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The next steps for Long COVID Dr Melissa Heightman COVID, NHS England and NHS Improvementonal Specialty Advisor for Long UKPoTS meeting 1.7.2022 NHS England and NHS Improvement ONS data re self-reported long COVID (> 4 weeks): 2 million people in private households in the UK (3.1%) of the population) Estimated prevalence of self-reported long COVID, UK: four-week periods ending 2 May 2021 to 1 May 2022 Composition by impact Composition by time on daily activities since (suspected) infection What proportion of these people would benefit from access to the NHS post COVID pathway? Source: Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 June 2022 The NHS Long Covid Plan 2021/22…. Additional £100 million in 2021/22 and £90million for 2022/3 Invest £30 million in the Invest a further £70 million to Establish 15 Post-COVID rollout of an enhanced expand Long COVID Care coordination to ensure assessment paediatric hubs services to add to the £24 care is joined up and across England in order to service for general practice to prioritised based on clinical coordinate care for children support patients to be million already spent on need. and young people across a managed in primary care, Post-Covid Assessment range of services. where appropriate. Clinics. Extend the use of the Your Collect and publish data to COVID Recovery online support operational Focus on equity of access, rehab platform. performance, and clinical outcomes and experience. and research activities. Support our NHS staff Promote good clinical suffering from Long COVID practice through the national Develop standard rehab pathway packages to treat by offering a package of learning network on Long the commonest symptoms comprehensive support for COVID for healthcare of Long COVID. health and wellbeing professionals. 390 Post-Covid Assessment Clinics 1. East Suffolk and North Essex NHS Foundation Trust 46. Mid Yorkshire Hospitals NHS Trust 2. Essex Partnership University NHS Foundation Trust 47. NHS Bassetlaw CCG 3. Hertfordshire Community NHS Trust 48. North Cumbria Integrated Care NHS Foundation Trust 4. Mid and South Essex NHS Foundation Trust 49. North Tees and Hartlepool NHS Foundation Trust 5. Norfolk Community Health and Care NHS Trust 50. Northumbria Healthcare NHS Foundation Trust 6. Herts Valley (Hemel Hempstead Hospital) 51. Sheffield Teaching Hospitals NHS Foundation Trust 7. Cambridge University Hospital NHS Foundation Trust 52. Rotherham NHS Foundation Trust 8. Norfolk Community Health and Care NHS Trust 53. South Tees Hospital NHS Foundation Trust 9. Barking Havering and Redbridge University Hospitals NHS 54. The Newcastle Upon Tyne Hospitals NHS Foundation Trust Trust 10. Chelsea and Westminster Hospital NHS Trust 55. York Teaching Hospital NHS Foundation Trust 11. Homerton University Hospital NHS Foundation Trust 56. Gateshead Health NHS Foundation Trust 12. Imperial College Healthcare NHS Trust 57. South Tyneside and Sunderland NHS Foundation Trust 13. London North West University Healthcare Trust 58. Mid Yorkshire Hospitals NHS Trust 14. St George’s University Hospitals Foundation Trust 59. Kirklees Local Post COVID Assessment Clinic 15. University College London Hospitals NHS Foundation 60. Doncaster Place Trust 61. Bolton NHS Foundation Trust 16. Croydon Health Services NHS Trust 62. Lancashire and South Cumbria NHS Foundation Trust 17. Epsom and St Helier University Hospitals NHS Trust 63. Liverpool University Hospitals NHS Foundation Trust 18. Kingston Hospital 64. Manchester University NHS Foundation Trust 19. North East London Foundation Trust 65. Salford Royal NHS Foundation Trust 20. King’s College Hospital NHS Foundation Trust 66. Stockport NHS Foundation Trust 21. Guys and St Thomas NHS Foundation Trust 67. Tameside and Glossop Integrated Care NHS 22. East London Foundation Trust Foundation Trust 23. Birmingham Community Healthcare NHS Foundation Trust 68. Wrightington, Wigan and Leigh NHS Foundation Trust 24. Northamptonshire