Last week the government announced that people currently shielding due to a variety of medical conditions could now leave their homes. The announcement, which hit the headlines the next morning, came as a complete surprise to England’s GPs and to NHS England.

NHS England’s head of primary care, Dr Nikita Kanani, tweeted that “as soon as she knew more, I will post on this thread. In the meantime continue to follow the guidance.” 

There are around 2.2 million people who have been shielding since March. These are patients who are considered to be particularly vulnerable to the virus and they were advised to take stringent measures to prevent the infection entering their homes and not to leave their homes until 30 June. 

The new guidance says that clinically extremely vulnerable people can now leave their home and meet with one other person, as long as they are able to maintain strict social distancing.

GPs and charities were both angry at not having been informed in advance about the changes to the guidance and concerned about the chaos and confusion that it will sow among patients. The suddenness of the announcement means that they have had no time to prepare advice for worried patients.

The specialist charity, Blood Cancer UK, said the news came as a ‘bolt out of the blue’ and that the government’s handling of the situation has added to the worry in its community. The charity criticised the way the changes were announced late on a Saturday night with “no warning or consultation with charities or clinicians” which has “created confusion.”

Even before this announcement, charities had become exasperated at the lack of communication for shielding groups, with millions of vulnerable and extremely vulnerable people getting mixed and confused messages. A group of charities, including Macmillan Cancer Support; British Lung Foundation and Asthma UK; MS Society; National Voices; Versus Arthritis; Kidney Care UK and Cystic Fibrosis Trust wrote an open letter to the government 28 May asking for more clarity and better communication.  

Shadow health secretary Jonathan Ashworth said it was “an utterly irresponsible way to treat highly vulnerable people worried about their personal health.”

Other medical professionals took to social media to voice concerns, with one GP anticipating “chaos” on Monday and another who works with cystic fibrosis patients noting that clinicians in secondary & tertiary care working with shielding groups had also not received any communication and they were expecting a lot of queries and anxiety from their patients. Another GP tweeted, tongue in cheek, that could all patients send queries to Matt Hancock as GPs hadn’t been told anything about the changes as they obviously weren’t important enough.

The lack of communication with GPs, was tackled at the 1 June briefing by Jaimie Kaffash, editor of Pulse. He asked Secretary of State for Health and Care, Matt Hancock, why the advice for shielders had been rushed through before patients and GPs understood it? Hancock denied the changes had been rushed through saying the “cautious changes” had been worked on “for some time” and “once we made that decision….we then communicated that decision and this was the right time to be able to change that advice.”

This didn’t really answer the question of why the media knew the change in guidance from a press release before the GPs. They had only just received NHS England’s updated Standard Operating Framework on the night before the changes went public. It said all shielding patients should have a named clinical lead – but did not mention the changes announced just a day later.

Charities and GPs report that patients are puzzled, as are they, about what prompted the change in advice. Asked this at the same press briefing, Hancock stated “One of the reasons that we could make that change is that the rate of incidence of the disease is now back down to the levels that it was before we introduced the shielding policy.”

The change in guidance does, however, seem at odds with the current threat level of level 4. All four of the UK’s chief medical officers (from England, Northern Ireland, Scotland and Wales) are reported to have rejected plans from Downing Street to lower the virus threat level due to evidence that the virus was still widespread. 

The virus alert level has therefore remained at 4. The easing of some lockdown restrictions and the changes to the shielding guidance were only supposed to take place when the threat level had reduced to 3 or below. When asked, the Foreign Secretary Dominic Raab told Sophy Ridge on Sky News that we are “transitioning from level four to level three”.

The Association of Directors of Public Health (ADPH) do not agree with the government’s move on easing restrictions and have said it is “increasingly concerned that the government is misjudging the balance of risk between more social interaction and the risk of a resurgence of the virus, and is easing too many restrictions too quickly”. They urged ministers to postpone the easing of restrictions until more is known about infection rate and a test and trace system is more established. 

Caution was also urged by the Royal College of Nursing Dame Donna Kinnair, the chief executive and general secretary of the Royal College of Nursing, said staff were “anxious that easing lockdown could undo the progress we’ve made as a country in combating this virus”.

Should infections surge, the government has said that there is a possibility of geographically-targeted measures, such as locking-down specific cities. The ability to do this will, however, be impaired by the loss of public trust engendered by the Dominic Cummings affair. 

The ADPH letter noted that “a relentless effort to regain and rebuild public confidence and trust following recent events is essential,” for lockdown restrictions to be lifted; which can be viewed as a reference to the Cummings situation. Such an effort will also be needed if geographically-targeted lockdowns need to be put in place. 

The situation across England varies, with some council areas not yet past their peak of cases and some areas with a R number close to 1.  This begs the question as to why shielders weren’t advised on an area by area basis how safe it was to ease up their self-isolation, instead they have all been told the same thing. For details see our article: Do shielding changes leave thousands exposed?

 

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