‘The risk of everything crashing is high’ - Health boss warns of ‘perilous’ state of Bristol healthcare system

This week, the health and social care system in Bristol reaced Opel 4 - its highest escalation level.

BristolWorld spoke to Bristol City Council’s Public Health Christina Gray on why this is - and how we can help relieve high pressure on the NHS this winter.

Why is the local healthcare system in Opel 4?

Our local health system this week declared what is called an Opel 4 situation, which is the highest level of alert.

The system has been highly pressurised for some time - but not primarily from Covid. Covid is additional to other pressures that are often referred to as ‘winter pressures’.

The healthcare system always comes under additional pressure in winter, but over the past few years those pressures have actually been present through the whole year and exacerbated in winter.

We’ve been anticipating a difficult winter for healthcare all the way through summer, and that’s what we’re seeing now.

How will healthcare change due to the system being on high alert?

The situation at the moment is so acute that clinicians are having to get patients to think about being discharged and how this can be done in the most timely way possible.

Normally, discharge from hospital is something that is thought about afterwards, not before treatment has taken place. But we simply don’t have the workforce capability to think about ‘afterwards’ as demand is now outstripping supply.

It means that relatives and friends are being asked to help with timely discharge of a patient and expected to do a bit more than perhaps they would normally.

It’s very important that people seek care when they need it, but for those situations where we can manage symptoms by for example seeking help from a pharmacy, where we can avoid creating a crisis, that’s what we should do.

What can I do to help to relieve pressure on the NHS?

We can all help by keeping ourselves well, physically and mentally, in simple ways by maintaining healthy lifestyles, taking exercise, eating well and spending times with loved ones and friends.

If you are unwell, whether that’s f Covid or not, don’t go out and spread it around. A heavy cold for you can become very serious for someone else and even result in a hospital admission. These chain reactions are something we’ve learned from coronavirus.

The next thing is vaccination. We live in an era where millions of lives have been saved across the globe from vaccination.

First, second, third, booster. Wherever you are in that process, clinically vulnerable or not, go out and get it.

We have set up local walk-in clinics so if you are eligible for a first, second or booster shot you can get it quickly (the third ones are for the clinically extremely vulnerable, so you would have to go to your GP for that).

In terms of flu vaccination, that programme has been opened to a much wider group of people.

You can get your flu vaccination from the pharmacy, by booking online or asking at the counter.

Should I still be wearing a mask in shops and social distancing?

Our Healthier Together partnership recommends this, yes.

We are in a deregulated space, but the government message remains that this is a voluntary effort- that we should ‘voluntarily’ be taking steps such as wearing a mask.

Now of course, that’s a difficult message, but in Bristol we have been very strong on this. You do it for yourself, you do it for other people. You do it to get back to normal.

Covid has not gone away and it’s not going to go away. We need to learn to accommodate to it, to limit the harms and to live with it.

That will be by a range of measures - the vaccination programme which we’re so fortune to have here, supporting the global vaccination programme and ‘voluntarily’ taking these simple measures.

You can create safe spaces by wearing a face covering in public places such as shops and on public transport, and keeping a bit of a distance from others.

Another important thing is ventilation. You don’t have to freeze, but open the windows periodically, especially if you have a lot of people in a small space, or meet them outside.

If everyone understands transmission, they can adapt their behaviours to minimise the risk to themselves and others.

Are you concerned about increased coronavirus cases in Bristol?

We’re just coming down, locally and nationally, from a wave. We’ve had quite a peak following the summer.

So two things happen. Once we lifted restrictions, we had the impact of that, from tourism etc.

We then had a wave recently in young adults, ages around 12 to 15. That wave is just coming down so we’re at about 360 cases per 100,000 of the population now, working down towards the national average.

But what we should expect to see are ongoing waves. Again, the message is Covid has not gone away.

The question is now, what will the next wave be? What will drive that?

If you look back at the graphs from March 2020, what you would see retrospectively is the waves getting smaller.

Wave one and two were extremely high with fatality rates attached. The subsequent waves were smaller with decreased fatalities and hospital admissions.

What that tells is vaccination is providing a shield. And to protect that shield everyone needs to keep with the programme.

We all want this to be over. We want to be able to see our friends. We want to keep businesses going. We don’t want the economy to crash. We need health services we can access. But all these are like stacks of cards. If we take the small steps, actually, you will make an impact. You will stop that chain reaction and prevent something happening further down the line.

When we met with partners last week, we said, ‘we’ve got to go harder with this’.

The risk of crashing everything is high. We have go to get through this winter. We are in quite a perilous state. But with small steps we can prevent a crisis. This is the message we really want to get out.