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Paramedics warn of avoidable deaths as emergencies wait for hours for help

Hundreds of people a day across London are waiting hours for an emergency ambulance to get to them, as paramedics warn that patients are dying as a result of delays.

Patients in emergency calls classified as category two, such as those involving a suspected stroke or chest pains, should be seen by paramedics within an average of 18 minutes but are being forced in some cases to wait up to 10 hours.

Even life-threatening calls where patients are in cardiac arrest and should be reached within seven minutes have experienced delays, with data suggesting one such call was waiting 20 minutes on Monday.

Internal data shared with The Independent shows that London Ambulance Service is holding hundreds of open 999 calls for hours at a time with the service’s boss acknowledging in an email to staff that the service is struggling to maintain standards. Experts warned that the problems in the capital were reflected in ambulance services across the country.

One paramedic told The Independent: “Patients desperately requiring ambulances aren’t getting them and, anecdotally, people are deteriorating and dying whilst waiting. Our poor dispatchers have to stare at screens of held calls, working out who gets the next available resource and who waits, suffers or dies.”

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Source: The Independent, 5 January 2021

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Regulator waives clinical exam so overseas nurses can bolster covid push

Overseas-trained nurses have been told they can join the temporary coronavirus register without undertaking a formal “clinical assessment” in an attempt to bolster the NHS workforce as the third covid wave surges.

The Nursing and Midwifery Council confirmed on Tuesday that it has invited the additional nurses in a bid to “strengthen workforce capacity in the immediate period and coming weeks”.

It comes as the number of covid inpatient admissions rises sharply across the country, with London and the South East of England badly hit. At the start of the pandemic last year, the NMC asked former nurses who had left within the last three years to join the emergency covid register as cases grew.

Unison union’s national nursing officer Stuart Tuckwood believed the move will help deal with “severe” staffing shortages, but warned they must be “supported and supervised” by fully registered nurses to ensure patient safety.

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Source: HSJ, 6 January 2021

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Urgent cancer ops cancelled in parts of London

Potentially life-saving cancer operations have been put on hold at a major London NHS trust because of the number of beds taken by Covid patients.

King's College Hospital Trust has cancelled all "Priority 2" operations - those doctors judge need to be carried out within 28 days.

Cancer Research UK said such cancellations did not appear to be widespread across the country.

And surgery has not been stopped on the same scale as during the first wave.

Rebecca Thomas, who has had her bowel cancer surgery at King's College Hospital "cancelled indefinitely", told the BBC she felt like she had been left "in limbo".

Until she has surgery her tumour cannot be studied to see how aggressive it is, and so she won't know until then how significant this wait will turn out to be.

A spokesperson for the Trust, which mainly serves patients in south London, said: "Due to the large increase in patients being admitted with COVID-19, including those requiring intensive care, we have taken the difficult decision to postpone all elective procedures, with the exception of cases where a delay would cause immediate harm.

"A small number of cancer patients due to be operated on this week have had their surgery postponed, with patients being kept under close review by senior doctors."

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Source: 5 January 2021

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Many 'long Covid' sufferers unable to fully work six months later

Many people suffering from “long Covid” are still unable to work at full capacity six months after infection, a large-scale survey of confirmed and suspected patients has found.

While COVID-19 was initially understood to be a largely respiratory illness from which most people would recover within two or three weeks, as the pandemic wore on increasing numbers reported experiencing symptoms for months on end.

These long haulers – with symptoms affecting organs ranging from the heart to the brain – have no real explanation and no standardised treatment plan for their long-term condition. There is no consensus on the scale and impact of long Covid but emerging data is concerning.

In one of the largest studies yet, which has not been peer reviewed, Patient Led Research for COVID-19 (a group of long Covid patients who are also researchers) surveyed 3,762 people aged 18 to 80-plus from 56 countries who responded in nine different languages to 257 different questions

Two-hundred and five symptoms across 10 organ systems were recorded, with 66 symptoms traced over seven months. On average, respondents experienced symptoms from nine organ systems.

