After the pandemic: is the new public health system in England fit for purpose? The perspective of England’s directors of public health

Centre for Health and the Public Interest (CHPI)

The CHPI was commissioned by the Joseph Rowntree Charitable Trust to conduct research on the new public health structures that have been put in place in England since it was announced in 2020 that Public Health England was to be abolished. As the current pandemic has shown an effective, well organised accountable public health system is not only key to controlling the spread of a disease – permitting the wider economy and public services to function – but is also vital in addressing growing health inequalities.

Read the Report – After the pandemic: is the new public health system in England fit for purpose? The perspective of England’s directors of public health

What is the proposed WHO Pandemic Preparedness Treaty?

House of Commons Library – Published Wednesday, 29 March, 2023

The WHO is negotiating a treaty on pandemic preparedness. The briefing outlines what has been proposed, where negotiations are up to, and what comes next.

In March 2021, a group of world leaders, including UK Prime Minister Boris Johnson, announced an initiative for a new treaty on pandemic preparedness and response. This initiative was taken to the World Health Organization (WHO) and will be negotiated, drafted, and debated by a newly-established Intergovernmental Negotiation Body.

A petition on the UK Parliament website called for the Government “to commit to not signing any international treaty on pandemic prevention and preparedness established by the WHO, unless this is approved through a public referendum”. The petition closed in November 2022 with 156,086 signatures. The Petition will be debated in Parliament on 17 April 2023.

This briefing will give an overview of the key background, progress, and developments of the treaty as of March 2023.

Read the briefing – What is the proposed WHO Pandemic Preparedness Treaty?

Pandemic preparedness for the real world: why we must invest in equitable, ethical and effective approaches to help prepare for the next pandemic

Institute of Development Studies – march 2023

This report warns the global health community to think beyond vaccines and lockdowns, proposing investment in a five point action framework for pandemic preparedness that responds to people’s experiences, knowledge and needs. The proposed five areas for investment are: health professionals; diverse knowledge, expertise and perspectives; reform of health, social and other systems and structures to support resilience to disease crises; people’s trust in politics; and ethics and social justice.

Read the Report – Pandemic preparedness for the real world

Learning networks in the pandemic: mobilising evidence for improvement

BMJ – 7 October 2022

The authors of this analysis examine how communities of practice developed and shared knowledge about Covid-19 and how the process could be more effective, concluding with some suggested questions for the government’s inquiry into the pandemic to consider.

The paucity of evidence during the early phase of the pandemic provided an opportunity for real time
learning driven by communities of practice
• Learning from these communities led to clinical and service innovation
• A mix of opportune and strategic support from regional and national bodies in England created
clinical learning networks, which adopted and spread change rapidly
• Health systems should develop learning networks to coordinate resources to innovate, evaluate, and
implement emerging best practice for both pandemic and non-pandemic times

COVID INQUIRY – 7th October 2022
Learning networks in the pandemic: mobilising evidence for improvement

Two years on: How has the coronavirus (COVID-19) pandemic changed people’s daily lives? #Covid19RftLks

Office for National Statistics | March 2022 | Two years on: How has the coronavirus (COVID-19) pandemic changed people’s daily lives?

These releases from the ONS explore the attitudes and behaviours of different social groups in relation to the coronavirus (COVID-19) pandemic, and feelings of returning to normal.

Coronavirus (COVID-19): disabled people are more likely to feel life will never return to normal

With most restrictions lifted, over half of people in Great Britain were avoiding crowded places and spending more time at home in February 2

Data on coronavirus (COVID-19) and the impacts on behaviours and attitudes to normal life

Opinions and Lifestyle Survey (OPN) data on public attitudes and behaviours relating to the coronavirus (COVID-19) pandemic, Great Britain: February 2022

Record 4.3 million referrals to specialist mental health services in 2021

Royal College of Psychiatrists | March 2022 | Record 4.3 million referrals to specialist mental health services in 2021

Mental health services received a record 4.3 million referrals during 2021 as the pandemic continued to take a toll on people’s mental health, according to research by the Royal College of Psychiatrists.

Analysis of new NHS Digital data shows there were 3.3 million referrals to adult services and 1.025 million referrals of under-18s in England between January and December 2021.

When the Omicron variant of Covid-19 arrived in December, a record one million people were receiving specialist treatment for conditions including addiction, anxiety, depression, eating disorders and post-traumatic stress disorder.

The NHS is working hard to respond to the unprecedented demand for specialist mental health care delivering 1.8 million consultations in December alone:

• 424,963 children and young people (0 to 18 years) were in contact with mental health services in December 2021 compared with 367,403 in December 2019 (15.7 per cent increase)
• 642,303 adults (19 to 64 years) were in contact with mental health services in December 2021 compared with 612,222 in December 2019 (4.9 per cent increase)
• 1,834,137 appointments attended across mental health, learning disability and autism services compared with 1,599,584 in December 2019 (14.7 per cent increase). (Source: Royal College of Psychiatrists).

Full details from the Royal College of Psychiatrists

In the news:

BBC News NHS struggling with ‘long tail’ of pandemic mental ill health

Joint statement on delivering the 100 Days Mission [future pandemic preparedness]

UK Government et al | March 2022 | Joint statement on delivering the 100 Days Mission

This policy paper commits to taking forward specific steps needed for future pandemic preparedness.The 100 Days Mission aims to have safe and effective vaccines, therapeutics and diagnostics within 100 days of an epidemic or pandemic threat being identified. It calls on the international community, including governments, industry, academia and international organisations, to work together to achieve the mission, which could prevent future pandemics before they start, saving millions of lives.

