ABSTRACT
Introduction The Joint Advisory Group (JAG) on Gastrointestinal (GI) Endoscopy biennial census provides an insight into the provision of UK endoscopy services. We report on the 2021 census which was conducted to understand the impact of COVID-19 and ongoing pressures on endoscopy services. Methods The census was disseminated to all JAG-registered services in April 2021 using an online survey platform. Prior to analysis, any missing data from services was sought as part of a second step verification process. Data were analysed across the domains of endoscopic activity, waiting time targets, workforce, COVID-19, safety, GI bleeding, anaesthetic support, equipment and decontamination. Outcome variables from each section of the census were analysed against independent variables derived from service-specific core demographic data (JAG accreditation status, sector and region) using a variety of statistical methods. Results Overall, 321 services completed the census, with information pertaining to 393 individual units (response rate 79.2%). In 2020, just over 1.5 million endoscopic procedures were performed across all services. In the first 3 months of 2021, 66% of services met urgent cancer waits, 38.7% met routine waits and 33.9% met surveillance waits (Figure 1). Workforce redeployment was the predominant reason cited for not meeting targets. There were significant regional differences in the proportion of patients waiting 6 or more weeks (p = 0.001). During the pandemic, 64.8% of NHS services had staff redeployed and there was a mean sickness rate of 8.5% with no clear variation across sectors or regionally. Endoscopic activity was outsourced to the private sector in 21.6% of services. Services were, on average, at 79.3% activity compared to 2 years ago. JAG accredited services are more likely to meet urgent cancer waits, with a lower proportion of patients waiting 6 weeks or more (p = 0.03). Clinical endoscopists, who make up 11% of the endoscopist workforce, have a significantly greater number of annual planned sessions per individual than consultant colleagues, who make up 75% of the workforce. Over 10% of services stated that equipment shortage interferes with service delivery. Conclusions Services are adapting to continued pressure and there are signs of a focussed response to demand during a time of ongoing uncertainty. These findings will inform ongoing guidance from JAG and relevant stakeholders.
ABSTRACT
The Covid-19 mortality rate varies between countries and over time but the extent to which this is explained by the underlying risk in those infected is unclear. Using data on all adults in England with a positive Covid-19 test between 1st October 2020 and 30th April 2021 linked to clinical records, we examined trends and risk factors for hospital admission and mortality. Of 2,311,282 people included in the study, 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days of a positive Covid-19 test. We found significant variation in the case hospitalisation and mortality risk over time, which remained after accounting for the underlying risk of those infected. Older age groups, males, those resident in areas of greater socioeconomic deprivation, and those with obesity had higher odds of admission and death. People with severe mental illness and learning disability had the highest odds of admission and death. Our findings highlight both the role of external factors in Covid-19 admission and mortality risk and the need for more proactive care in the most vulnerable groups.