Shielding list to add extra people

I don't think the list of clinically extremely vulnerable has changed much in a year:

"People with the following conditions are automatically deemed clinically extremely vulnerable:

-solid organ transplant recipients
-people with specific cancers
-people with cancer who are undergoing active chemotherapy
-people with lung cancer who are undergoing radical radiotherapy
-people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
-people having immunotherapy or other continuing antibody treatments for cancer
-people having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
-people who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppression drugs
-people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
-people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)
-people on immunosuppression therapies sufficient to significantly increase risk of infection
-problems with your spleen, for example splenectomy (having your spleen removed)
-adults with Down’s syndrome
-adults on dialysis or with chronic kidney disease (stage 5)
women who are pregnant with significant heart disease, congenital or acquired
-other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs. GPs and hospital clinicians have been provided with guidance to support these decisions,

People with heart problems were never considered to be clinically extremely vulnerable, unless there were other issues.

At the start, it was considered to be mainly a disease of the respiratory system and the damage done to other organs was not really recognised.

Iam64

Marydoll, mumsnet has a lively thread on the issue. Radio 2 had a phone in, none of the women who had been asked to shield had diabetes after their pregnancy. For one, the pregnancy was 10 years ago. It may be the algorithm adds other issues, eg living in a deprived area. One of the callers lived in a wealthy area, 4 years since pregnancy. It does seem odd.

I had gestational diabetes and developed full-blown T2 diabetes less than a year later. It's a known risk factor, but not the only one. I wasn't overweight and was fit and ate healthily. It was a puzzle why I developed it.

It could be that if these women have no other risk factors, there's an error in the codes on their NHS records.

I used the algorithm and a tool to calculate my own risk. I ended up with a score of 88, which means only 12% of people are more likely to die if they're infected but isn't high enough to put me in the shielding group. I posted the link, but can't find it now.

I've never completely understood the basis on which the original shielding list was drawn up. One friend who has had illnesses but doesn't have any chronic conditions was told to shield right at the start. My DH has a chronic heart problem but was never told to shield, though we actually decided to do it ourselves. Yet DH did get a relatively early vaccination and I was offered one too.
From a cynical point of view I have to ask if the high number of people from ethnic groups working for the NHS has caused the delay in them being asked to shield.
A friend's DIL (from an ethnic background) was very worried about going back to her work as an NHS consultant after maternity leave but also worried about her highly skilled job in a prestigious medical unit. Presumably if an employee is asked to shield their job must be protected?

I’d thought the same Marydoll about updating of records. In the same way the various NHS records won’t show where we work, they won’t know if we’ve lost (or gained)2 stone over lockdown unless it’s been recorded in our notes. Occasionally there will be an error but if we think there is then we can contact the doctor. Like you I feel better understanding all the ins and outs of decisions. I think what needs to be better communicated in general is issues around prediction, risk and probability. Models like this can make predictions which are true across a group of people but cannot possibly be 100% true for each individual.

Marydoll, mumsnet has a lively thread on the issue. Radio 2 had a phone in, none of the women who had been asked to shield had diabetes after their pregnancy. For one, the pregnancy was 10 years ago. It may be the algorithm adds other issues, eg living in a deprived area. One of the callers lived in a wealthy area, 4 years since pregnancy. It does seem odd.

suziewoozie, thank you for that link.
I had been pestering my RA consultant for months during lockdown, as to how high a risk I am. He was never precise, just saying you will not survive it and won't be resucitated!

The link clarified things, so thank you. I always need an explanation and all the in and outs of my treatment and conditions.
However, as I fulfil at least five of the criteria for shielding, I'm surprised that I'm still here! ? The one thing I don't have is diabetes!

I had a Tesco delivery on Friday and the driver, with very mild asthma, had been five weeks in hospital with the virus. Initially, he thought he was having an asthma attack.
Also, he said he thought he would die. It serves to show that no-one can predict the effect on people.

I wonder if the lady with previous gestational diabetes, may need her medical record updated, if she no longer has diabetes. It may be worth contacting her GP for advice.

So gestational diabetes is a subset of T2 diabetes. However, having any kind of diabetes does not mean a person is automatically on the new shielders list. The whole point of the model is that it combines as many known relevant facts about the person and comes up with a predicted risk. So for example, dh is white, not overweight, not living in area of high deprivation, so despite T1 diabetes, is not a new shielder. Hence not all women who’ve had GD will be on the list, it will depend on the combination of all relevant factors a particular woman has.

If anyone is interested, here’s the research which produced the risk prediction algorithm. Obviously there are limits to how it is individualised - it’s a public health tool. So for example, it doesn’t take into account where you work, but where you live. I think it’s a very impressive piece of work. I hadn’t heard about gestational diabetes being factored in - I’ll look at that.

www.bmj.com/content/371/bmj.m3731

I’ve been hearing about the Gestational Diabetes issue. I had it ten years ago and have subsequently been diagnosed with Diabetes and am not overweight - but I haven’t received the notification. I do live in an affluent area though and we have had very few cases - despite us being in Tier 4 prior to this lockdown.

There have been questions regarding the accuracy of the algorithm. I’m currently working from home but spent four months last year working in an environment where many people contracted Covid, in a town which had very high rates. To be honest, I’m not too keen on returning but I don’t really have much of a choice.

