Recommendation 3

Huge local variation strongly suggests that GPs were inconsistent when judging who was clinically extremely vulnerable and should therefore be advised to shield and be eligible for support. As well as NHS Digital using national data to identify clinically vulnerable people, GPs and hospital doctors were quite sensibly asked to review those listed, and, using their clinical judgement, add or remove people. The 6 Covid 19: supporting the vulnerable during lockdown list grew from 1.3 million to 2.2 million largely as a result of GPs adding people. However, the extent to which it grew varied hugely in different areas, with increases in those being added between 12 April and 15 May ranging from 15% to 352% by local authority. DHSC acknowledges that clinicians took different approaches to adding people. DHSC and NHS Digital believe they did everything possible to ensure consistency, where they identified possible over-inclusion or over-exclusion, they have worked with NHS England’s clinical directors to challenge some of the differences. DHSC tells us that NHSE&I and NHS Digital consider that ultimately additions were a decision for local clinicians. DHSC has also provided us with details of NHS Digital’s analysis of the variation as of 11 February 2021. Based on this analysis, DHSC concludes that the level of variation in how local clinicians added people to the list is acceptable. However, and despite the best intentions of all involved, it is not credible to assert that the same criteria and judgements were applied consistently in all parts of the country when the extent of local variation in numbers added was so vast. Recommendation: Within six months, DHSC and NHS Digital should provide to the Committee a detailed explanation for the local variation in growth for the shielded patient list between April and May 2020 including the extent it was due to appropriate clinical judgements and identify lessons for how to support a consistent clinical approach in future.