Joint Statement from Prof Graham Medley and Professor Stephen Powis on hospital admission data

The Daily Telegraph reported on Friday 21 August ‘hospital admissions for COVID inflated‘.

This article was wrong and misleading. It is completely untrue to suggest or imply that there has been any ambiguity in how COVID admissions have been recorded in England.

Throughout the pandemic, hospitals in England have been asked to record for operational and management information purposes whether any patient has tested positive for COVID.

This is of course sensible and responsible. Hospitals need to know who in their service has tested positive. The alternative would be for hospitals not to know which of their patients could be infectious.

It is also inevitable that when dealing with a novel virus pandemic, new evidence emerges which prompts advice to be updated.

This also, is sensible and responsible. The NHS would rightly have been criticised were it not to have updated advice in line with the latest available testing capacity and scientific evidence.

Given the lack of information about the virus, and the understandable absence of a pre-mortem test for COVID-19 at the outset of the pandemic, the definition the NHS used – “a confirmed COVID-19 patient is any patient admitted to trust who has tested positive for COVID-19” – was based on advice from the chief medical officer.

Later, as PCR testing came online, England’s hospitals were able to refine the definition of ‘positive’ patients in its service management information.

This absolutely does not mean that reported data are “inflated” or untrustworthy, but rather reflects the improved understanding of the disease caused by COVID.

Data on hospital admissions, people in hospital with COVID and people on mechanical ventilation in England were published and presented daily at the Downing Street press conferences, along with clear and transparent explanations online, including for example clarification that some admissions in devolved administrations had to be reclassified and included suspected and not just confirmed cases.

Crucially, patients’ care is always determined by each individual’s circumstances; the specific definition does not affect clinicians’ decisions about their patients.

The NHS’ approach has been consistent, transparent and robust throughout, and informed always by the latest available scientific evidence.

Professor Stephen Powis

Stephen Powis is the National Medical Director of NHS England and Professor of Renal Medicine at University College London.

Previously he was Medical Director (and latterly Group Chief Medical Officer) of the Royal Free London NHS Foundation Trust from 2006 to 2018. Professor Powis was also a member of the governing body of Merton Clinical Commissioning Group for five years and a Director of Healthcare Services Laboratories LLP.

He is a past Chairman of the Association of UK Universities (AUKUH) Medical Directors Group and has been a member of numerous national committees and working groups, including the Department of Health Strategic Education Funding Expert Group. He is a past non-executive director of the North Middlesex University Hospital NHS Trust, including a period of eight months as acting chairman.

He is a past chairman of the Joint Royal Colleges of Physicians Training Board (JRCPTB) Specialty Advisory Committee (SAC) for Renal Medicine and a former board member of Medical Education England. He was Director of Postgraduate Medical and Dental Education for UCLPartners from 2010-13. He is a past treasurer and trustee of the British Transplantation Society and a former member of the UK Transplant Kidney Pancreas Advisory Group.

He has also served as a member of the Renal Association Executive Committee. He was Editor of the journal Nephron Clinical Practice from 2003 to 2008. In 2017 he became the inaugural Editor-in-Chief of the journal BMJ Leader. He has been a trustee of several charities, including the Royal Free Charity and the Healthcare Management Trust.

Professor Graham Medley is Professor of Infectious Disease Modelling at the London School of Hygiene and Tropical Medicine.

He joined the London School of Hygiene and Tropical Medicine in April 2015. He is a member of the Neglected Tropical Disease Modelling Consortium and the SPEAK India Consortium, and is currently the director of CMMID.

Graham’s overall interest is the transmission dynamics of infectious disease, and he has published on many different pathogens and hosts. He is particularly interested in understanding how interventions are and should be designed to control infectious disease, and how models relate to policy development. The interaction of transmission with societal and political processes is of particular interest to me, and the focus of my work on HIV/AIDS.

He is on the Board of Reviewing Editors for Science, on an expert group in the Infected Blood Inquiry, and chair of SPI-M, and currently attending SAGE as part of the UK COVID-19 response.