Action needed to meet health needs of shielded population affected by pandemic

Urgent action is needed to meet the needs of millions who shielded during the pandemic to avoid further deterioration of their health, a think tank has warned.

Failure to do so will “inevitably” see the conditions of people within the clinically extremely vulnerable population get worse and add to pressures on an already-stretched NHS, the Health Foundation said.

The organisation said analysis by its Networked Data Lab (NDL) showed the shielded population had a higher rate of deaths compared to the general population over the pandemic.

The think tank said that at the peak of the first wave in April 2020, the rate of deaths among the clinically vulnerable population was more than two-and-a-half times that in the general population.

By the end of August last year, the clinically extremely vulnerable population accounted for almost a fifth (19%) of all deaths despite only making up 4% of the total population in England, according to the analysis.

Measures taken to protect the health service near the beginning of the pandemic also had an effect, the Health Foundation said.

It said planned admissions for clinically extremely vulnerable people decreased by 51% while outpatient appointments were down by 48%.

Emergency admissions for clinically extremely vulnerable people fell by almost a third (32%) from April 2019 to April 2020, and A&E attendances decreased by 42%, the organisation said.

The think tank said their research also indicated the clinically extremely vulnerable population might have significant unmet mental health needs.

From March to September 2020, one in 50 clinically extremely vulnerable people in Wales were clinically recorded with depression, anxiety or both during shielding, the Health Foundation said.

Of those, one in five had no previous history of these conditions, the organisation added.

The think tank said that their research showed rates of antidepressant prescriptions were approximately 50% higher for the clinically extremely vulnerable cohort in Liverpool and Wirral compared with the general population.

The Health Foundation also questioned the way in which the shielding patient list was compiled, saying there was “significant variation” across England, Scotland and Wales in terms of the numbers of people on their lists.

They suggested this raises questions about how effectively clinically extremely vulnerable people were identified and whether everyone had access to the support they needed through the pandemic.

Kathryn Marszalek, senior analytical manager at the Health Foundation, said that despite the “rapid steps” taken by the Government to protect the clinically extremely vulnerable who are “by definition, a high-risk group” they have seen “worse rates of infection and death from Covid-19”.

She added: “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.

“Our research reveals the toll this has taken on the mental wellbeing of many clinically extremely vulnerable people who were already more likely to suffer from mental health conditions than the general population.

“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.

“Failure to prioritise the needs of the clinically extremely vulnerable population will inevitably result in further deterioration in their health, putting additional pressure on the NHS which is already struggling to deal with a massive backlog of care.”

She called for further investment to ensure quick action can be taken to “accurately and consistently identify individuals to enable rapid planning and delivery of relevant support” in the event of a future health emergency.

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