The must-read stories and debate in health policy and leadership.

Politicians and the public alike have been concerned about the impact of the pandemic and lockdown on the mental health of children.

The number of youngsters in contact with CAMHS has increased by more than a quarter on the year to November 2020, according to NHS Digital figures.

But it is those who are most in need of specialist help who may be suffering the most. HSJ reports on what has been described as a “crisis point” in inpatient care, with one clinical commissioning group area having two eating disorder patients being managed on normal paediatric wards – something which only happens when they are physically too unwell to stay at home – and four other CAMHS patients who needed admission kept at home because beds were not available.

One leading psychiatrist said there was a “perfect storm”, with more children presenting in crisis, sometimes needing police detention.

There’s little national data on these issues – the CAMHS eating disorder dataset shows an increase in those waiting to start urgent treatment but not all of those may be waiting for an inpatient bed. And there is no information on the numbers with other mental health conditions who can’t be admitted.

But with multiple mental health trusts mentioning this in their board papers, there is no doubt the issue is real. NHS England – which commissions tier four CAMHS beds – talks of “mutual aid” and providers working together. However, that does little to help when a shortage of beds is nationwide.

Not shielded soon enough?

A major extension of the shielding programme has been announced by the Department of Health and Social Care this week. It said 1.7 milion people will now be advised to shield and will be prioritised for vaccination as a result. This figure represents a 77 per cent increase of the 2.2 million people that were told to shield at the start of the pandemic, 11 months ago.

The shielding list expansion follows research into a risk calculation method, called QCovid, which officials have now decided is robust enough to add people to the list.

The 820,000 people who are under 69 on the new list will now be invited for a vaccination shortly, with the rest likely already vaccinated based on their age.

The news was greeted by concerns as to why the government waited until now to announce the extension.

Joe Farrington-Douglas, senior policy fellow at the Health Foundation, said on Twitter that the new numbers are based on an algorithm that “was completed and submitted for publication in July and published in peer reviewed BMK in October [2020].”

He added: “Then why suddenly add these names now? Presumably to inform vaccine prioritisation rather than actual shielding. But it begs the question: How many of the ~70,000 deaths since then *could have been prevented* if these high-risk had been told (and enabled) to shield?”

The announcement also comes just one day after the government met its deadline to vaccinate everyone in the top four cohorts – those over 70, frontline health and care workers and those who were already identified as clinically extremely vulnerable.

At the same time, DHSC announced also that those extremely vulnerable to covid will be asked to shield until at least 31 March. This is an extension from the current end date of 21 February.