Healthcare NHS Foundation Trust 69. Pennine Acute Hospitals NHS Trust 25. Shropshire Community Health NHS Trust 70. Ashford and St Peter’s Hospital NHS Foundation Trust 26. The Dudley Group NHS Foundation Trust and Central Surrey Health 27. The Royal Wolverhampton NHS Trust 71. Buckinghamshire Healthcare NHS Trust 28. University Hospitals Coventry and Warwickshire NHS Trust 72. East Sussex Healthcare NHS Trust 29. University Hospitals Leicester NHS Trust 73. First Community Health and Care CIC 30. Worcestershire Acute Hospitals NHS Trust 74. Frimley Health NHS Foundation Trust 31. Derbyshire Community Health Services NHS Foundation 75. Oxford University Hospitals NHS Foundation Trust Trust 76. Royal Berkshire NHS Foundation Trust 32. Lincolnshire Community Health Services NHS Trust 77. Royal Surrey County Hospital NHS Foundation Trust 33. South Warwickshire NHS Foundation Trust 78. Surry Downs Health and Care Partnership 34. George Eliot Hospital NHS Trust 79. Sussex Community NHS Foundation Trust 35. Midlands Partnership NHS Foundation Trust 80. Isle of Wight NHS Trust 36. Nottinghamshire Healthcare Trust and Nottingham 81. Solent NHS Trust CityCare Partnership 82. Southern Health NHS Foundation Trust 37. Sandwell and West Birmingham Hospitals NHS Trust 83. Maidstone and Tunbridge Wells NHS Trust 38. Walsall Healthcare NHS Trust 84. Gloucestershire Health and Care NHS Foundation 39. Barnsley Healthcare Federation CIC Trust 40. Bradford Teaching Hospital NHS Foundation Trust 85. Sirona Health and Care 41. Calderdale and Huddersfield NHS Foundation Trust 86. Wiltshire Health and Care 42. County Durham and Darlington NHS Foundation Trust 87. Dorset Healthcare University NHS Foundation Trust 43. Harrogate and District NHS Foundation Trust 88. Livewell South West, including University Hospitals 44. Humber Long COVID Triage and Assessment Service, Plymouth NHS Trust, Royal Devon and Exeter NHS hosted by City Healthcare Partnership, covering Hull Trust, Northern Devon Healthcare NHS Trust, and University Teaching Hospital and North Lincolnshire and Torbay and South Devon NHS Foundation Trust 4 | Goole 89. NHS Somerset CCG 45. Leeds Community Healthcare NHS Trust 90. Royal Cornwall Hospitals NHS TrustChildren and young peoples specialist Post COVID hubs North East and Yorkshire • The Newcastle upon Tyne Hospitals NHS Foundation Trust • South Tees NHS Foundation Trust • Hull University Teaching Hospitals NHS Trust • Leeds Children’s Hospital • Sheffield Children’s NHS Foundation Trust North West • Alder Hey Children’s NHS Foundation Trust • Royal Manchester Children’s Hospital East of England Midlands • Cambridge University Hospitals • Birmingham Women’s and Children’s NHS NHS Foundation Trust Foundation Trust • University Hospitals of Leicester NHS Trust London • London hub led by the Evelina, Imperial, University College London Hospital (UCLH) and South West Great Ormond Street Hospital for Children • Bristol Royal Hospital for Children (GOSH) South East • Solent NHS Foundation Trust • Oxford University Hospitals NHS Foundation Trust 5 |Post COVID services: NCL/UCLH what is commissioned? • Evolved: emergency response to ICS level network for a multisystem condition • Doctor led assessment services: Post COVID generalists • MDT is crucial (physiotherapy, OT, psychology, specialist nursing- and SLT, nutritionists, voluntary sector) • Access to multi-speciality input • Address health inequalities- NHSE registry/ local PH • Codesign/ communication / training to the system • Personalised care, supported self management, integration of physical/ mental health • Integrated pathways with post COVID rehab and community MDT meetings with GP leadership important • No ivory tower- bring the specialist component to the interface • 4000 patients seen since 11/5/20MDT meetings have been essential in NCL -both multi-speciality and community multi-professional • Rapid learning- strengthening the post COVID generalist • Avoid siloed thinking/ missing opportunities to improve treatment • Avoid