Casebook February 2021

Casebook February 2021

Posted: February 16th 2021


In Casebook this month, vaccines, variants, pubs and reorganisations. Plus the little matter of the reorganisation of the NHS!!


UK reaches milestone of offering first Covid vaccinations to 15m people

Passing 15 million feels like a moment …….

The government has reached its target of offering at least first vaccinations to the four groups of people in England seen as most vulnerable to coronavirus by mid-February, it has announced.

In a video message sent out via social media, Boris Johnson said Sunday marked “a significant milestone in the United Kingdom’s national vaccination programme”, with a total of 15m first injections offered across Britain.

He added: “In England, I can now tell you, we have offered jabs to everyone in the first four priority groups, the people most likely to be severely ill from coronavirus, hitting the target that we set ourselves.”

Further details would be announced on Monday, the prime minister said, saying that that in the response to coronavirus there would still “undoubtedly be bumps in the road”.

It remains unclear whether the prime minister’s announcement formally marks the completion of the target to offer first injections to the top four groups by 15 February, as the government’s planning documents feature that target as part of what is described as a UK plan for vaccine uptake.


Covid variants: What are they and will vaccines work?’

Just to keep us on our toes this story tells us:

The UK, South Africa and Brazil variants could be much more contagious or easy to catch.

All three have undergone changes to their spike protein - the part of the virus which attaches to human cells.

As a result, they seem to be better at infecting cells and spreading.

Experts think the UK or "Kent" strain emerged in September and may be up to 70% more transmissible or infectious. The latest research by Public Health England puts it between 30% and 50%.

The South Africa variant emerged in October, and has more potentially important changes in the spike protein. Experts have recently found a small number of cases of the UK variant that have one of these more concerning changes too.

It involves a key mutation - called E484K - that may help the virus evade parts of the immune system called antibodies.

South Africa coronavirus variant: What's the risk?

UK variant has mutated again, scientists say

The Brazil variant emerged in July and has this E484K mutation too.


Boris will rip the heart out of rural communities if he does not lift lockdown on pubs

A slightly different story with a covid-spin. This reminds us it is very important for us to consider community alongside personal well-being, it tells us:

The warning comes after Downing Street was forced to scotch claims that it intended to allow pubs to reopen in April but not be allowed to serve alcohol until May. But landlords across England have told the Sunday Express that existing restrictions designed to control covid in cities are killing off their businesses and threatening to end centuries of history in towns and villages. This includes ending the ban on them selling takeaway alcohol and the rule which means people must have a substantial meal if they order a drink.

Some in popular tourist areas are hoping that a return to summer holidays may provide a much needed boost but a Redfield and Wilton survey for the Sunday Express has revealed that 52 percent have already decided to stay at home this year while just 25 percent will go on holiday in the UK.

Phil Doyle, publican at the Three Tuns in Heddon near Hadrian’s Wall, is hoping for a return to the walkers and coach parties who visited his pub on the way to the historic attraction each year.

He became tithe free from the brewery last year but is now forking out thousands of pounds each month to keep the business afloat and believes he has until June or July when he would be forced to give up.

He said: “It’s not that we don’t understand the need for restrictions, we understand that coronavirus is very serious. We just want fairness.”


The future of health and care

Two stories which presage a big change acomin….

The white paper is built on more than 2 years of work – with the NHS, local councils and the public.

At its heart, this white paper enables greater integration, reduces bureaucracy and supports the way that the NHS and social care work when they work at their best: together.

It strengthens accountability to this House and, crucially, it takes the lessons we’ve learned in this pandemic of how the system can rise to meet huge challenges – and frames a legislative basis to support that effort.

