On Friday 17 December, a record number of Covid-19 cases (93,045) was reported in the UK. Unfortunately, the recently identified Omicron variant has proven to be considerably more infectious than previous variants. Vaccines are also less effective against Omicron, with two doses of the vaccine providing only limited protection from symptomatic Covid-19 infection. A booster (third) dose increases protection but not to the level seen against other variants.
Although the clinical severity of Omicron-linked cases is still to be fully determined, the sheer volume of cases will lead to greater pressures on all sectors of England’s NHS. This comes at a time when the NHS in England is already struggling to cope with existing demands, whilst also trying to manage the enormous backlog that has built up since the start of the pandemic in early 2020.
With the NHS now tasked with substantially increasing the number of Covid-19 vaccines available, we are entering a very challenging period, juggling; the increased rollout of Covid-19 vaccinations, a surge in Covid-19 cases, usual winter pressures, such as seasonal respiratory infections and other urgent medical problems, and maintaining rapid access to care for people with suspected cancer.
Other important areas of work also need to continue. This includes childhood vaccinations, mental health services, and community care for vulnerable patients. Inevitably, much of the elective work that the NHS does will have to be deferred, leading to yet further increases in NHS waiting lists for specialist care. There will be less capacity to defer elective NHS care in general practices, leading to further frustrations from patients, if access to primary care services is curtailed.
Unfortunately, due to these challenges a deterioration in health outcomes will occur. It is not always easy to separate out urgent from non-urgent medical problems. If people are asked to defer seeking care, some patients will inevitably suffer delays to their diagnosis.
It is essential that access to primary care services is maintained during this challenging time. Unfortunately, many community healthcare providers are already suffering from long-standing workforce shortages that cannot be easily addressed. Ideally, expanding Covid-19 vaccination capacity would be in addition to, rather than in place of, these services. But this requires rapid planning at national and local level, and a willingness to give local clinicians the autonomy to develop their own solutions without the bureaucratic hurdles that are often the hallmark of the NHS.
The continued waves of infection the NHS has faced since the start of the pandemic have taken a considerable toll on the physical and mental health of NHS staff. The largest wave of infection yet, from Omicron, will add further to this toll. As well as the direct risks from Covid-19, an infection that has disproportionately affected healthcare workers, the mental health of NHS staff has also been adversely affected; with high levels of problems such as stress, burnout and post-traumatic stress disorder. This in turn has led to high levels of absence due to illness, which further compounds the pre-existing shortages of staff. Recognising the impact of working during the pandemic on healthcare professionals is essential, as are initiatives to improve the well-being of staff.
The NHS is entering one of its most challenging phases – probably more challenging than the previous two large Covid-19 waves in March 2020 and January 2021. The public need to understand that the NHS urgently need support. In the worst-case scenario, this could mean the NHS being placed on an emergency footing for several months if there are very high numbers of Omicron cases and the reduced effectiveness of vaccines lead to a prolonged increase the number of severely ill patients in need of NHS care.
A version of this article was first published in The House Magazine.