Casebook May 2021

Casebook May 2021

Posted: May 17th 2021


In casebook this month a significant focus on lock down and the impact of covid on mental health and an exciting foretaste of the launch of a new rural community of practice planned in partnership with the NHS Confed.

Covid: Indian variant could disrupt 21 June easing, PM says

I think there is no doubt that rural places will be adversely affected if we cant push on with the re-opening of the country. However it also seems to me that we are on a knife edge here. This story tells us:

The Indian virus variant could pose "serious disruption" to lockdown easing in England on 21 June, the PM says.

Boris Johnson said if it was found to be "significantly" more transmissible there could be "some hard choices".

The wait between jabs will be cut from 12 weeks to eight for the over-50s and clinically vulnerable because of concern over the variant, he added.

Cases of the Indian coronavirus variant have nearly tripled in the past week, Public Health England figures show.

Surge testing is already taking place in 15 areas across England, including Bolton, Blackburn, London, Sefton and Nottingham.

According to Friday's government figures, a further 17 people have died in the UK within 28 days of a positive test and another 2,193 coronavirus cases have been recorded.

Speaking at a Downing Street briefing alongside the UK's chief medical adviser, Prof Chris Whitty, Mr Johnson said first Covid vaccine doses will also be prioritised "for anyone eligible who has not yet come forward". Currently, England's vaccination rollout is open to people over the age of 38.

The prime minister said he did not believe that the "present evidence" showed a need to delay the next stage in the easing of lockdown in England on Monday - when pubs and restaurants will be allowed to serve customers indoors and six people or two households can meet in a private home.

Mental Health Poor for 11 Percent of U.K. Adults During COVID-19

We’re starting to get a significant handle on the impact of Covid in relation to mental health and this story along with the other mental health feature in casebook is very revealing. It's just a shame it doesn’t apply a rural filter to the analysis.

About 11 percent of U.K. adults experienced deteriorating or consistently poor mental health during the COVID-19 pandemic, according to a study published online May 6 in The Lancet Psychiatry.

Matthias Pierce, Ph.D., from the University of Manchester and colleagues tracked average mental health during the pandemic, characterised distinct mental health trajectories, and identified predictors of deterioration. The 12-item General Health Questionnaire was used to assess mental health in 19,763 adults.

The researchers observed a deterioration in average population mental health with onset of the pandemic, which did not begin improving until July 2020. Five distinct mental health trajectories were identified up to October 2020. Most participants had consistently good or very good mental health (39.3 and 37.5 percent, respectively). 

Twelve percent comprised a recovery group, who initially experienced a decline in mental health followed by improvement to prepandemic levels by October. For 7.0 percent, there was a steady deterioration in mental health during the pandemic, and for 4.1 percent, mental health declined initially and remained very poor throughout. 

The likelihood of having pre-existing mental or physical ill health, living in deprived neighborhoods, and being non-White was increased for these two groups. Subsequent deterioration in mental health was predicted by severe acute respiratory syndrome coronavirus-2 infection, local lockdown, and financial difficulties.

Covid: Will UK vaccine success keep virus at bay?

I suspect, even though I have little evidence to substantiate it, that smaller rural settlements, will be less susceptible to the re-emergence of the pandemic to the same degree as larger urban settings, what do you think? This story tells us:

Next week will see the most significant lifting of restrictions yet in England, with indoor mixing to be allowed. The rest of the UK is making similar steps.

It means the onus is increasingly shifting on to the vaccines, rather than social distancing and restrictions, to keep the virus at bay. How well do they work? And is there now enough immunity in the population to protect us all?

The UK has benefited from both fast rollout and good uptake. Currently, a third of the adult population is fully vaccinated, with another third having had one dose.

Among those at most risk - the over-50s and younger adults with health conditions, where 99% of Covid deaths have occurred - uptake for the first dose has been 95%.

Some describe that as being only partially vaccinated. But that can underplay the significance of that first dose, which provides most of the protection - the second acts to boost immunity and is important for long-lasting protection.

