Joe Buglass tried 46 times to call his GP about booking a Covid booster jab last Wednesday. “The phone was just ringing and ringing,” he said. He had tried several times over the previous six weeks, since getting an NHS text message.
“You click the link and it gives you the doctors’ surgery number,” he said. Buglass, who runs a property maintenance business in Newcastle, is clinically vulnerable because he donated a kidney. When he finally got through, he was told he was ringing the wrong people. Eventually, someone rang him back.
“They told me that because the clinics were finishing this Sunday, they didn’t have any bookings for the next few weeks,” Buglass said. He was incredulous. “Where do I go from here?” He has since been offered a booster jab for today after a cancellation. “They said because of the Covid cases rising, all the [medical] personnel were getting pulled back to hospital.”
Problems like Buglass’s are echoed by hundreds on social media who are baffled as to how to go about their boosters. The spring’s rapid vaccine rollout feels like a long ago as colder weather kicks in. Research by the Covid-19 Actuaries Response Group shows that although 5 million booster jabs and third doses have been delivered, the pace has not kept up with the 8.5 million people eligible for a jab.
With Covid cases rising, the effectiveness of the government’s plan A – relying on vaccination to allow society to function without restraint – appears to be waning fast. Ministers are now under enormous pressure to adopt some of the measures it outlined in its plan B – compulsory masks, vaccine passports for crowded indoor settings such as nightclubs, and encouraging people to work from home.
“For us this isn’t shroud-waving or alarmism; this is saying, the crisis is on us now,” Matthew Taylor, chief executive of the NHS Confederation, told the Observer. “And it’s only going to get worse.
“This isn’t about money. Even if the government were to spend money, we haven’t got the staff – and that’s why we have to do everything we can to reduce demand, with plan B-plus.”
Until last week, ministers appeared to be holding the line that although at least 40,000 people a day were testing positive for Covid, vaccinations were restraining the worst effects of the virus, with most of the 900 patients being admitted to hospital each day coming from the ranks of the unvaccinated.
Then, last Wednesday, Taylor delivered a stark warning on behalf of hospital trusts and other NHS bodies, saying the health service would be plunged into a “profound crisis” unless ministers enacted plan B winter measures urgently.
By the end of the day, Sajid Javid had convened the government’s first Covid press conference in five weeks, admitting that winter posed “the greatest threat to our road to recovery” and warning of the impact of Covid under “darker skies” and “colder weather”.
Yet the sense that the government was losing its grip on the Covid crisis amid the distractions of COP26, the supply chain crisis and the energy crisis, has continued to grow, with the British Medical Association warning that urgent action is now needed.
The following day, the Royal Cornwall Hospitals Trust declared a critical incident with 25 ambulances waiting outside A&E, filled with patients needing emergency treatment without anywhere for them to go.
Then the Care Quality Commission delivered a report confirming the warnings that the care sector had been delivering for months – that there would be a “tsunami” of people left without care because of a severe shortage of staff. Many of those people would instead be stuck in hospital, waiting for care, and others waiting outside.
Local public health officials have become so concerned that they took matters into their own hands on Friday, effectively asking English schools to enact plan B at local level.
The labyrinthine health and care system in the UK can appear baffling, but the principles are relatively simple: the NHS is faced with rising demand for hospital care during the winter months. It delivers treatment according to its capacity. Then patients leave hospital to go home or into care homes. But if the health and care services run out of capacity: the system has to either leave people waiting for treatment, or try to reduce demand.
For the last decade, the NHS has tried streamline its services to fit expected demand, in the name of driving greater efficiency, while services not protected by the NHS badge, such as care homes and public health, have been pared back by austerity.
Covid has blown that model apart – infection control measures needed to prevent the virus spreading in hospitals means far more spare capacity is needed. But with 39,000 nursing vacancies, according to the Royal College of Nursing, capacity is already severely limited, and unlike those in other sectors, health professionals have not been able to sidestep the “pingdemic”.
The political argument has been about capacity. Edward Argar, the health minister, said last week after Taylor’s intervention that there were 6,000 Covid beds available across the NHS. Intensive care staff were incredulous.
