North by North West: The long and slow decline

Coronavirus in the community and its demands on the health service in the North West have continued to decrease over the last fortnight.

The previous edition of NxNW illustrated clear reductions in transmission rates, as well as a drop in hospital admissions and bed occupancy.

These trends have accelerated, with critical care bed occupancy and deaths also now falling.

All this, of course, is very good news. The virus seems to have been brought under control more quickly than in other regions.

But one of the lessons from the first wave is that the descent down the charts could be very slow, and potentially drag on for months.

Demand on the NHS during the first wave declined at a much slower rate in the North West than in the rest of the country (for reasons explored by University of Liverpool researchers).

So, although the virus is in decline, it remains at relatively high levels, and could do for weeks or months to come.

It’s no coincidence the North West was hit hard and early by the second wave — because community transmission never reduced to the extent it did in the south of England over the summer.

Any significant relaxation of the lockdown measures or drop in compliance could bring the numbers surging back up quickly, meaning lots of risk around the Christmas period.

Impact on electives

This means elective activity is likely to be severely restricted until the spring, or longer depending on vaccine availability.

The NHS has stopped publishing its monthly activity stats, but internal data for the six months to the end of September, seen by NxNW, suggests elective admissions in the region were at around 43 per cent of the same period last year, compared to 50 per cent nationally.

With overall covid bed occupancy still higher than in the spring (and critical care occupancy almost as high), it will be difficult to get much higher than that percentage in the six months to the end of March 2021.

Longer journeys

In the same week that HSJ revealed serious failings and toxic relations within the trauma and orthopaedics division at University Hospitals of Morecambe Bay FT, the trust was receiving an award from the National Joint Registry.

That juxtaposition is explained by the stories relating to two different hospitals, Lancaster Royal Infirmary and Westmorland General Hospital respectively.

The former has been bogged down in internal squabbles and management failures to act on whistleblowing concerns for several years, while the latter appears to have its house in good order (which is admittedly easier on a cold site).

One of the solutions to the problems at Lancaster is to move more activity to Westmorland.

This was one of the recommendations in an external review document exposing the problems. It said Westmoreland benefits from the absence of emergency services, meaning elective lists are less prone to disruption. It recommended the hospital should be developed as a centre of excellence.

The review estimated 17 per cent of joint replacement surgery was taking place at Westmorland, and this could be increased to 80 per cent.

The difficulty will be persuading Lancaster based surgeons to take their lists 20 miles up the M6.

The review said: “Some surgeons I understand are reluctant to do any of their surgery at WGH but in the final analysis, unless they can demonstrate this is not safe, they should be instructed to do so.

“This is always a difficult situation as persuasion is always better than dictate but in the final analysis, they are government employees.”

NxNW will look at those activity levels in the new year, 12 months on from the review.

Toxicity and cultural problems are by no means limited to the T&O division at Morecambe Bay.

Serious concerns within the urology services have been well documented, and are currently subject to a major investigation, while cultural issues are also being looked at in paediatrics and ophthalmology. More on that next time.