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Shielding patients have ‘unmet health needs and worsening mental health’

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COVID-19 has resulted in significant unmet health needs and worsening mental health among the more than four million people who were forced into shielding during the pandemic, according to new research.

Data from the charity the Health Foundation’s networked data lab (NDL) also showed there was a higher rate of deaths in this “clinically extremely vulnerable” group compared to the general population over the course of the pandemic.

Led by the charity, the NDL comprises experts from across the country, including the University of Aberdeen and NHS Grampian’s “Aberdeen Centre for Health Data Science”, who analysed the impact of shielding on health outcomes.

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Based on their findings, the Health Foundation is calling for the NHS to prioritise these patients to ensure that their conditions do not deteriorate further. 

When the first wave peaked in April 2020, the rate of deaths among the clinically vulnerable population was more than 2.5 times that of the general population (1 in 2500 or 0.039% compared to 1 in 7000 or 0.014%). 

By the end of August last year, the clinically extremely vulnerable population accounted for 19% of all deaths while only making up 4% of the total population of England,and the report found that demand for NHS care accumulated during the pandemic and has now translated into record hospital waiting lists and a huge backlog of care.

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Action is now needed by those planning the pandemic recovery locally and nationally, said the foundation, to better understand the needs of their clinically extremely vulnerable populations and ensure their needs are prioritised. 

The research also suggested there were significant issues in the way the shielding patient list was compiled, with a centralised algorithmic approach used nationally to identify the group, supplemented by local clinical judgement. Its authors note that, while this did ensure some level of consistency between regions, there has been significant variation across the UK in terms of the numbers of people who have been added to the shielded patient list.

This is due to differences in how the list has been compiled in different areas and the quality of data available, which, they say raises questions about how effectively the group was identified and whether everyone had access to the support they needed when they needed it.

Those who were not identified would have missed out on vital support such as food parcels delivered to homes, priority delivery slots for online grocery shopping, and a medicine delivery service. 

Dr Jess Butler, who led the Aberdeen leg of the project said: “Identifying clinically extremely vulnerable people with records was challenging. Clinicians in Grampian, across the acute sector and primary care, worked hard to identify those who were at risk and add them to the shielding list.

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“This accounted for almost half of all people asked to shield and took a considerable amount of work. While this approach helped rapidly identify some individuals, there are limitations to an algorithm-driven approach.

“Greater access to data from general practice and better data sharing would improve identification. Investment in data sharing and data quality monitoring will be essential to improving the process.

“This is needed to provide the NHS with an accurate picture of the clinically extremely vulnerable population so that services can be designed and delivered to meet their needs.

“Better data is also needed so that in the event of future emergencies we can more effectively identify those at the highest risk of poor outcomes.”

Kathryn Marszalek, senior analytical manager at the Health Foundation, added: “Those who are clinically extremely vulnerable are, by definition, a high-risk group and the government took rapid steps to ensure that they would be protected during the pandemic.  “Despite this, they have seen worse rates of infection and death from Covid-19 and, having greater health care needs, have been particularly impacted by changes to NHS services during the pandemic. 

“However, the negative impact goes beyond the harm to their physical health. Over a period of 10 months, those advised to isolate at home have been unable to take part in usual activities, such as shopping for food, exercising, or seeing friends and family … Action is now needed by those planning the recovery at local and national levels to address the unmet need for NHS care and worsening mental health.

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“Further investment is urgently needed to ensure that in the event of a future health emergency, we can quickly, accurately and consistently identify individuals to enable rapid planning and delivery of relevant support.”

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