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Source: The Guardian, 5 January 2021

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NHS plea for private help as covid forces cancer surgery cancellations

NHS leaders are holding fresh talks with private healthcare groups to try to secure surgery for urgent cancer patients in London, as the covid-19 second wave causes hospitals in the capital to make widespread cancellations, HSJ understands.

In recent weeks, pivotal independent sector providers have declined to do the procedures for the payments on offer.

In the spring covid peak, the NHS block-booked private capacity in London, but now only small, spot contracts are in place for this work. Under the previous deal, rules meant low-priority private patients could not be treated ahead of NHS patients who needed surgery urgently.

But now providers can prioritise their private patients as they see fit. HSJ understands NHS England, under pressure from the Treasury, was not willing to pay the prices asked by the three private providers.

As London NHS hospitals continue to fill with covid patients, particularly in critical care, they are able to do few cancer procedures beyond the most urgent category, P1, and are suspending many procedures in the lower categories, including P2, sources said. P2 is defined as patients who need treatment within four weeks.

One senior clinical manager in the city told HSJ on Monday: “Cancellations [are] rife. We have stopped almost all operating in our elective hub apart from P1 [patients assessed as needing surgery within three days].

“The independent sector has not opened up capacity and lifestyle operations [are] still planned [in private hospitals].”

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Source: HSJ, 5 January 2021

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GPs insist NHS ‘ready to go’ in rapidly rolling out Oxford vaccine

Doctors on the front line of the UK’s vaccine programme have said they are “ready to go” and will be able to administer doses “very quickly” in the months ahead, amid questions over whether or not the NHS can inoculate 2 million people a week.

After suggestions that staffing constraints could hinder the roll-out of the Oxford/AstraZeneca vaccine, which was approved for use last week, NHS officials and GPs have insisted that the health service is primed to deliver doses as soon “as supply becomes available”.

On Monday, Professor Stephen Powis, national medical director of NHS England, said 100 hospital hubs and 700 vaccination centres – based in GP practices and other community settings – would have access to the vaccine by the end of the week, with plans in place to expand the programme.

“We aim to get it into people’s arms as quickly as it is supplied to us,” Prof Powis said. “If we get 2 million doses a week, our aim is to get 2 million doses into the arms of those priority groups."

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Source: The Guardian, 4 January 2021

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Medics appeal for more to get higher level PPE

A thousand health professionals have backed an appeal for hospital staff to be given improved personal protective equipment.

In an open letter to UK political leaders, they say there is growing evidence that tiny coronavirus particles can spread through the air.

The group want general ward staff to be given the type of high-quality masks usually only worn in intensive care.

Nurses' leaders said higher level PPE should be provided as a "precaution".

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Source: BBC News, 5 January 2021

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NHS staff fear speaking out over crisis in English hospitals

Nine months ago, Boris Johnson praised staff at St Thomas’ for saving his life. Now, a senior intensive care nurse at the London hospital has warned that patient care is being compromised because of staff shortages and a failure to plan for the second Covid wave.

Dave Carr, an intensive care charge nurse, is one of many NHS workers desperate for the public to know what is going on inside their hospitals at a time when misinformation and scepticism about the virus are rife.

“The public needs to be aware of what’s happening. This is worse than the first wave; we have more patients than we had in the first wave and these patients are as sick as they were in the first wave. Obviously, we’ve got additional treatments that we can use now, but patients are still dying, and they will die,” said Carr.

As a representative for the union Unite, Carr feels emboldened to speak out. But across the NHS, many more staff claim they have been threatened with disciplinary action or even dismissal if they put their head above the parapet.

In Devon, one nurse working on a Covid ward said safety standards had slipped at her hospital, but she feared for her job if she was identified by name. “The infection control restrictions are more relaxed. Before, we had to use a separate entrance but now we don’t, and some doctors feel they don’t have to obey the infection control protocols and are still unsure of how to properly remove the PPE,” she said.

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Source: The Guardian, 1 January 2021

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Leaks reveal record waits for emergency care due to covid pressures

Very long waits for emergency hospital care have surged in London since mid December, due to a rapid rise in COVID-19 admissions combined with limited capacity, according to figures leaked to HSJ.

