Casebook September 2020

Casebook September 2020

Posted: September 21st 2020


In Casebook as the second wave begins to bite there is no real escape from Coronavirus stories! But please do read “other stuff” it will give you a useful fix of progress from a National Centre point of view.

Coronavirus: infection control fund for English care homes to double

I am pleased that care homes which became defacto a diversionary opportunity for some acute care settings in the first round of the pandemic are now being treated in a better and more reasonable way. This article tells us:

The health secretary, Matt Hancock, has announced an almost doubling of the infection control fund for care homes in England in an attempt to stop mobile temporary staff spreading Covid-19 in the coming months. But care providers have warned the cash injection could be rendered redundant if testing and supplies of protective equipment falter.

Care operators used a £600m fund set up in May to hire extra permanent staff, pay workers’ wages when they were self-isolating and to buy up exclusivity among agency staff. It was due to wind up this month but Hancock has responded to campaigning from the care sector and added £546m to keep it running until March 2021.

The move, reported on Wednesday by the Guardian, comes amid a rise in infections in care homes, albeit from a low level, with higher numbers of staff testing positive than residents and in most cases, without virus symptoms.


Coronavirus: NHS staff off work due to testing shortages, say bosses

Worrying but not surprising……

A lack of coronavirus tests for NHS staff is leading to staff absences and services being put at risk, hospital bosses have warned.

NHS Providers, which represents English hospital trusts, said staff are having to self-isolate because they cannot get tests for themselves or family members.

It comes after widespread reports of people struggling to get tested.

The home secretary said the government was "surging capacity" where it was needed.

The government's testing system - part of its test, track and trace operation which Prime Minister Boris Johnson promised would be "world-beating" - has faced criticism in recent weeks.

An increase in demand for coronavirus tests has led to local shortages, with some people being directed to test sites hundreds of miles from their homes.

Meanwhile, there have been fewer than 100 Covid-19 deaths in a week in the UK for the first time since March, according to Office for National Statistics figures.


Covid-19: UK test and trace 'barely functional' as 11 million face lockdown

All this reporting and isolating makes me think it is perhaps better to be based in a rural area in the context of the pandemic. I do remain however very concerned about what will happen is the pandemic takes hold in some isolated rural communities distant from the acute care people may need. This article replays the now familiar story of the challenges around test and trace it tells us:

The coronavirus test and trace system was condemned as “barely functional” today as its tsar admitted that demand was up to four times capacity, while 90% of tests were failing to hit the 24-hour turnaround target.

The Guardian has seen documents showing tracers taking up to two weeks to contact friends, relatives and workmates of people diagnosed with Covid-19 – the entire length of the self-isolation period.

It came as sources said Leeds and Lancashire were expected to face enhanced lockdown measures, bringing the number of people subject to restrictions to more than 11 million, including nearly 2 million in north-east England. Official figures confirmed a 75% increase in positive weekly cases across England last week.


Covid: Can a 'circuit break' halt the second wave?

Why do people use electrical analogies for intense action? This is the equivalent of a “short, sharp, shock” proposal for the virus. Bearing in mind the relative low rates of infection in some rural settings this story makes me wonder if those badly affected places should perhaps not be exempt? It tells us:

Expanding "local" restrictions mean more than 13 million people (one-fifth of the UK population) have extra curbs on their lives.

And the surge in cases is not contained to just the hotspots, but is widespread across the UK. Local restrictions do not suppress a virus that is spreading outside of those areas.

It is against this backdrop the government is deciding what to do next. One idea is a "circuit-break" - a short, sharp period of tightened restrictions for everyone to curb the spread of coronavirus.

So why might a circuit break be needed and what could it achieve?

Let's do some rough maths.

Take 6,000 cases a day, double them every week - as the Scientific Advisory Group for Emergencies (Sage) suggests is happening - and by mid-October you have more than 100,000 infections a day as we did at the peak.

That is not sophisticated disease modelling, it is not written in stone and measures such as the "rule of six" should slow the spread.

But that simple sum gives a sense of how quickly a small problem can be become a huge one.

A circuit break is all about trying to change that trajectory.


Other Stuff

Parliamentary Inquiry - The National Centre has managed to run two very good sessions in the latest stage of the parliamentary inquiry into rural health and care: one on mental health and one on social care. Once the minutes are completed they will be published on the website. The next sessions are on international perspectives and if you would like to know more please send me an email.

Local Covid Dashboard – Our work with Nuffield to develop a local covid dashboard is gathering pace. It is beginning to reveal some powerful issues in the context of rural disadvantage including more significant rates of delayed elective surgery in rural areas. It should be published in the next month or so.

Rural Proofing Toolkit – The rural proofing toolkit is almost ready to launch. We’re aiming for November. In the meantime we are beginning to test it in prototype form in a number of settings. If you would like to know more or perhaps even get involved just drop me an email at the above address.

Collaborations – The National Centre is in detailed discussions with a number of well-know health and care bodies about formal collaborations. These will provide us with an opportunity to widen our influence and impact. We hope to announce the first of these in October.

RSN Conference – I am pleased to report that we had a very successful health day at the RSN conference – Sian Griffiths (Covid) and Debbie Freak (Rural Systems) who are National Centre Board Members both presented along with Michelle Howard from East Lindsey District Council, who outlined the really exciting plans for the Campus for Future Living – a health and technology hub on the Lincolnshire Coast in Mablethorpe. Presentations from all the speakers will be available through the Rural Services Network.