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Facing the second COVID-19 wave: four lessons we have learnt

With winter approaching, RCP president Professor Andrew Goddard outlines four lessons we have learnt as we face the escalating second COVID-19 wave.

News of the encouraging preliminary data from the Pfizer BioN Tech and Moderna vaccines has given us all a lift in these challenging times. But while we wait for the crucial safety data, we must of course get on with the escalating second COVID-19 wave.

As we approach winter in a second lockdown in England and rising COVID admissions across the UK, now is a good time to reflect on some of the key lessons from an extremely difficult spring, summer and autumn. Healthcare workers and the whole country have already sacrificed much, but we must consider what we have to do differently this winter.

1. Staff testing is crucial

The capacity of the NHS workforce will be even more stretched in this second wave, not least because of the usual winter surge in demand. Prior to the first wave, there was a reduction in acute activity - many elective services were stood down to free up physicians to help out in other acute areas. This is not the case for this second wave. Neither do we have the benefit of medical students coming to the end of their final year of training, whose stepping up to support the delivery of care in the first wave was invaluable.

Our most recent workforce survey found 1 in 16 physicians were off work. Almost 40% were self-isolating either because they had COVID-19 or someone in their household did. Quick and easy access to staff testing is vital to tackling this. We were therefore pleased to hear the announcement from NHS England national medical director Steve Powis that regular testing would be introduced for all NHS staff in high-risk  areas. This needs to be rolled out urgently. The CQC’s plans to monitor infection prevention and control in hospitals and care settings this winter will also help to support the system. It should ensure adequate PPE provision, and that effective plans and procedures are in place.

2. The NHS must work more closely with social care

The first COVID-19 wave demonstrated the need to properly fund social care, and step up the integration of health and social care. The RCP recently published guidance on discharging COVID-19 positive patients to care homes, which should help doctors and other clinicians understand the quickly evolving advice from government and elsewhere.

Underpinning this guidance is the need for greater cooperation between secondary and primary healthcare providers, the care home sector, other care providers – such as community palliative and hospice care - and local authorities. This will be imperative in supporting better patient care in the second wave, while the much-repeated call for a sustainable funding settlement for social care is more urgent than ever. Place-based models of care are also imperative, designed around local circumstances with local people, including patients.

3. Communication, communication, communication

The power of good communication is never more valuable than in a crisis. More than 7 months after we first heard ‘Stay Home, Protect the NHS, Save Lives’, it is still vital to emphasise the basics of social distancing and good hand hygiene.

As we went through spring and summer, the government rightly realised that too many people were being put off coming forward for treatment. A shift was needed to make clear the NHS was ‘open for business’ for those who needed it. As this second lockdown continues, government must be very clear that the NHS is still there to deliver potentially life-saving non-COVID care – and that ‘hands, face, space’ is a vital part of enabling the NHS to do just that.

4. We cannot afford to ignore health inequalities

Some 40 years ago the Black Report laid out the pernicious impact of health inequalities. COVID-19 has exposed how those inequalities can have an impact not just over a lifetime, but a matter of weeks. It is crucial that government and NHS decision-making in the coming months takes proper account of health inequalities.

NHS England has taken a positive step, recommending in its guidance on implementing phase three of the NHS response that all systems and every NHS organisation should therefore identify, before October, a named executive board-level lead for tackling inequalities’.

We also hope the establishment of an Inequalities in Health Alliance, with over 100 other organisations, will help shine a light on the need for action. The alliance is advocating a cross-government strategy to reduce health inequalities; the commencement of the socio-economic duty, section 1 of the Equality Act 2010; and a ‘child health first’ approach in all policies.

A key feature of the first COVID-19 wave was that we were able to use the information you provided us to urgently press for rapid improvements, from PPE, to rota gaps and risk assessments. This feedback will no doubt be crucial again, and we encourage you to contact us via policy@rcplondon.ac.uk if you think there’s something we need to know about.