I was surprised to hear yesterday that women who were diagnosed with gestational diabetes are to be advised to shield. One woman was diagnosed 10 years ago when pregnant with BMI of 30. Ten years on her BMI is 23 and she’s training for a marathon. Her blood sugars are normal. One of my loved ones is in similar situation.
How can young women who have worked throughout the pandemic, suddenly be told to shield. If their sugar levels have been normal since the end of the pregnancy (years ago) how realistic is it to recommend and expect shielding. Mumsnet is WTF about this

I have had a phone call from my doctor’s surgery today inviting me for my vaccination on Thursday. I am thrilled. I think, maybe, they have been prioritising some people, like me, after reassessing their medical history. As I said earlier, l am a lifelong asthmatic and I have been so very careful this year. I feel as if l have won a gold medal.

susytish

If you are in this category and have had covid and first vaccination, does this extra time apply to you?

Yes

If you are in this category and have had covid and first vaccination, does this extra time apply to you?

Thanks to suzie and growstuff - and any others who have given factual information on this subject.
Otherwise so many unknowns and rumour-spreading.

It seems shielding has been a blunt instrument. Better than no official shielding though.

It shows Growstuff!

Not medical or scientific, but I have been (and still am sometimes) a serious historical researcher. Many years ago, I had plans to be a journalist.

Very informative Growstuff thanks. A few of you on here are very helpful and thorough with their links and explanations. Do you have a medical/scientific/research background? I’m impressed!

Why it might be worth checking what details the NHS holds about you:

www.liverpoolecho.co.uk/news/liverpool-news/invited-covid-vaccine-because-nhs-19857990

suziewoozie

OnwardandUpward

The whole article is very unclear.

I would like to know what "poor neighbourhood's" mean and how a Dr is supposed to know the financial state of their patients in order to send out these letters?

Also, if "poor" or low status workers cant work, who will do the essential jobs? It sounds like Tory fudging. I cant see how they will enforce it.

It’s done on post codes and GPS have your post code. Using post codes to identify areas of deprivation is used widely for all sorts of purposes within government.

There is also a strong correlation between high incidence rates and areas of deprivation, so somebody in a "poor" area is more likely to be infected from community transmission. The NHS doesn't have data on what kind of housing people live in, but it can work out whether people are more likely to live in overcrowded housing just from the postcode. On its own, that wouldn't be enough to place somebody on the SPL. I think age is still the most important factor. It's more about offering people additional support rather than locking them up.

The algorithm used to decide which people should be on the list is quite complicated. The complete list of criteria is available in the public domain, but without the computer software to calculate the data, it's difficult to use.

If people are concerned that they should be on the list or don't want to be on the list, they should read this:

Managing my entry on the SPL

If you think you should be added to the SPL you should speak to your GP. They will be able to discuss your circumstances with you and, if appropriate, add you to the SPL.

You can also request to be removed from the SPL by asking your GP. They will add a low or moderate flag (note) to your record and you will be removed from the SPL within a short period of time (up to two weeks).

digital.nhs.uk/coronavirus/shielded-patient-list/shielded-patient-list-transparency-notice#managing-my-entry-on-the-spl

It has been calculated that the majority of people who have died from Covid-19 would be classified as in the most vulnerable 2%, according to the algorithm.

The list is being doubled to include approximately the most vulnerable 4%. People are advised to take extra precautions by shielding themselves and are being offered extra support, but aren't being forced to do anything which everybody else isn't doing.

Blinko

growstuff

Blinko I tried all of them last year. Pharmacy4U don't deliver to my area.

It's something to do with my GP practice not being signed up for some digital service or other. I spoke to the practice manager about it. Apparently, they're trying to save their own onsite pharmacy and are worried that if people signed up for home deliveries, they'd have to shut, which means that the people living in the sticks (it's a semi-rural practice) wouldn't be able to get prescriptions made up at the same time as they have appointments.

Sorry to hear that, Grow . What a pain it all is!

In practice, it really isn't such a pain. If I were forced to self-isolate, I know there are people who would pick my medication up. The individual pharmacies would offer their own delivery service too, if I were on the SPL and the GP requested it.

I was bemused more than anything at how Neanderthal my GP practice's system still is. It relies on somebody from the pharmacy walking about a mile (both ways) to pick up paper prescriptions, when it could all be done digitally. I order online, but after that, everything goes to paper. When I pick up my prescriptions, it's been mislaid maybe 1 in 4 times. The pharmacist then has to wade through a huge pile of prescription forms.

When this all kicked off, I was determined to organise everything as efficiently as possible, requiring the absolute minimum of personal contact. I'd seen all the ads for home delivery of medications, so thought it would be easy to arrange, but it isn't. I suppose I should be grateful that my GP practice wants to keep it all within the NHS, but it's one example of where the private sector could provide something more efficiently and provide patients with a better service.

For many of us who have been shielding for the last year, it has been impossible to have medication delivered. I live in a large town, so no excuse. I have ask family to get it.
However, if you need help, there is number where you can phone your local council for help. They can arrange volunteers.
The number is: 0800 111 4000

growstuff

Blinko I tried all of them last year. Pharmacy4U don't deliver to my area.

It's something to do with my GP practice not being signed up for some digital service or other. I spoke to the practice manager about it. Apparently, they're trying to save their own onsite pharmacy and are worried that if people signed up for home deliveries, they'd have to shut, which means that the people living in the sticks (it's a semi-rural practice) wouldn't be able to get prescriptions made up at the same time as they have appointments.

Sorry to hear that, Grow . What a pain it all is!

I’m not sure, to be honest. I have Flutiform.