The Primer provides a rapid guide to the most interesting comment and analysis on the English health and care sector that has not (usually) appeared in HSJ.

After a nail-biting December awaiting the full extent of the damage caused by omicron, there are signs that 2022 may get off to a better start than 2021.

Yes, the military is being drafted in again to help over-stretched parts of London’s NHS, but the capital’s omicron outbreak has most likely peaked – according to a senior chief.

Kevin Fenton, regional director for London at the UK Health Security Agency, yesterday said the number of covid cases are falling in the capital, and suggested the peak may have occurred last week.

He told Sky News: “Data from the Office for National Statistics suggests that the peak may have occurred at or just about the new year period and we’re seeing reductions in overall case rates across the city and the prevalence of infections within the community.”

London is generally accepted to be a few weeks ahead of the rest of the country for infection rates and hospital admission. While case rates are higher this time in the north of the country, the emerging picture of falling numbers in London offer some cause for hope at the start of the year.

When is the NHS overwhelmed?

Predictably, the age-old debate about to what extent the NHS is – or will be – “overwhelmed” is back as the public grapples with covid restrictions that fall short for some and go too far for others.

It is worth remembering that warnings of the NHS being overwhelmed during winter has become an annual tradition, but the pandemic has shifted the goalposts.

The Tories are batting away suggestions this is the worst winter the NHS has faced, with former vaccines minister Nadhim Zahawi yesterday telling the BBC the number of trusts declaring critical incidents is similar to 2017-18.

Writing in the Guardian, Polly Toynbee on the other hand argues that the NHS has already passed the point of being overwhelmed and that today’s situation is the “new normal” in the words of an anonymous medical director quoted in her piece.

Her conclusion is that the NHS is “coping” (a word Tory ministers would approve of), but only in a way that actually amounts to a rationing of care which is far more cruel than most people would accept.

Pritchard’s perspective

Whichever side of the debate you stand, numbers of covid hospitalisations — and particularly intensive care admissions and deaths — do look better now than 12 months ago.

But NHS England chief executive Amanda Pritchard believes the next few weeks could be the “steepest” faced by the NHS throughout the pandemic.

During a visit to London’s King’s College Hospital on Friday, Ms Pritchard warned that another fortnight’s worth of covid patients are “baked in” following record levels of infection over the Christmas and New Year period.

She added: “The only unknown is what level we will see and, of course, we will hope that the more optimistic forecasts are going to be the right ones.”

Fears over un-jabbed staff

Speaking of King’s College Hospital, its CEO - Clive Kay - on Sunday morning articulated in stark terms what the impending mandating of the covid vaccination could mean for his trust.

Professor Kay acknowledged the trust stands to lose 1,000 or more staff (around 10 per cent are so far not vaccinated). The jab becomes mandatory in April for patient-facing and other NHS professionals, although the cut-off to have a first dose is in early February, only a matter of a few weeks away.

This is a worst-case scenario, but there will likely remain a significant number of unvaccinated staff who may not accept or be eligible for redeployment, which is causing NHS managers considerable headaches and concern.

Professor Kay emphasised the importance of treating unvaccinated staff with “kindness and compassion” and said it was vital that they are given “every single opportunity to talk through if they don’t want the vaccine, if they’d like to talk, if they need any help or clarification”.

For some staff however, it may not even be the jab which makes them leave the NHS.

Professor Kay also predicted some doctors will leave due to the unprecedented experiences they have been forced to endure in the last two years.

He added: “Some of the things they have seen and experienced and the things they’ve had to go through, I think will last a very, very long time, if not forever. I do fear that some of them will decide that, actually, they don’t want to stay.”