Data sent to HSJ indicates that December will set a new record high nationally for the number of 12-hour “trolley waits”. This is when there are 12 hours or longer from the decision is made to admit a patient from the emergency department to hospital, to when they are actually admitted to a bed.

It adds to fears about what will happen if rising covid occupancy — which has left some hospitals running out of staff and acute beds, and intensive care well over normal capacity —  combines with potential additional winter demand in coming weeks.

Several senior hospital managers in areas heavily affected by covid said there were two main factors. One is shortage of beds and operational issues: there are about 6,300 fewer general and acute beds open nationally this winter, due to infection prevention measures. The beds that remain have to be split between covid positive and negative, often taking time to convert more.

Two sources said bed shortages were exacerbated by problems with discharge, particularly of covid patients who no longer need acute care, including “local authorities taking their eye off the ball on designated settings and covid-positive pathways”, according to one.

And another reason behind delays is waiting for covid test results before admitting patients.

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Source: HSJ, 4 January 2021

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Coronavirus: No increase in severe child cases, paediatricians say

Doctors have sought to reassure parents that there has been no increase in the severity of COVID-19 cases among children because of the new variant.

The Royal College of Paediatrics and Child Health (RCPCH) said children's wards are not seeing any "significant pressure" from COVID-19.

It comes after a London hospital matron told BBC Radio 5 Live of having a ward full of children with coronavirus. 

Laura Duffel said the surge in cases was "much scarier" than the first wave. Ms Duffel, who has been working on Covid wards since the beginning of the UK's epidemic and specialises in children's intensive care, told 5 Live's Chiles on Friday show that people were "wrong" to say busy hospitals were merely a reflection of normal winter pressures on the NHS.

"This wave has just hit us so fast. It's literally in the space of a week that this has gotten so bad," she said.

However, doctors denied that the virus is putting significant additional pressure on children's wards across the country. 

Prof Russell Viner, president of the RCPCH, said: "Children's wards are usually busy in winter. As of now we are not seeing significant pressure from COVID-19 in paediatrics across the UK.

"As cases in the community rise there will be a small increase in the number of children we see with Covid-19, but the overwhelming majority of children and young people have no symptoms or very mild illness only.

"The new variant appears to affect all ages and, as yet, we are not seeing any greater severity amongst children and young people."

Dr Ronny Cheung, a consultant paediatrician at Evelina Children's Hospital, in London, added: "I've been the on-call consultant in a London children's hospital this week. Covid is rife in hospitals, but not among children - and that is corroborated by my colleagues across London."

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Source: BBC News, 3 January 2021

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Medics complain of 'bureaucracy' in bid to join Covid vaccine effort

When dentist Andy Bates offered to help administer the coronavirus vaccine, he hadn't bargained for the "overload of bureaucracy" he says came his way.

Dr Bates, from North Yorkshire, is one of a number of health staff to criticise the paperwork needed to gain NHS approval to give the jabs.

Some medics have been asked for proof they are trained in areas such as preventing radicalisation.

The PM said the health secretary would be "taking steps" to address the issue.

Asked about reports potential volunteers were being deterred by the additional training and forms about "de-radicalisation measures" and "fire drills", Mr Johnson told the BBC's Andrew Marr on Sunday: "I think it's absurd and I know that the health secretary is taking steps to get rid of that pointless bureaucracy."

The NHS has previously said training and checks were needed for vaccinators.

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Source: BBC News, 3 January 2021

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New data reveals the 23 trusts with over a third of beds occupied by covid patients

Twenty-three hospital trusts had more than a third of their core bedbase occupied by COVID-19 patients on Tuesday, and occupancy is still rising at all but one.

Three trusts (North Middlesex in north London, as well as Medway and Dartford and Gravesham in Kent) had more than half of general and acute beds occupied by patients who had the virus, and others were not far behind.

Several trusts saw their covid occupancy share up by more than 10 percentage points in a week — a rate of growth which would soon see them entirely filled by covid patients, a situation with radical consequences for emergency hospital care in those areas.

London as a whole had a third of these beds occupied by patients with COVID-19.