multiple appointments, multiple waiting lists • Think of opportunities for research, potential mechanisms • Provide efficient support for community Post COVID teams, holistic community based care where possible • Respiratory, Cardiology, Neurology, Endocrinology, Dermatology, Rheumatology..Long Covid Plan for 2022/3 and beyond Emerging Key Themes • Learning from patient outcomes evaluation. What does good look like? 95% of services collect PROMS, 56% use EQ5D%L • Patient experience evaluation- friends and family test, and other research • Improving self management resources (yourcovidrecovery.nhs.uk) • Modelling ongoing need (including impact of omicron, vaccines, latest treatments) • Widening access- proactive case finding, working with vulnerable groups, voluntary sector • Increasing capacity – clinical prioritisation through triage/ innovating in the rehab offer/ coordinating care to reduce multiple appointments/ access to diagnostics. Improve waiting times • Workforce training- e-learning and webinar series in development for post-COVID service clinicians • Requirement to support primary care. Long COVID toolkit • Maximising opportunities to engage with research (STIMULATE- ICP/ LOCAMOTION)Public Health data (Camden &Islington PH for NCL) -Wikum JayatungaNCL: Can a single point of access help? • Consistent approach to triage • Save clinician time • Optimise opportunities for self-management • Direct patient to the right part of the pathway for them • IG governance (record visibility) • Pathway coordination NHS England and NHS Improvement 10Support primary care process | 11What we have been learning… How to match post COVID care to patient need 33 Medically overseen service – generalist with post COVID expertise MDT assessment to deliver therapy prescription. In house psychology. Access diagnostics and pharmacological aspects of treatments if relevant Multi-speciality service- avoid multiple referrals Advice and support to levels 2 and 1 Monitor outcomes across the pathway. Link with research. Personalised care. Share learning/ support training. Consider PIFU options. 2 Therapy-led – community based multi-faceted rehab including vocational rehab Lower Medium High Integrated psychology support Complexity/ Complexity/ Complexity/ Close support from level 3 Group intervention / individual intervention need need need Peer-to-peer learning encouraged Ongoing reassurance and wrap around support to manage lifestyle changes 3 Digital support as an adjunct/ sup[port to ongoing individual /group intervention Careful discharge planning. Share learning/ support training 2 1 Primary care led support and early intervention / support Self-management approach with community-based support Focus on wellbeing conversations 1 Involvement of social prescribers Utilisation of personalised health budgets / voluntary and 3rd sector/ other statutory services (ie Local Authority / DWP / citizen’s advice) |A multi-system approach Identifying treatable componentsAssessment (UCLH) • 30 mins doctor, 30 min therapist, psychologist if needed • Affirm the diagnosis. Pattern recognition • Not everything is long COVID! • ASD, CNS tumours, lung cancer, myositis, sarcoid, thyroid • Evaluate “biomarkers” • Identify treatable components (such as PoTS) • Exercise test/ BP/HR or “active lean” • ECG/CXR/CT/ Echo same day if needed (don’t overuse) • Other diagnostics as per clinical judgement/ MDT discussion (Holters/ walk tests/ MRI imaging) • Define appropriate ongoing support/ need for referral: • Continue to measure progress • Manage the fluctuating aspectRecovery Support (NCL) Multi-faceted Rehab • Fatigue management (activity v rest) • Disordered breathing pattern • Vocational rehab • Physical rehab/ reconditioning/ exercise- personalised • Neurocognitive rehab • Psychology integrated with the model • Personalised integrated coordinated care, coaching Self Management Support • yourcovidrecovery@nhs.net • Digital tools- Living With app • Group solutions/ peer support • How to monitor? C19- YRS, SBQ-LC 15