NHS and social care blueprint: key points
  • Every part of England to be covered by an integrated care system (ICS), incorporating local NHS bodies, local government and other organisations, together tasked with supporting integration of health and social care.
  • Enhanced “powers of direction” for the government over a newly merged body comprising NHS England and NHS Improvement.
  • A recognition that competition is not the only way of driving service improvement, the reduction of bureaucracy on commissioners and providers, and elimination of the need for competitive tendering where it adds limited or no value.
  • A requirement for health and adult social care organisations to share anonymised information where such sharing would benefit the health and social care system.
  • Introduction of powers for the health and social care secretary to require data from all registered adult social care providers about all services they provide, whether funded by local authorities or privately by individuals.
  • A new duty for the Care Quality Commission (CQC) to assess local authorities’ delivery of adult social care services, and a power for the secretary of state to intervene where, following assessment under the new CQC duty, it is considered that a local authority is failing to meet their responsibilities.
  • Powers enabling the health and social care secretary to make emergency payments directly to all social care providers when needed to prevent instability in care.
  • Increasing collaboration between ICSs and with NHS England on commissioning to make decisions, pool funds and facilitate services to be arranged for their combined populations.
  • Power to impose capital spending limits on foundation trusts, which have greater autonomy that non-foundation trusts, where necessary as a safeguard for financial sustainability.
  • Establishment of a statutory medical examiner system within the NHS for the purpose of scrutinising all deaths that do not involve a coroner, to increase transparency for the bereaved.
  • Tackling obesity by conveying a new power on ministers to alter certain food labelling requirements, in addition to already announced further restrictions on the advertising of high fat, salt and sugar foods including before the 9pm watershed.
  • Responsibility for the process of introducing fluoridation of water to be moved from local authorities to central government.
  • Bringing forward measures to enable the health and social care secretary to set requirements in relation to hospital food.
  • Allowing the Medicines and Healthcare products Regulatory Agency to develop and maintain publicly funded and operated medicine registries in order to provide patients and prescribers, as well as regulators and the NHS, with the information they need to make evidence-based decisions.
  • Powers to implement comprehensive reciprocal healthcare agreements with countries outside the EEA and Switzerland to support the health of citizens when they travel abroad, subject to bilateral agreements.
  • Remove the Competition and Markets Authority’s function to review mergers involving NHS foundation trusts, placing oversight in the hands of NHS England.
  • Allowing the secretary of state to intervene at any point of a reconfiguration process – for example, the closure of several stroke units being replaced with a single centralised hyper-acute unit. At present the secretary of state can only intervene in reconfigurations after a local authority referral.
  • A duty for the health and social care secretary to publish a document once every five years setting out roles and responsibilities for workforce planning and supply in England


Other stuff

Rural Health and Care Proofing Toolkit – we are now canvassing local health systems to work with us on piloting this facility. We have active discussions in play in Lancashire, Devon, Leicestershire, Suffolk, Surrey and Norfolk. For more information email me at 

AGM 2020/21 – We held our AGM on 3 February 2021. We have an impact card setting out the achievements of the National Centre this year and you can read them on the National Centre Website. Highlights are:

  • The recruitment of Professor Sian Griffiths to the Board
  • The completion of more Parliamentary Inquiry sessions taking the total achieved to 13
  • A membership at its widest point (including RSN members eligible for joint benefits) of 181
  • An ongoing action research programme involving: University of Exeter (Dispensing Doctors Association), Wye Valley NHS Trust and Nuffield Trust
  • Completion of two toolkits for members and wider practitioners on rural proofing and the impact of Covid
  • 5 seminars organised
  • Formal partnership arrangements in train with: Lincoln International Institute for Rural Health, NHS Confederation, Rural Services Network and ongoing discussions with the National Rural Health Association in the USA
  • Major exposure on rural proofing in Sunday Telegraph and the BBC in relation to the impact of Covid in Rural Areas 


Reorganisation of the NHS – this is not down to us! If you read the White Paper though don’t hold your breath looking our for references to “rural”. We have featured a couple of articles in this month’s Casebook about the process. Over the next few weeks we’ll be gathering views and comments and organising our response. We’d be fascinated to hear your views. Please email: 

Partnership Bid – We’ve submitted a bid with partners in Lincolnshire in partnership with the Remote and Rural Healthcare Education Alliance in Scotland for Health Foundation funding to look at links between health and economic development. We’ll keep you posted on progress!