“Those of us who are on the ground working in ICUs feel that the pressure is significant and it’s not sustainable,” said Dr Stephen Webb, president of the Intensive Care Society. “Some ICUs are full to capacity. We’ve got nursing staff, medical staff and AHP [allied health professionals] who are off sick or self-isolating.”
Since the second wave was brought under control and vaccinations got under way earlier this year, the NHS has been focusing on trying to clear the backlog of 5.7 million people needing surgery. But rising Covid cases is starting to threaten that drive, Webb said.
“In many places, the planned urgent surgery is being cancelled,” Webb said. “This is not because of a lack of physical beds; it’s because of a lack of staffing to be able to open those beds. We’ve heard about urgent cardiac surgery being cancelled, major bowel surgery being cancelled because these patients needs post-operative intensive care beds.And that’s not just in one or two areas – that’s across the whole country.”
Emergency doctors often talk about the “elastic walls” of A&Es that somehow expand to meet demand. “If the health service had to deal with more people with Covid, would it be able to? Yes, it could, of course,” Taylor said. “But the problem is the knock-on effect – the fact that we’ve got unprecedented demand across the system. That needs to be cleared, but those people who are waiting are more likely to be going to A&E and other parts of the health service that are under pressure.”
Taylor said the government must recognise that “we need a national mobilisation. You’ve got to recognise that there is a health and care crisis coming over the next three or four months and accept it, acknowledge it and encourage the public to do everything they can to help – by using 111, using NHS online, and using the NHS app.”
Saffron Cordery, deputy chief executive of NHS Providers, said there was “extreme pressure” on ambulance services. “I don’t think I can stress this heavily enough. Last week, every ambulance trust in the country was on black alert [the most severe level]. Some were seeing three times more calls than usual.”
Waiting lists, transfers from hospital into care and winter pressures of flu and other, non-Covid illnesses were creating “a vortex of pressure,” she said.
“We don’t have the staff, we don’t have the resources, we don’t have the right settings to treat people in, and we don’t have the flow of patients because social care needs fixing. None of those cracks in the NHS that pre-dated Covid have been fixed.”
If capacity is at its limit, the alternative is to reduce demand, and schools are on the frontline of new cases. The campaign to vaccinate 12- to 15-year-olds had been intended to conclude next week, but by Friday only 18.9% had been vaccinated.
Headteachers have blamed the slow rollout on a lack of nursing staff. School-age immunisation service teams have struggled to cope with demand, and spiralling case numbers have also delayed jabs. Nearly 1,900 in every 100,000 children aged 10-14 tested positive on 17 October, the latest figures available on the government’s Covid dashboard – almost twice the highest rate of any age group at the peak of the second wave.
However, there are other complaints from schools about promises for CO2 monitors and a lack of ventilation in many old school buildings.“The rollout has been extremely slow to date, and the government seems to be hoping the delivery of CO2 meters will placate schools and colleges, but their arrival will not solve issues with poor ventilation in classrooms,” said Julie McCulloch of the Association of School and College Leaders.
Vic Goddard, head of Passmores Academy in Harlow, Essex, is furious with the government because one staff member who could not have the jab is now in intensive care.
“He couldn’t get vaccinated for medical reasons,” Goddard said. “We have a government that’s very much pro choice – but you haven’t got a choice if you’re working in education. We’ve had more cases since September than we had in the whole time up to September.”
Since the start of term, there have been more than 250 positive cases of Covid at the academy chain of three primary and secondary schools Goddard leads. At one primary, four out of seven teachers are off work because of Covid.
Goddard has started advising secondary pupils to wear masks, but only one in five are doing so. Only a quarter of the pupils at Passmores who were eligible for a vaccine chose to have it. To try to keep infections down, he has begged the parents of children who have contracted Covid to keep all siblings off school until each sibling has taken a PCR test and tested negative.
The National Education Union says that so far 13 councils – six run by the Conservatives, four by Labour and three which are under no overall control – have recently started advising schools to reintroduce Covid mitigation measures such as mask wearing, bubbles and a ban on assemblies.
