The move by the government to trigger step four of its ‘roadmap’ back to pre-pandemic normality, confirmed today in the Commons by health secretary Sajid Javid, is set to have a disastrous knock-on effect on A&E attendances, hospitalisations and waiting lists, just as the NHS is struggling to deal with a rapid rise in covid infections. 


With hospitals now reporting ‘black alerts’ and ‘major incidents’ year-round, and waiting lists set to reach 13m within months, the move to relax most covid restrictions in England on 19 July – a date breezily marketed to the public as ‘freedom day’ – will further undermine an understaffed and underfunded health service that is already close to being overwhelmed by the pandemic. 


One of the most dangerous elements of the move concerns mask-wearing in healthcare settings such as hospitals and care homes, which now appears to be only optional under step four. More infections, including among NHS staff, are sure to follow as a result.


Vaccines minister Nadim Zahawi told Sky News on Sunday that the public would simply be “expected to wear masks indoors in enclosed spaces”, rather than be required to, while Javid told the Sunday Telegraph that people would merely be “irresponsible” if they refused to wear masks in enclosed spaces.


The impact of this laissez-faire approach is already being seen, with doctors complaining that patients are coming into hospitals thinking they no longer have to wear masks at all. One medic told the Guardian, “We are [now] inviting the virus to spread among the very people we need to protect.”


And a heavy hint of how this ‘return to normal’ strategy could backfire and harm the NHS was very much in evidence last week, with news of covid vaccinators facing verbal and physical abuse, especially from younger adults demanding second jabs early just so they can go on holiday this summer. In some cases staff had to call the police, in others security guards had to be hired – probably not what the government intended when it devised its ‘Protect the NHS’ slogan last year.


One report suggested this behaviour has been driven in part by the government’s questionable decision to allow double-jabbed Brits to return from amber-list countries without having to quarantine – another element of the ‘freedom day’ plan.


Meanwhile, HSJ tweeted today that the number of covid-positive patients in English hospitals has risen by 48 per cent in the past week alone, to 2,798, a rate of increase not seen for nine months. The total number of new cases recorded last week in the UK was up 34 per cent on the previous week  – passing 32,000 for the first time since January  – as was the total of confirmed and probable case numbers for the Delta variant. Last week also saw the highest daily increase in lab-confirmed covid cases since 22 January.


The ONS said the percentage of people testing positive for covid has increased in all regions in England, and across all age groups. Backing up these figures, the covid reproduction number – the R value – has risen to between 1.2 to 1.5, meaning the outbreak can grow exponentially, and is now increasing by up to 7 per cent every day. And Imperial College London’s React study found a quadrupling of new infections in England between mid-May and early July.


Despite Downing Street’s protestations that vaccinations have broken the link between covid infections and hospitalisations, A&E and elective surgery statistics nevertheless continue to show the growing impact of the pandemic.


Attendances at 24-hr A&E departments (described by NHS England as ‘type 1’) last month were more than 40 per cent higher than in June 2020, signifying the highest-ever number since this type of data was collected. Emergency admissions via type 1 departments were up by more than 20 per cent since a year earlier. Across all A&E services, there were more than 2.1m people attendances, making it the busiest-ever June. 


As for the waiting list backlog, analysis of NHS England figures by HSJ last week showed the number of patients waiting more than two years for elective care grew by almost 50 per cent in the space of a month. The waiting list in England broke records for the second month in a row, and has now reached 5.3m.


Last week Leeds Teaching Hospitals NHS Trust had to call off some planned non-urgent operations, including cancer surgery, to help it cope with an influx of patients seriously ill with covid, and Birmingham’s Royal Orthopaedic Hospital also had to postpone planned elective surgery because so many of its staff were off work while in quarantine. 


In fact NHS staff, as well as elective patients, seem very much an afterthought in the government’s preparations for 19 July. Downing Street’s failure to address the issue of pay, at a time when many nurses and hospital doctors are suffering from burnout and are justifiably terrified of the consequences of moving to stage four, is something of a national scandal. This indifference prompted a new pay campaign by Unite last month, pressure from Unison, and both the BMA and the Royal College of Nursing are now considering industrial action in protest at this ‘slap in the face’ situation.


