benl

I always think A&E is the pressure valve of the health service. As elective stuff waits longer, problems build up requiring more 'unscheduled care' even if this is just fatigue from the suffering. This also filters back from GPs who are equally left in a fire fighting situation managing chronic conditions until definitive input. In demand terms, probably small absolute numbers are quite a large relative increases for Noble's an extra five very sick patients probably puts a strain on things. Add to this bed pressures as covid requires people to be risk stratified means beds may be free but they might not be of the right category. Lack of staff and resources comes a lot from short term UK planning whom the Island is pretty heavily dependent on. The population is ageing, money is less free flowing and care is becoming more complex so Manx Care probably hold a pretty toxic hand. For comparison, Aintee currently has between a 6-12 hour and the Royal a 9 hour wait. A category one call to Northwest Ambulance (should be within one hour) is currently taking 6+ hours. 111 calls, unless categorised as amber, are taking over 24 hours to answer in the Northwest.

I can only speak from my own experience (working in Liverpool), but one of the problems I have noticed during the pandemic is more stuff is being pushed back to GPs during the pandemic. Things like "please organise these blood tests before my next clinic", or "we found this problem please refer to x" or my personal favourite was "this lady is unsafe at home, please sort out social care". None of these things are a big deal on an individual level, but when they come in the 10s per day. The hub and spoke model definitely needs some alteration. There's also the problem of longer waiting lists leaving a fire fighting situation until definitive treatments. Then patients booking an appointment to know when their next hospital appointment is. I think having a social worker embedded in a GP surgery would be more beneficial, and perhaps a bit more mental health integration. We're trialing a physiotherapy first point of access clinic, I like the idea but even my limited knowledge of shoulder anatomy better than navigating social care. I don't think it needs to be x-ray/ultrasound on site as the article suggests, if you need results that quickly you probably shouldn't be seeing some one in primary care. Lots of people are retiring early or going part-time straight away after qualifying negating any increase in training numbers. I don't know how to fix it, but it's going to take years. I imagine at least some of these apply to the IoM

EMIS is kind of like Windows Vista once was, years of accumulated features bolted together under a shiny skin. It has some really strange quirks but it does link things together better than most hospital systems. I think it's been used for so long it makes it harder to migrate.

I know a long wait is awful, but just for comparison, the waiting time in Liverpool last week for category 4 calls was 7+ hours. Waiting times can push 5-6 hours overnight. I don't really think minor injuries cause an immense amount of pressure, where else do you go with a broken finger? Most of these are seen quickly and dispatched a team of highly trained nurses. People are stuck in A&E waiting for the right category of bed i.e the right category of covid risk, gender and medical specialty. I can only imagine this is worse in relatively small hospital such as Noble's. Bed stats are useful as a gross marker, but should be under the caveat of usable/appropriately staffed. I also read that 1 in 8 healthcare professionals are currently off sick or isolating. It's a perfect storm in an over-pressurised system from primary care onwards.

I think the press got a bit excited about Sweden and I don't really think it is fair. Doing my public health training there, and having lived there I don't really think it is comparable to other counties. The swedes generally have a lot more trust in their government and their public agencies have a lot more freedom from political intervention. At the start of covid, they issued recommendations that weren't too dissimilar from the UK, self isolate, don't go out other than for essentials, work from home if you can and try to avoid public transport. The difference was they didn't make it law/compulsory, instead leaving it to the judgement of the people. The result seems to be that they ended up with more of a slow burn with the authorities seemingly accepting they aren't going to beat it rather than the peaks and troughs the UK has seen. Society in Sweden is much more socially distant, very few multi-generational households, and a different attitude to working when unwell; you're essentially treated as a danger if you go to work even with a cold and told to go home. Their public health surveillance is incredible, every test, prescription, medical records, school records and essentially any interaction with the state is recorded and linked to your national insurance number. They even use bots to monitor twitter, newspapers and facebook to look for clusters of people who report not feeling well. The result is data you can trust and usually free from political interference. The swedish economy has been hit by exports and other impacts, and they openly accept they failed to protect nursing homes (as happened in the UK). I don't think it's fair to slam them, neither do I think it is fair to hallow their actions. It's just different and proof not one size fits all.

I think the problem with statistics is without knowing the method and the analysis, they are not quite meaningless but very difficult to make sense of. In the defence of epidemiologists, communicating this stuff is an unimaginable task. Case definitions are nothing more than a pre set criteria, i.e postive swab, or clinical symptoms. I think i't just the swabs and antibodies being reported. My slightly educated guess is all cases are under reported. The swab that goes into your mouth is only about 68% sensitive (IIRC) and there have been quite a few people who clinically have it, but there test is negative. Also, many just choose to self-isolate and don't bother with the faff of a test. Death are even harder, I think the UK changed the goal posts to 'within 28 days of positive test'. Death certification has always been a bit crap if you get a blood clot or pneumonia after having had covid, I don't think it counts, so again probably under estimated. I'm sorry to hear about your family and friends, I really don't know what the right answer is. I think a realistic and discussion with family members and whatever means most to them should be respected, but it's harder when other care home residents could be put at risk. I would agree it's not humane, we were informing families their loved one had died via telephone, it's horrific from every angle. I understand the rationale from a population point of view but I can only imagine how it would feel to be that family member. I think hospitals are being more realistic now and rules are being flexed a lot more but still, some people don't want to come to hospital because they wont see their loved ones.

I'd love nothing more than for you to be right. However, in retrospect in A&Es in Liverpool we were seeing cases of covid mainly in young adults from late January/early February, but there was a bit of denial and no real plan on a national level. It was from March it got really messy and the number of cases at that time point was a huge under estimate, doctors were going through notes and binning swabs from people who were being discharged to save testing capacity. The hospitals were somewhat spared because everything else stopped, wards cleared of elective patients, people staying away from hospital and the protective effect of lock-down. The problem with the latest set of events is less likely to be the overall numbers as it was last time, but the insistence that the normal must carry on. The cases of serious COVID were stacking up, not huge but building steadily. I suspect this is going to continue and this time there will be no 'save the NHS' as people fatigue from social restrictions. As the number of asymptomatic cases rise in the community it only takes a few to go to nursing homes to cause absolute carnage. There may well be fewer deaths than last time, as probably some of the more fragile population members have already died, as reflected by the below expected death rates in the last few months. However, I think this resurgence poses a bigger threat to healthcare infrastructure. I think the Island is lucky to have some semblance of normal life, if the borders are closed, it's probably a small price to pay. I'd say the Isle of Man has handled it really well and in the longer term, having kids back at school earlier, people back at work and resumption of the hospitality industry (other than tourism) will be protective.