The Parliament’s Public Accounts Committee Inquiry into supporting the vulnerable during lockdown has been concluded in a report published on 21 April, finding the shielding response through the Covid-19 pandemic has exposed the high human cost of the lack of planning for shielding in pandemic scenarios.
The main purpose of the report was to evaluate the support the government provided to vulnerable people throughout the pandemic, with a focus on shielding – not only its success in reaching vulnerable people in society, but also its success in providing vital support and services to enable them to shield.
The Committee highlighted both teething problems associated with the launch of any emergency strategy and the systemic, perennial issue of poor data and collaboration across the health system. The report critically found that some 800,000 potentially clinically extremely vulnerable people may not have been contacted on shielding at all through serious delays in access to health data required to identify CEV patients, with certain groups excluded entirely from support, highlighting the urgent need for non-clinical factors to be considered for future pandemics and improved health data collation.
The report concludes with six key issues and findings in the provision shielding guidance:
- CEV criteria: DHSC’s initial clinical criteria for identifying and supporting clinically extremely vulnerable people excluded several factors which it became clear also made people more vulnerable.
- CEV patient identification: DHSC and NHS Digital took too long to identify all clinically extremely vulnerable people.
- Shielding guidance variation: Huge local variation in patient identification indicates GPs lacked consistency when assessing clinical vulnerability and who should be eligible for guidance and support.
- Central planning: Government chose a centrally directed system to support clinically vulnerable people as it did not have confidence all local authorities and supermarkets could meet people’s needs, particularly for food.
- Missed support: MHCLG and DHSC do not know whether 800,000 clinically extremely vulnerable people slipped through the net and missed out on much needed support.
- Inadequate data: Missing or inaccurate telephone numbers in NHS patient records undermined government’s efforts to contact 375,000 people.
The report made a series of recommendations to tackle each of these six conclusions, and the APPG on Vulnerable Groups to Pandemics echoes this call for better national preparedness to future pandemics. National preparedness with tailored support for CEV patients is imperative, and should be joined up with local action to enable the capacity and resilience to support the needs of clinically extremely vulnerable people. The risk for clinically extremely vulnerable patients is still high even with the vaccine, especially now that shielding support has been ended.
Our recent letter to Chief Medical Officer Chris Whitty and Health Secretary Matt Hancock coincides with the recommendation that continued support is needed for all vulnerable patients.