Virologist Professor David Matthews of Bristol University said the government should consider the example of France, which has introduced vaccine passports.
“We don’t seem to have any problem in making sure people wear seatbelts, and we need to be thinking about how to do the same for vaccines. We need to be pressing people much more rigorously to have a Covid-19 jab.”
Ravi Gupta, professor of clinical microbiology at Cambridge University. “Britain should have been vaccinating children early on, as the US and Europe did, and we should have been getting the boosters online quicker.”
Stephen Griffin, an associate professor of virology at Leeds University, also criticised government failures to maintain the successes of early summer. “People say things are not as bad as they were last year. But we’ve got vaccines now and if it was as bad as last year then we’d be really in trouble. The question is: if this was a new outbreak, and this was the level of death and illness that you were experiencing, would you accept it? You wouldn’t.”
Yet the politics of Covid may allow ministers to hold out longer. Shadow health secretary Jonathan Ashworth appeared to say Labour was “in favour” of plan B measures this week, before the party corrected him by stating it was not calling for the full implementation of plan B, instead favouring “making plan A work”. Keir Starmer is nervous about calling for the wider imposition of Covid passports for major gatherings, which is part of plan B.
There is also frustration among the Covid Recovery Group of Tory MPs, who have led opposition in parliament against the imposition of restrictions, with some believing more restrictions are on the way when they do not have scope to use parliament to vote any measures down. Mark Harper, the former chief whip who is leader of the group, has demanded that ministers speed up the booster jab process and pump promised extra resources into social care to free up hospital beds. NHS figures suggest the latter is unrealistic in the very short term.
In the end, it is patients who will suffer. Imelda Redmond, national director of Healthwatch England, said that if people do have to wait longer for treatment, the NHS must communicate better. “People need to have easy ways to update the NHS about changes in their condition,” she said. “People need an ongoing relationship which minimises the risks and stress of waiting.”
Buglass is still concerned about how the vaccination campaign can be staffed. “When you look at the way the situation’s going – the way Covid cases are rising, hospitalisations are rising – you can see that maybe all these people administering Covid jabs, booster jabs, flu jabs are required in hospitals,” he said. “It’s very, very frustrating. You’re watching the news, hearing adverts on TV and being told to contact your GP or get your booster, and you can’t get through. You begin to think, what’s the point?”
The key questions
What is the prevalence of Covid-19 in the UK and what changes in infection rates are occurring?
Figures released on Friday by the Office of National Statistics revealed that for the week ending 16th October prevalence of Covid-19 in England increased from 1 in 60 to 1 in 55 of the population while in Scotland prevalence has continued to fall from its September peak of 1 in 45 down to 1 in 90 last week. Based on Scotland’s experience this trend suggests cases will continue to increase in England but might peak in a few weeks when the country reaches its prevalence of 1 in 45.
What factors might affect this forecast?
Several variables might change the course of the disease in England. Waning vaccine protection could cause further rises in cases. There is also concern about a new “delta plus” strain which may have a 10 % increased transmissibility and could also boost case numbers. And as winter approaches, and people head indoors, there is likely to be a further jump in infections.
What can be done to counter these pressures?
Both school and booster vaccination programmes have faltered and badly need to be improved, a point stressed by Professor Jim Naismith, director of the Rosalind Franklin Institute, Oxford. “Increasing vaccine coverage will tend to decrease the spread of the virus. We can do better,” he said. This view is shared by many other scientists.
How will this be reflected in hospitalisations and deaths?
We are currently seeing around 1000 people a week die from covid19. This figure will rise while it seems fairly certain we will reach and exceed 1,000 people a day being admitted to hospital.
“The UK has decided to run at a high number of daily cases since the summer,” added Naismith. “This means we are deciding to immunise significant numbers of people by infection rather than vaccination. This is seen in increased death and long covid19 in the UK compared to other countries. It does mean that immunity will be higher than simply relying on the vaccine alone. In a democracy, politicians – not scientists – take these decisions.”