Investigating changes in mental health services utilisation in England and their impact on health outcomes and wellbeing during the COVID-19 pandemic: Protocol for a health data-linkage study.

INTRODUCTION: Linking routinely collected health care system data records for the same individual across different services and over time has enormous potential for the NHS and its patients. The aims of this data linkage study are to quantify the changes to mental health services utilisation in responses to the COVID-19 pandemic and determine whether these changes were associated with health-related outcomes and wellbeing among people living in the most deprived communities in North East and North Cumbria, England. METHODS AND ANALYSIS: We will assemble a retrospective cohort of people having referred or self-referred to NHS-funded mental health services or Improving Access to Psychological Therapies (IAPT) services between 23rd March 2019 and 22nd March 2020 in the most deprived areas in England. We will link together data from retrospective routinely collected healthcare data including local general practitioner (GP) practice data, Hospital Episode Statistics admitted patient care outpatients, and A&E, Community Services Data Set, Mental Health Services Data Set, and Improving Access to Psychological Therapies Data Set. We will use these linked patient-level data to 1) describe the characteristics of the cohort prior to the lockdown; 2) investigate changes to mental health services utilised between multiple time periods of the COVID-19 lockdown including out of lockdown; 3) explore the relationship between these changes and health outcomes/wellbeing and factors that confound and mediate this relationship among this cohort. STRENGTHS AND LIMITATIONS OF THIS STUDY: This study comprises a deprived population-based cohort of people having referred or self-referred to NHS-funded secondary mental health services or Improving Access to Psychological Therapies (IAPT) services over an extended period of the lockdown in England (2019-2022).This study will utilise a new longitudinal data resource that will link together detailed data from a cohort of individual participants and retrospective administrative data relating to the use of primary, secondary, and community care services.The study period covers pre-lockdown, different lockdown and post-lockdown, and out of lockdown periods up to March 2022.Routinely collected administrative data contain limited contextual information and represent an underestimate of total health outcomes for these individuals.Routinely collected datasets can often been incomplete or contain missing data, which can make it difficult to accurately analyse the data and draw meaningful conclusions.Intervention and treatment for mental health conditions are not wholly captured across these data sources and may impact health outcomes.

An analysis of the COVID-19 vaccination campaigns in France, Israel, Italy and Spain and their impact on health and economic outcomes.

Objectives: This paper presents an overview of the vaccination campaigns in France, Israel, Italy and Spain during the first eleven months from the first COVID-19 vaccine approval (Dec 2020 - Nov 2021). These four countries were chosen as they share similar socioeconomic, and epidemiological profiles and adopted similar vaccination strategies. Methods: A rapid review of available primary data from each country was conducted. Data were collected from official government documents whenever possible, supplemented by information from international databases and local reports. The data were analysed via descriptive and graphical analysis to identify common patterns as well as significant divergences in the structural changes of countries' healthcare systems during the pandemic, outcomes of the vaccination roll-out, and their impact on contextual policies. Results: The four countries adopted similar interventions to protect and strengthen their healthcare systems. The effective coordination between the governance levels, ability to ensure a large supply of doses, and trust towards health authorities were amongst the determinants for more successful vaccination outcomes. The analysis reports a positive impact of the COVID-19 vaccines on epidemiological, political and economic outcomes. We observed some evidence of a negative association between increased vaccine coverage and fatalities and hospitalisation trends. Conclusions: The strengths and weaknesses of COVID-19 pandemic crisis management along with the various strategies surrounding the vaccination roll-out campaigns may yield lessons for policymakers amidst such decisions, including for future pandemics. Lay summary: This paper presents an overview of the vaccination campaigns in France, Israel, Italy and Spain during the first eleven months following approval of the first COVID-19 vaccine (Dec 2020 - Nov 2021). These four countries were chosen as they share similar demographic, socioeconomic, and epidemiological profiles, and adopted similar vaccinations strategies. Effective coordination between governance levels, ability to ensure a large supply of doses, and trust towards health authorities were amongst the determinants for successful outcomes of vaccination campaigns. The strengths and weaknesses of COVID-19 pandemic crisis management, along with the various strategies surrounding the vaccination roll-out campaigns may yield lessons for policymakers amidst such decisions, including for future pandemics.

Elective orthopaedic cancellations due to the COVID-19 pandemic: where are we now, and where are we heading?

AIMS: The primary aim is to estimate the current and potential number of patients on NHS England orthopaedic elective waiting lists by November 2020. The secondary aims are to model recovery strategies; review the deficit of hip and knee arthroplasty from National Joint Registry (NJR) data; and assess the cost of returning to pre-COVID-19 waiting list numbers. METHODS: A model of referral, waiting list, and eventual surgery was created and calibrated using historical data from NHS England (April 2017 to March 2020) and was used to investigate the possible consequences of unmet demand resulting from fewer patients entering the treatment pathway and recovery strategies. NJR data were used to estimate the deficit of hip and knee arthroplasty by August 2020 and NHS tariff costs were used to calculate the financial burden. RESULTS: By November 2020, the elective waiting list in England is predicted to be between 885,286 and 1,028,733. If reduced hospital capacity is factored into the model, returning to full capacity by November, the waiting list could be as large as 1.4 million. With a 30% increase in productivity, it would take 20 months if there was no hidden burden of unreferred patients, and 48 months if there was a hidden burden, to return to pre-COVID-19 waiting list numbers. By August 2020, the estimated deficits of hip and knee arthroplasties from NJR data were 18,298 (44.8%) and 16,567 (38.6%), respectively, compared to the same time period in 2019. The cost to clear this black log would be £198,811,335. CONCLUSION: There will be up to 1.4 million patients on elective orthopaedic waiting lists in England by November 2020, approximate three-times the pre-COVID-19 average. There are various strategies for recovery to return to pre-COVID-19 waiting list numbers reliant on increasing capacity, but these have substantial cost implications. Cite this article: Bone Jt Open 2021;2(2):103-110.

An analysis of the policy responses to the COVID-19 pandemic in France, Belgium, and Canada.

OBJECTIVES: This paper presents an overview and comparative analysis of the epidemiological situation and the policy responses in France, Belgium, and Canada during the early stages of the 2020 Covid-19 pandemic (Feb.-Aug. 2020). These three countries are compared because they represent a spectrum of different governance structures while also being OECD nations that are similar in many other respects. METHODS: A rapid review of primary data from the three countries was conducted. Data was collected from official government documents whenever possible, supplemented by information from international databases and local media reports. The data was then analysed to identify common patterns as well as significant divergences across the three countries, especially in the areas of health policy and technology use. RESULTS: France, Belgium and Canada faced differing epidemiological situations during the Covid-19 pandemic, and the wide variety of policy actions taken appears to be linked to existing governance and healthcare structures. The varying degrees of federalism and regional autonomy across the three countries highlight the different constraints faced by national policy-makers within different governance models. CONCLUSIONS: The actions taken by all three countries appear to have been largely dictated by existing health system capacity, with increasing federalism associated with more fragmented strategies and less coordination across jurisdictions. However, the implications of certain policies related to economic resilience and health system capacity cannot yet be fully evaluated and may even prove to have net negative impacts into the future.