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Hospitals are being warned they could face a fourth wave of covid, with half the number of patients as the first wave in spring last year.

And NHS England has also told them to carry on with 80 per cent of normal elective activity should the fourth wave occur.

NHSE has held discussions in recent weeks asking trusts what resources they would need to continue planned operations when covid once again puts hospitals under pressure.

Staffing and bedspace are likely to come under substantial pressure again while hospitals perform balancing acts between urgent and planned care this winter.

But sources have told HSJ that NHSE believes that even with another wave, hospitals should still be able to keep electives at 80 per cent of normal activity.

There are already warnings – including from the Royal College of Anaesthetists – that this target may be missed if urgent care comes under severe pressure.

London lags

The covid vaccination in the UK has broadly been a remarkable success, achieving uptake overall uptake rates well over 90 per cent, against expectations closer to 75 per cent, and better than seen in much of the globe (even where it does have decent supply).

That has not prevented much concern about where it is low, though, whether that be among some communities in Bolton, or among some health and social care staff groups. Low rates could let covid and its mutants get a foothold; and in NHS and care settings they are an obvious safety concern.

London has lagged in terms of uptake both in the community and among staff. Perhaps no surprise — it is relatively young and more diverse — or maybe it highlights a deeper problem, about whether the capital’s healthcare system is really fit for and trusted by all its communities; including many of its own employees?

Either way it is a definite worry for London’s health leaders.

There has been little transparency about how NHS trusts are getting on vaccinating their staff. There are still, six months into the programme, doubts about data quality. A few have commendably put figures in board papers, but many have declined to answer the question. 

However, HSJ has now seen figures for the capital, where there is most concern. It highlights that while the large majority have got over the 80 per cent mark for their “frontline” staff; only a very few are in the 90 per cents — where most cohorts in the general population have ended up. And a small number of trusts still have a full quarter of their staff who have not been vaccinated.