently need the Scottish Government to support the urgent and emergency care system to cope with these pressures.”

Two NHS Grampian hospitals have announced this week that they are at capacity as Covid cases rise.

Scotland was expected to move to level zero on 19 July, with remaining legal restrictions lifted on 9 August, but First Minister Nicola Sturgeon conceded yesterday that th planned dates are not “set in stone”.

She will be holding a media briefing at lunchtime today:

NHS Lothian given £27 million in extra COVID funding

NHS Lothian has been given £27 million in extra COVID-19 funding from the Scottish Government as part of a £380 million package allocated to health boards across Scotland.

This comes on top of the £1.7 billion already provided to health boards and Health and Social Care Partnerships last year.

The additional funding includes ongoing support for the vaccination programme, the Test and Protect system, and personal protective equipment for health and care workers.

SNP MSP for Edinburgh Pentlands, Gordon MacDonald MSP said: “NHS Lothian has been under incredible pressure during the pandemic, not only will this additional funding support the health board with its efforts to treat patients but it will also play a role in supporting our NHS in its remobilisation programme as we come out of the pandemic.

“It is essential that our health services can be on a sure footing as we re-emerge from the pandemic and other services that have been disrupted can restart smoothly.

“This is a demonstration again that the only party in Scotland that can protect Scotland’s NHS is the SNP.”

	Covid Funding (£m)
NHS Ayrshire and Arran	13.7
NHS Borders	3.4
NHS Dumfries and Galloway	4.9
NHS Fife	11.6
NHS Forth Valley	10.1
NHS Grampian	16.2
NHS Greater Glasgow and Clyde	45.8
NHS Highland	9.8
NHS Lanarkshire	25.9
NHS Lothian	27.0
NHS Orkney	0.7
NHS Shetland	0.7
NHS Tayside	13.7
NHS Western Isles	0.9
National Waiting Times Centre	3.9
Scottish Ambulance Service	17.4
The State Hospital	0.3
NHS 24	2.7
NHS Education for Scotland	1.8
NHS National Services Scotland	156.3
Healthcare Improvement Scotland	0.4
Public Health Scotland	12.6
Total	379.6