The latest government data - based on evidence from the rollout - suggests one dose of the Pfizer-BioNTech or Oxford-AstraZeneca vaccine cuts the risk of infection by as much as 70% and death by even more.

Data on their effectiveness after two doses is only just emerging - but, as expected, it suggests this level of protection is boosted even further. For Pfizer, which was rolled out first, the risk of death is reduced by 97%.

What is more, those that are vaccinated but do become infected are thought to be about half as likely to pass the virus on.

The vaccines are working about as well as could be hoped in the real world - and confirm what the trial results always suggested.

Could digital platforms help bolster UK workers' mental health?

The second of our mental health stories adding more flesh to the bones of the clear impact of the pandemic and crying out for the application of a rural lens to measure the specifics of the impact.

UK workers are facing a rise in mental health issues in the wake of the coronavirus pandemic, according to a study by Kooth PLC, a digital mental health and well-being platform.

The Kooth Pulse 2021 report shows lead indicators for mental health in the UK are deteriorating as the nation prepares to leave COVID-19 behind. The research, based on anonymous data from 192,000 people on Kooth’s mental health platforms, covers March 2020 to March of this year.

Among the findings: 17% of adults who sought professional intervention said they think about hurting themselves or feel suicidal nearly every day, a 40% increase over the previous year. Another 41% say that they feel nervous every day.

The data echoes similar findings over the past year, including a report from Slack that found 56% of UK employees experienced burnout in 2020. And research by tech recruitment firm Harvey Nash highlighted a 75% increase in tech workers concerned about their mental health.

Councils in England facing funding gaps plan to cut special needs support

Many of the most significantly affected authorities and therefore communities referenced here are rural. This story tells us:

Councils in England, facing a funding shortfall of more than half a billion pounds for educating children with special needs, are planning spending cuts and service reviews, according to figures compiled by the Observer.

Campaigners fear children could lose some of their support as local authorities try to clear yawning historical deficits, with government rules stopping them using other reserves to help to fund the special educational needs and disabilities (Send) system.

Figures covering 131 of England’s 151 “upper tier” local authorities show the combined forecast “overspend” on high needs budgets comes to £503m for the 2020-21 financial year.

The figures were obtained from freedom of information requests and council documents, and show forecasts made late in the financial year.

Surrey council confirmed it overspent its high needs budget by £35m in 2020-21, and is forecasting a further overspend of £24m in 2021-22. Kent forecast an overspend of £35.8m in 2020-21, and 14 other councils forecast overspends of £10m to £18m.

Cambridgeshire has a forecast deficit of £13.7m in 2020-21. It is planning to reduce top-up funding for Send children in mainstream schools, as well as launching a variety of reviews covering individual support packages. A council spokesperson said: “In addition to the continuing rise in the number of education, health and care plans (EHCPs) being allocated to those in need, we are seeing an increase in the complexity of need among our children and young people. Our funding allocation is not sufficient to adequately match the increase in demand.”

Other Stuff

Here are some clipped excerpts which tell the story of last month from our Board meeting held last week.

Parliamentary Inquiry:

The first full draft of the write up of the Parliamentary Inquiry is now completed in draft form. We anticipate being able to share the headline findings with the Parliamentary Inquiry stakeholders in June.

Rural Proofing Toolkit Update:

We have interest from Lincolnshire and Devon ICS in trialling this toolkit but would really welcome additional expressions of interest in joining in the process of testing.

Defra Discussions:

As a consequence of discussions at the Rural Coalition (of which the National Centre is a member) the centre has entered a dialogue with Defra to identify how we might support their feed into DHSC as part of their rural proofing responsibilities. We have identified that there are 4 core areas of relevance where the National Centre has made progress: 



The IMD Research

The Differential Impact on Health Systems in Rural Area

We are currently developing a briefing note to support the dialogue with Defra.

Membership and Website Round Up:

Membership numbers are holding up well for the centre. We are planning a refinement of the website which will be more accessible and dynamic. Watch this space!!!

NHS Confederation MoU Progress:

Following the agreement of a joint working MoU with the NHS Confed a community of practice and June launch event are being planned. We will be in touch with more information very soon.