Covid: What is the difference between NHS and government alert levels?

NHS system is based on centrally-agreed list of definitions, whereas government’s system has five stages based on variety of factors

After a sharp rise in omicron cases, and the expansion of the UK’s booster jab programme, the NHS announced it had raised its Covid-19 alert category to level 4 on Monday.

The government has also raised its alert level, from level 3 to level 4, after recommendations from NHS England and the chief medical officers.

So, what is the difference? The NHS uses a system called Operations Pressure Escalation Levels. Opel 4, or what is sometimes referred to as a “black alert”, is the most severe. This differs from the UK government’s system, which has five stages.

NHS England classes Opel 4 as a “serious incident”, which means services are currently under severe pressure.

The health secretary, Sajid Javid, told MPs that the NHS moving to Opel 4 means their “response to omicron will be coordinated as a national effort rather than led by individual trusts”.

The Opel framework was introduced in October 2016 and adopted by hospitals across England.

Whilst it is rare for a hospital to declare an Opel 4 situation, some have done so this year, with Barnsley Hospital in South Yorkshire reaching that point in June 2021, and York and Scarborough Teaching Hospitals NHS Foundation Trust moving to Opel 4 late last week.

The last time NHS England was placed on Opel 4 was in November 2020, when it was announced by former chief executive Sir Simon Stevens.

The Opel framework is based on a centrally-agreed set of definitions and guidelines for NHS Trusts to follow when they are under pressure. Opel 4 is usually declared if bed capacity is reached, or if there are severe handover delays meaning ambulances are unable to unload patients.

Opel 4 can also be declared if there are significant staffing issues due to sickness or severe weather conditions.

A full list of the levels can be found below:

·       Opel 1: The health and social care system is able to “maintain patient flow” and can meet “anticipated demand within available resources”

·       Opel 2: The system is starting to “show signs of pressure”

·       Opel 3: The system is experiencing “major pressures compromising patient flow and continues to increase”

·       Opel 4: The system is “unable to deliver comprehensive care. There is increased potential for patient care and safety to be compromised.

The UK government’s alert level system for Covid-19 is different. It has five stages, all of which can be found below:

·       Level 1: Covid-19 is not known to be present in the UK

·       Level 2: Covid-19 is present in UK, but the number of cases and transmission is low

·       Level 3: a Covid-19 epidemic is in general circulation

·       Level 4: a Covid-19 epidemic is in general circulation; transmission is high and direct Covid-19 pressure on healthcare services is widespread and substantial or rising

·       Level 5: as level 4 and there is a material risk of healthcare services being directly overwhelmed by Covid-19

The UK Health Security Agency provides advice to the UK chief medical officers (CMOs), who then advise ministers on the UK’s Covid-19 alert level. The methodology was developed after a consultation with national public health experts, reviewed by the Scientific Advisory Group for Emergencies (SAGE).

Whilst the methodology will continue to evolve, as it stands, the UKHSA’s approach is based on moving between levels, rather than the criteria which defines each level. Their approach aims to blend expert judgement and risk assessment.

The UK Covid-19 alert level focusses on data that relates to the impact of Covid-19. However, if the alert level moves from level 4 to level 5, this is based on the consideration of source pressures and informs the likelihood of healthcare services being overwhelmed.

Both the NHS and the UK government have increased their alert levels in response to the rise in Covid-19 cases, and the growing threat of the new omicron variant.

To combat this, the UK has now expanded its booster programme to everyone over the age of 18, introduced mandatory pre-arrival testing for travellers coming from countries not on the red list, and also advised daily lateral flow tests for those with two vaccine jabs who come into contact with a known Covid-19 case, amongst other measures.