HSJ has analysed data published for the first time by NHS England last night. The data concerns the status of adult general and acute beds, which make up the large majority of the acute bedbase. They do not include intensive care, which is also now under huge pressure in London, the south east and the east of England. Most hospitals in these areas are stretching IC capacity above normal levels.

Such high covid occupancy in both intensive care and the core bedbase is putting severe strain on hospitals’ ability to treat other patients. Most or all of the trusts under the greatest pressure have now cancelled routine planned surgery, and many are struggling with crowding, delays getting patients into and out of emergency departments due to the space available, and a lack of staff.

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Source: HSJ, 1 January 2021

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Elderly fall victims having to wait six hours for ambulances dealing with Covid patients

Elderly people who suffer falls are having to wait up to six hours for an ambulance because of rising Covid pressures, a medical body has warned. 

The delays are due to paramedics having to prioritise 999 calls from people suffering from coronavirus related breathing difficulties.

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Source: The Telegraph, 1 January 2021

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Covid: 12-week vaccine gap defended by UK medical chiefs

The UK's chief medical officers have defended the Covid vaccination plan, after criticism from a doctors' union.

The UK will give both parts of the Oxford and Pfizer vaccines 12 weeks apart, having initially planned to leave 21 days between the Pfizer jabs.

The British Medical Association said cancelling patients booked in for their second doses was "grossly unfair".

But the chief medical officers said getting more people vaccinated with the first jab "is much more preferable".

Pfizer has said it has tested the vaccine's efficacy only when the two vaccines were given up to 21 days apart.

But the chief medical officers said the "great majority" of initial protection came from the first jab.

"The second vaccine dose is likely to be very important for duration of protection, and at an appropriate dose interval may further increase vaccine efficacy," they said.

"In the short term, the additional increase of vaccine efficacy from the second dose is likely to be modest; the great majority of the initial protection from clinical disease is after the first dose of vaccine."

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Source: BBC News, 1 January 2021

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NHS staff face burnout as Covid hospital admissions continue to rise

England’s chief nurse has said that NHS and care staff are working incredibly hard to cope with record numbers of COVID-19 patients, amid concern that frontline staff are close to burnout.

Ruth May pleaded with the public to follow the coronavirus advice to help relieve the pressure on hospital staff, after two days of record hospital admissions.

Adrian Boyle, the vice-president of the Royal College of Emergency Medicine, told BBC Breakfast that health employees were “tired, frustrated and fed up”.

He said: “What is it going to be like over the next couple of months? I don’t know, I am worried. We are very much at battle stations.

“There will be short-term surges of morale but people are tired, frustrated and fed up, as everybody is, whether they work in hospital or not. The people who go into emergency medicine expect it to be tough from time to time.

“There is a real worry about burnout.”

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Source: BBC News, 1 January 2021

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Roll out covid vaccinations to frontline staff ‘immediately’, says NHS England

COVID-19 vaccinations should now be “immediately” rolled out to frontline staff, NHS England has told trust leaders.

New instructions from the national body follow the approval today of the Oxford/AstraZeneca coronavirus vaccine, which NHS England said will “substantially to accelerate vaccine delivery”. Until now, only limited quantities of the Pfizer/BioNTech vaccine have been available.

NHS staff are in the second priority category for covid vaccines, behind care home residents and alongside over 80s. But there have been complaints from clinicians around the country that they have been unable to get the jab, as well as uncertainty about how the vaccine deliveries should be divided between the priority groups.

A letter to local leaders from NHS England says that until now, healthcare workers who have been identified at highest risk of serious illness from covid-19 have been given the vaccine in unfilled appointment slots.

The letter, from chief executive Sir Simon Stevens and senior officials, now states: “Increased supply means that vaccination can also now immediately be expanded to frontline health and social care workers.”

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Source: HSJ, 31 December 2020

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Covid vaccine: UK doctors criticise rescheduling of second doses

Plans to delay giving the second dose of a Covid vaccine to more than 500,000 people who have received the first jab have caused outcry among doctors who say cancelling appointments wastes time, causes confusion among patients and is potentially unethical.

On Wednesday the government announced a change to its Covid vaccination strategy, saying second doses of the newly approved Oxford/AstraZeneca vaccine and the previously approved Pfizer/BioNTech jab would now be given up to 12 weeks after the first dose.

