But why are we forcing our nation’s most vulnerable to run a gauntlet of disease to receive a potentially lifesaving vaccine?
The UK’s health system has significant access issues. It is also entering the winter period during a pandemic. And the NHS can’t cope with seasonal flu numbers even in a normal year. It remains to be seen how the winter flu season coupled with Covid will impact NHS Trusts performance. Firstly, on the positive side, there are indications that the incidences of flu are significantly lower than in previous years. The fact remains that even with lower flu rates, NHS hospitals will be struck by their annual winter crisis overlaid by the pandemic.
The government has decided that the best way to distribute the new Covid-19 vaccine is to hand it to an already overstressed, and in some cases dysfunctional system. Descriptions of the planned distribution indicate it will revolve around patients having to access large hard to access NHS Hospitals. To complicate matters, the Pfizer vaccine requires recipients to take a second jab 30 days later to be effective.
We still have not fully calculated the impact that Covid has had on patients when care was denied or delayed. There is reporting suggesting that waits are conservatively being pushed much further than a year. We may never know the real number of deaths caused by delayed diagnosis and treatment. As it is hard to capture undiagnosed people who never entered the system.
What we do know is that the UK routinely scores at the bottom of measured cancer survivorship. Even before the pandemic began. In 2019 when compared against six comparable national health systems, the NHS was last. The main reason the UK languishes at the bottom of performance charts for cancer survivorship is access to diagnostics.
Long waits for scans from machines that typically reside in large NHS hospitals are killing patients. When the impact of Covid is finally measured, many thousands will have lost their lives. Many from not being able to access simple diagnostics. This will also apply to the millions who suffer from diabetes, heart disease, and other chronic diseases. The disruption of just administering a jab is not what the struggling NHS needs. Even if it delays one person’s scan, who then goes on to die, it should be seen as one too many. The reality is that it will most likely impact thousands.
This approach also relies on the struggling NHS ambulance service. Transport those who can’t make it on their own to the place where they will receive the vaccine. This, at a time when isolation from potential exposure to the virus is the most effective way of preserving life. Picking recipients up with others at risk in enclosed vehicles. Then transporting them to places riddled with disease and the virus itself, is inviting infection. It’s exactly the best way to spread it to the elderly.
On the face of it, it makes sense to take people to hospitals. Use already scheduled appointments as a way of distributing the vaccine quickly. The reality is much different; The NHS will have to re-task staff to administer the jab. Allocate space in already crowded hospitals containing potential super spreaders. It is by far the best way to distribute the vaccine for the NHS. And there’s the problem. Transporting the elderly from relatively safe nursing and private homes into bug-riddled facilities is precisely the wrong thing for patients. Requiring them to congregate in small vehicles with others is again, the wrong thing for elderly patients. It is a recipe for disaster.
The explanations for the current vaccine delivery will revolve around the NHS knowing who requires the vaccine. An insistence they have the medical facilities needed to safely administer jabs. And the logistical capability in the form of NHS ambulances to transport patients. The NHS has the necessary cold chain equipment to store the highly volatile vaccine. All true. The reality? During the winter, as the NHS itself admits, the service tips into crisis. This year’s predictions are for catastrophic impacts on patient access and care. That includes the poorly performing ambulance trusts. Relying on an ‘in crisis’ institution to deliver the most important inoculation programme in 100 years is folly. By its own admission, the NHS can’t provide care this winter for many who should have access to its services.
The NHS’s growing dysfunctionality has forced a 20% increase in NHS patients turning to the private sector for care. They pay out-of-pocket to access orthopaedic, gynaecology and ophthalmology surgeries as the NHS queues only continue to balloon. Average cost is on average £12,000. Admittedly, we have a long tradition of stepping outside failing state services to access quality. That is certainly so with our willingness to pay taxes and send our children to very expensive private schools. There is a difference between a middle-aged couple gainfully employed choosing to send their children to a private school. And a pensioner who has contributed their entire life to the NHS, paying to restore their ability to walk or see.
The NHS solution centers around its already overwhelmed infrastructure. Requires the patient to take the risk. The government should have thought this through out of the proverbial box. Injections are not rocket science. With the changes by the MRHA allowing allied health professions not in the NHS to administer jabs. There now exists a deep pool of health professionals to draw from. The cold storage of the vaccine at -70c is technically challenging. But that issue must have already been resolved by the companies who deliver the vaccine to hospitals. So, if cold storage is mobile the rest of the delivery supply chain is easily transported. Why didn’t we work from a position of protecting the patients and targeted distribution?
By taking the vaccine to patients. We free up the already struggling NHS to take care of those they are currently unable to. Or at the very least, not let care slip for even more patients. We de-risk the exposure of the vulnerable to the virus. Cut out the need to use unreliable, overcrowded ambulances from the process. As stated, this is not a complicated problem requiring the use of specialized medical facilities, or even doctors’ surgeries. Vaccines for children are given in schools. There isn’t any reason other than the storage requirement that this vaccine can’t be administered from mobile clinics.
An immediate rethink needs to occur around the future delivery of the vaccine. Possible solutions may involve the armed services, private sector, or even practices of physiotherapists as fast, safe, and unencumbered providers. Taking a patient’s exposure from multiple people in high-risk in crisis facilities to one person in a safe setting. Be it their room in a nursing home or a socially distancing compliant mobile clinic, should be a priority. We must take the vaccine to patients and not require them to potentially put their lives at risk to accommodate an overwhelmed NHS.