Agenda item

This paper provides a summary of the Post-Covid Syndrome Clinic at University College London Hospital (UCLH).

Dr Melissa Heightman, Clinical Lead for the Covid follow up Service and NCL representative for the London Respiratory Network, introduced the item. She explained that that a clinic was started to meet patient need in May 2020 when it transpired that patients going home from the Accident & Emergency department (A&E) were having difficulties related to Covid-19; this was followed by similar reports about the long term effects of Covid-19 from the community through GPs. It was noted that University College London Hospital (UCLH) was named as the key provider for the post-Covid assessment service. It was stated that there had been over 1,000 appointments in the assessment clinic for around 800 people and that half of these people had been referred from outside NCL as there was a national shortage in this area. It was explained that the clinic had a multi-specialty team and tried to offer a ‘one stop shop’ for patients, covering respiratory, cardiology, neurology, and therapies assessments. It was added that clinicians tried to follow a clinical line of questioning but that there was a huge amount of information missing in this area and treatments were not guaranteed to be effective. It was highlighted that the team was working to develop an integrated care pathway for patients but that evaluation was required in relation to how to assess someone in primary care, when to make a referral, how to investigate, and the correct forms of rehabilitation.

The Chair noted that some patients had expressed concerns that they had been referred to other specialists but had not been given access to the post-Covid syndrome service. It was enquired whether people should specifically ask for a referral. Dr Melissa Heightman noted that people should talk with their GP about their symptoms. There was increasing awareness of the service amongst GPs and there was a process to follow with screening questionnaires and initial tests. It was explained that GPs would then decide the best course of action for the patient; this could involve the post-Covid syndrome service or another course of action.

Cllr Smith enquired about the numbers of post-Covid syndrome for Black, Asian, and Minority Ethnic communities who had been disproportionally impacted by Covid-19. Dr Melissa Heightman noted that there was an excess of white, British people in the patients referred and it was not certain whether this reflected the nature of post-Covid syndrome or whether this related to health inequality. It was explained that, on average, 34% of post-Covid syndrome patients were from Black, Asian, and Minority Ethnic backgrounds. However, in one cohort of patients that had been proactively contacted after leaving A&E, 47% of people were from Black, Asian, and Minority Ethnic backgrounds.

Cllr Das Neves enquired whether the post-Covid service had sufficient capacity for demand and whether GPs were sufficiently aware that they could make referrals. Dr Melissa Heightman noted that some communications work was required but that the London pathway needed to be confirmed beforehand to ensure that there was a clear process. In relation to capacity, it was explained that there were three clinics per week and this was generally undertaken in additional to other work; there were some digital solutions but the service was waiting for funding to become available in order to be more sustainable. It was noted that treatment was currently delivered by the therapies team and there were concerns about capacity within this team. It was noted that the waiting time was currently six weeks but that information could be sent to patients as soon as their referrals were received. It was added that increased referrals were expected, as people from the second wave of transmission recovered, and there were concerns about capacity.

Cllr Smith enquired whether the scale of post-Covid syndrome was known. Dr Melissa Heightman noted that post-Covid syndrome was more prominent in community cases rather than hospital cases. The ZOE app, which was tracing data relating to community cases, suggested that 2% of people were experiencing post-Covid syndrome symptoms. It was noted that, based on referral rates, using GPs as a guide, it was anticipated that 4,000 people in NCL were experiencing post-Covid syndrome but it had been suggested that this could be 8,000. It was noted that it was challenging to design services when the extent of the issue was unknown.

Cllr Das Neves noted that some patients were referred to other services who were not aware of post-Covid syndrome; it was enquired whether sufficient information was being provided to other services to ensure satisfactory patient care. Dr Melissa Heightman stated that there was a need for communications about the developing pathways and services. It was noted that every Trust had a Covid follow up clinic for its hospital discharge patients that should be acting as a spokesperson for the post-Covid syndrome service. However, it was acknowledged that the health service was struggling with capacity and this was a new outpatient demand; it was noted that the process for this pathway was being planned but was not yet perfected.

The Chair stated that this report had been very informative and that it would be useful for the Committee to receive further information about the communications for the post-Covid syndrome service, particularly how GP practices and clinicians in other settings were getting these communications and how they would be disseminated to the public, especially in areas where there were high levels of deprivation. It was added it would also be helpful for the Committee to receive information on funding for the therapies teams. In addition, the Chair requested an overview of the London pathway for post-Covid syndrome, even if this was in draft form, so that the Committee could consider the strategies, concerns, and risks.

RESOLVED

1.    To note the report.

2.    To receive a report on the post-Covid syndrome pathway in London, including information about communications and funding for the therapies teams.