The move applies to people scheduled to have their second dose of the Pfizer jab after 4 January, as well as those yet to receive either jab. The government said it hoped the approach would mean as many people as possible soon have some protection against the disease.

However, the announcement caused controversy, with Pfizer and BioNTech warning that two doses of their vaccine were required for maximum protection against Covid and that they did not have evidence that the first dose alone offered protection after three weeks.

Now doctors have said cancelling appointments for the second dose will take huge amounts of time and could lead to confusion.

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Source: The Guardian, 31 December 2020

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COVID-19: Frontline doctors speak out about struggle to maintain care standards

Frontline doctors have testified to deteriorating conditions in hospitals in London and the south east as the NHS deals with a surge in COVID-19 cases.

Speaking to the Independent SAGE group of experts on 30 December, Jess Potter, a respiratory doctor in east London, told how she and colleagues were afraid of resources running out.

“My greatest fear is having a patient that I cannot provide lifesaving treatment to,” she said. “We had one of our largest medical intakes yesterday, the vast majority with coronavirus. What do we do when we run out of resources, and who is going to provide that guidance? It will harm our patients and our staff, because we have a set of values by which we practise, and we will have to reduce the level of care we deliver.”

She added, “Back in April I never saw a case where we didn’t provide a bed to a patient who needed it in intensive care, and decisions were taken as if in normal times. Now I hear from medics across the country that things are very bad, and the situation is the same as in April, if not worse. We are afraid of what will happen if we don’t act now.”

Sonia Adesara, a doctor in London, spoke to Independent SAGE after a set of night shifts at her trust and told of a chronic shortage of continuous positive airway pressure (CPAP) capacity.

“In the past few days, despite my hospital significantly increasing intensive and critical care capacity, our intensive care unit has been full, and there is no spare CPAP capacity. Medics are spending shifts trying to closely monitor all of our patients who are on the highest level of oxygen that we can give with a normal mask, assessing who is most unwell and unstable—and then frequently checking on patients who are on CPAP and then swapping people [around]."

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Source: BMJ, 31 December 2020

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Oxford vaccine: People with allergies and pregnant women can now get inoculation, updated guidance says

People with allergies and pregnant women can now be given the country’s two approved COVID-19 vaccines, the medical regulator said on Wednesday.

Previous advice from the Medicines and Healthcare products Regulatory Agency (MHRA) said people with a range of allergies to food and medicines should not be given the Pfizer vaccine.

Dr June Raine, the MHRA’s chief executive, said growing evidence from a pool of at least 800,000 people in the UK and around 1.5 million people in the US who have had the vaccine has "raised no additional concerns".

This, she continued, "gives us further assurance that the risk of anaphylaxis can be managed through standard clinical guidance and an observation period following vaccination of at least 15 minutes.

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Source: The Independent, 30 December 2020

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COVID-19: Expedite vaccination or deaths will surge, researchers warn

Deaths from COVID-19 in England in the first half of 2021 could exceed those seen in the whole of 2020 unless the vaccination programme is vastly increased and a national lockdown implemented—with educational settings closed for at least a month—researchers have warned.

In a preprint released on 24 December, researchers from the London School of Hygiene and Tropical Medicine used modelling to compare the effects of varying COVID-19 restrictions on the virus spread, hospital and intensive care admissions, and deaths from 15 December 2020 to 30 June 2021. The model took account of the new variant spreading rapidly in southern England, which it estimated to be 56% more transmissible than non-variant COVID-19.

The study, which has yet to be peer reviewed, said that control measures similar to the November national lockdown would be “unlikely to reduce the effective reproduction number to less than 1, unless primary schools, secondary schools, and universities are also closed.” It added that it would be necessary to “greatly accelerate vaccine rollout to have an appreciable impact in suppressing the resulting disease burden.”

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Source: BMJ, 29 December 2020

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London faces ‘ticking time bomb’ over oxygen supplies as another hospital issues warning to staff

Concerns are mounting over the number of coronavirus patients being admitted to hospitals in London as another NHS trust in the capital issued an urgent warning over its oxygen supplies.