The only response from Number 10 on the topic of staff shortages, likely offered solely because these shortages have played a role in the cancellation of elective surgery, came a few days ago – a suggestion to allow fully vaccinated nurses and doctors to forgo immediately the obligation to self-isolate when ‘pinged’ by the NHS covid app, rather than wait until 16 August when everyone double-jabbed can do so. 


That specific relaxation – dropping the need to self-isolate when fully vaccinated – touches on a related move flagged up last week, ostensibly designed to make people’s lives easier and to ‘protect the NHS’, but hinting at a ploy simply to hide the numbers.


With the sharp rise in cases already overstretching local testing capacity, the threat posed by the wholesale lifting of covid guidance and restrictions on 19 July has led one public health director to suggest testing may have to be rationed because the case numbers are rising so rapidly. One sign of this happening is the 62 per cent increase in the number of people ‘pinged’ by the NHS covid app in the last week of June, advising them to self-isolate.


Unsurprisingly, many users of this app are said to be ditching it to dodge the need to self-isolate in the run-up to 19 July. In a move designed to address this problem, last week UK Health Security Agency head Dr Jenny Harries revealed that the government was considering ‘adjusting’ the app, effectively cutting the numbers being told to isolate. 


Labour leader Keir Starmer dismissed this move, describing it as “like taking batteries out of a smoke alarm”, and news of the app revamp came as vaccine uptake almost halved in early July, a major concern for the NHS given the increasing awareness that ICU cases involving unvaccinated people are on the rise.


The government’s decision to press on with the move to step four while the data suggests caution – no-one in the Cabinet seems to remember the ‘data not dates’ slogan – has justifiably been panned as premature, if not ill-advised, by leading voices in the NHS and elsewhere. 


The BMA has urged the government to reconsider its plans, and wants mandatory wearing of facemasks in enclosed indoor public settings to remain. Its council chair Chaand Nagpaul said last week, “We now have twice as many people in hospital and on ventilators compared to a month ago. Even modest rises in patients being admitted to hospital will undermine our ability to treat the record 5m patients waiting for treatment. Why is the prime minister knowingly putting more people at risk of becoming ill when masks are proven to be effective and can reduce the spread of infection?


Health union Unite said the lifting of restrictions represented a ‘gung-ho’ approach and called for a review of the decision to end social distancing and mask wearing in hospitals, clinics and other NHS buildings.


WHO head of emergencies Mike Ryan even suggested the government’s approach risked coming across as “epidemiological stupidity”. And one NHS consultant radiologist, along with a senior clinical lecturer and more than 100 international scientists and doctors writing a joint letter in the Lancet, all described Downing Street’s plans as “a dangerous experiment”.


Even the Daily Mail felt obliged last week to note that more than 100 patients could die from covid each day following the ‘freedom day’ relaxations on 19 July, after health secretary Sajid Javid admitted daily cases of infections were now close to 50,000 and could soon reach 100,000. 


Quite why the government is so determined to keep to the 19 July date is unclear, but the Evening Standard offered one explanation. It claimed last week that officials at the Department of Health & Social Care subscribed to a hybrid version of the much-discredited concept of herd immunity, and were expecting the virus will “run out of people to infect” within weeks now that so many have been vaccinated.


Similar hints of libertarian bravado were on display in health secretary Javid’s Sunday Telegraph interview, when he suggested that lifting most of the covid restrictions – and paying more to private health providers – would actually help solve the waiting list crisis. 


But public opinion generally seems to be pushing back against the easing of restrictions, with polling suggesting 90 per cent of people were against the policy, and 70 per cent suggesting mask-wearing and social distancing should continue for at least another month.


And a look at what’s happening in the Netherlands right now should also give the government pause for thought.


Lockdown measures – curbs on nightclubs, music festivals and restaurants – which were lifted on 26 June as cases fell, have already been re-imposed there after a surge in covid infections. Nearly 7,000 new cases were reported over 24 hours one day last week, compared to less than 1,000 a day a week earlier. Within days there were 10,345 new daily cases, the highest figure since Christmas, representing a daily average 7.5 times higher than 11 days previously. 


Moving to step four therefore seems like a reckless experiment with both the public’s health and that of the NHS. Surely it would make more sense to stick with ‘Stay Home. Protect the NHS. Save Lives’ for a little bit longer, eh Mr Johnson?

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