Joint statement on delivering the 100 Days Mission

Covid-19 preparedness and response: Implications for future pandemics #Covid19RftLks

BMJ | nd| Covid-19 preparedness and response: Implications for future pandemics

This collection provided by The BMJ comprises analyses of 28 country responses to covid-19. It aims to provide policymakers with a road map to prepare for the next health threat, including whole-of-society approaches, treating pandemic tools as a global commons, and ensuring equity.

Covid-19 put every country and the global health system to the test. Responses came in the context of diverse and complex political and social systems. What were the factors that led to success, or failure?

This collection comprises unparalleled analyses of 28 high, middle and low-income country responses to covid-19 and draws on the work and analysis of the Independent Panel for Pandemic Preparedness and Response. Based on real-world experience, the collection provides policymakers with a road map to prepare for the next health threat, including whole-of-society approaches, treating pandemic tools as a global commons, and ensuring equity, communities and human rights are central to preparing for and responding to the next threat.

Covid-19 preparedness and response: Implications for future pandemics [collection]

COVID-19 hospital activity and in-hospital mortality during the first and second waves of the pandemic in England

Gray, W.K., Navaratnam, A.V, Day,J. Wendon, J. & Briggs, T.W.R. | 2021| COVID-19 hospital activity and in-hospital mortality during the first and second waves of the pandemic in England: an observational study | Thorax | http://orcid.org/0000-0002-9597-5446

In-hospital mortality rates are a key marker for the performance of health services in managing patients with COVID-19. However, little is known about how hospitals within the National Health Service in England coped with the surge in cases during winter 2020/2021. The aim of this study was to investigate mortality rates over time and in specific patient groups during the first and second waves of the pandemic in English hospitals.

Thea authors of this paper provide a complete record of all COVID-19-related hospital activity in England over a 13-month period. Understanding how outcomes have changes over time and which patient groups have responded less well to advances in patient management is important in preparing for future case surges.

Abstract

Introduction We aimed to examine the profile of, and outcomes for, all people hospitalised with COVID-19 across the first and second waves of the pandemic in England.

Methods This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics data set for England. All patients aged more than or equal to 18 years in England with a diagnosis of COVID-19 who had a hospital stay that was completed between 1 March 2020 and 31 March 2021 were included. In-hospital mortality was the primary outcome of interest. The second wave was identified as starting on 1 September 2020. Multilevel logistic regression modelling was used to investigate the relationship between mortality and demographic, comorbidity and temporal covariates.

Results Over the 13 months, 374 244 unique patients had a diagnosis of COVID-19 during a hospital stay, of whom 93 701 (25 per cent) died in hospital. Adjusted mortality rates fell from 40 per cent–50 per cent in March 2020 to 11% in August 2020 before rising to 21 per cent in January 2021 and declining steadily to March 2021. Improvements in mortality rates were less apparent in older and comorbid patients. Although mortality rates fell for all ethnic groups from the first to the second wave, declines were less pronounced for Bangladeshi, Indian, Pakistani, other Asian and black African ethnic groups.

Conclusions There was a substantial decline in adjusted mortality rates during the early part of the first wave which was largely maintained during the second wave. The underlying reasons for consistently higher mortality risk in some ethnic groups merits further study.

COVID-19 hospital activity and in-hospital mortality during the first and second waves of the pandemic in England: an observational study [paper]

Record number of children and young people referred to mental health services as pandemic takes its toll

Royal College of Psychiatrists | September 2021 | Record number of children and young people referred to mental health services as pandemic takes its toll

New analysis by the Royal College of Psychiatrists demonstrates that since the start of the pandemic more children and young people have been referred to mental health services than ever before.

The College’s analysis NHS Digital data shows that:

• 190,271 0–18-year-olds were referred to children and young people’s mental health services between April and June this year, up 134 per cent on the same period last year (81 170) and 96 per cent on 2019 (97 342).
• 8,552 children and young people were referred for urgent or emergency crisis care between April and June this year, up 80 per cent on the same period last year (4 741) and up 64 per cent on 2019 (5 219). 
• 340,694 children in contact with children and young people’s mental health services at the end of June, up 25 per cent on the same month last year (275 529) and by more than half (51 per cent) on June 2019 (225 480). 

The College is calling on the Education secretary, to make children and young people’s mental health needs a top priority. It is also asking the government to invest in a national network of early support hubs to provide easy-to-access, drop-in mental health support for young people, on a self-referral basis.

“The pandemic has had a devastating effect on the nation’s mental health, but it’s becoming increasingly clear that children and young people are suffering terribly.

“Early intervention is key to recovery. Schools have a critical role to play in this and the education secretary must do all that he can to prioritise pupils’ mental health.

“Children’s mental health services must also be properly funded and properly staffed if we are to treat the ever-growing number needing mental health care. Without investment, we run the risk of many more needing crisis help.”

Dr Elaine Lockhart chair of the Faculty of Child and Adolescent Psychiatry at the Royal College of Psychiatrists

Read the full news story at RCPscyh