On Tuesday afternoon, the North Middlesex University Hospital Trust warned clinicians the numbers of coronavirus patients it was treating “was putting a strain” on the oxygen system, sparking several alarms.

The trust currently has around 200 patients using oxygen with the trust consuming 2,400 litres of oxygen a minute. It normally uses around 1000 litres a minute and has a limit of 3,000 above which the system could cut out.

It is only the latest hospital to face the problem – which is caused by the sheer demand for oxygen by sick Covid patients, which is more than the hospital piping can physically deliver.

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Source: The Independent, 30 December 2020

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COVID-19: Oxford-AstraZeneca coronavirus vaccine approved for use in UK

The Oxford-AstraZeneca vaccine has been approved for use in the UK, with the first doses due to be given on Monday amid rising coronavirus cases.

The UK has ordered 100 million doses - enough to vaccinate 50 million people.

This will cover the entire population, when combined with the full order of the Pfizer-BioNTech jab, Health Secretary Matt Hancock said.

It comes as millions more people in England are expected to be placed under the toughest tier four restrictions.

On Tuesday, 53,135 new Covid cases were recorded in the UK - the highest single day rise since mass testing began - as well as 414 more deaths within 28 days of a positive test.

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Source: BBC News, 30 December 2020

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Covid: Essex declares major incident over virus cases

A major incident has been declared in Essex amid fears the number of COVID-19 cases could overwhelm the county's health services.

The Essex Resilience Forum (ERF) said "growing demand" was putting stress on hospitals and social care settings.

On Tuesday Mid and South Essex NHS Trust placed all three of its hospitals on critical alert.

All of Essex is in tier four and the south of the county has some of the worst-affected districts in England.

Essex Police Chief Constable BJ Harrington, who is co-chairman of the ERF, said declaring a major incident allowed it "to seek further support from the government to address the severe pressures which the health system is under".

The forum said the number of patients being treated for Covid in the county had exceeded the levels seen at the peak of the first wave and "these levels are likely to increase further in the coming days".

The ERF - comprised of health services, blue light responders and councils - said issues included "critical care and bed capacity, staff sickness/self-isolation levels and the system's ability to discharge patients quickly into safe environments".

Mr Harrington urged the public to continue only dialling 999 or attending A&E in an emergency.

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Source: BBC News, 30 December 2020

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Nightingale hospitals stand empty despite surging Covid cases as medics warn of staff shortages

The flagship Nightingale hospital is being dismantled as medics warn that there are not enough staff to run the facilities despite the NHS being at risk of being overwhelmed by coronavirus.

Amid surging virus case numbers, elective surgery is being cancelled as the number of patients in hospitals in England passes the peak of the first wave in April. 

Although the NHS is "struggling" to cope, the majority of the seven Nightingale hospitals, created at a cost of £220 million, have yet to start treating COVID-19 patients during the second wave. The Exeter Nightingale has been treating Covid patients since mid-November. 

The facility at London's Excel centre has been stripped of its beds and ventilators.

The NHS has told trusts to start preparing to use the overflow facilities in the coming weeks, but bosses have failed to explain how they will be staffed.

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Source: The Telegraph, 28 December 2020

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All vulnerable people to be vaccinated by ‘late spring’ says head of NHS

All vulnerable people will have been offered a coronavirus vaccination by “late spring” the head of NHS England has said as he warned the health service was “back in the eye of the storm.”  

In a New Year message, Sir Simon Stevens described 2020 as the “toughest year” and he paid tribute to nurses, doctors, therapists and other NHS staff including hospital cleaners, carers and volunteers as well as care home staff.

Sir Simon visited a new vaccination centre on Monday saying: “We think that by late spring with vaccine supplies continuing to come on stream we will have been able to offer all vulnerable people across this country Covid vaccination. That perhaps provides the biggest chink of hope for the year ahead.”

His comments came as the NHS in London was said to be “teetering on the edge” as latest data showed the numbers of hospital admissions in the capital jumped more than 200 per cent since the end of lockdown on 2 December.

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Source: The Independent, 29 December 2020

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