North by North West: ‘Whatever we think the NHS needs’

Back in March, the government promised to give the NHS “whatever it needs” during the coronavirus pandemic – and has essentially met this pledge during the spring and early summer.

Treasury documents published in July suggested £32bn of additional budget headroom was created, which included an astonishing £15bn for personal protective equipment.

But as the crisis dragged on, the budgets were always likely to be guarded a little tighter, with far closer inspection of expenses over the remainder of 2020-21.

No to Seacoles

And in the eyes of those with a hand on purse strings, the NHS doesn’t “need” a massive expansion of rehabilitation beds in time for winter, because they believe this can be delivered in people’s homes or in existing physical facilities.

As reported here previously, in late spring NHS England asked leaders in the North West (and we think other regions too) to prepare plans for a huge expansion of community rehab beds, to be provided in up to around 30 “Seacole-style” units dispersed across the region. It was suggested there would be capital funding available to create new modular buildings or to repurpose existing facilities.

Plans for up to 900 new beds were duly submitted by the three health systems at the end of June, although some local leaders always felt it was about seeing what was possible, as opposed to a definite plan. The tight timelines involved, and lack of any public announcement, only added to the feeling of it being a fishing expedition.

As it turned out, they were right to be dubious. Last week we were reliably told that capital funding was not being offered by government and the plans had been scrapped.

Were they needed?

Several local leaders I spoke to thought the Seacole proposals made perfect sense for patients requiring rehab, but not quite ready to go home. This would free up beds, avoid people with covid being stuck in hospital, and ensure these patients were not sent straight to care homes and risk seeding the virus there.

This cohort of patients being stuck in hospital would represent a nightmare scenario if there was a second covid wave in the middle of winter, alongside a surge in other respiratory cases.

They point out that systems only coped with the initial covid wave by suspending huge amounts of normal activity, which will not be acceptable the same extent a second time around. NHSE’s phase three guidance orders trusts to deliver cancer and elective activity at almost their normal levels in the coming months.

However, others thought a focus on more physical capacity and beds was daft, because an increase in physical capacity means nothing if you haven’t got an increase in staff to match it. Patients can be rehabilitated at home just as well, providing you have those staff, while new technology can increasingly be used to fill some of the gaps.

For many patients this may be true. But if there are significant numbers where a return home is too risky, then it means they’ll be stuck in hospital, with this having a knock-on impact on the crucial issue of patient flow. Many patients are also unable to use some of the new technology that’s being suggested.

Care home solution

A more convincing case is that lots of spare physical capacity already exists, in the shape of empty care home beds. I’m told the care home sector in the North West is only around 80 per cent full currently, which suggests there are more than 10,000 empty beds in care homes that must now be struggling to survive due to the income they’ve lost.

So long as they can be segregated to isolate covid patients – a crucial condition that must be met – couldn’t these beds be used for NHS rehabilitation?

Some areas, including Salford, had actually proposed this instead of a new-build facility on an acute site, although it was still likely to require some capital resource to repurpose two buildings.

It might be that the Salford plans, and others that required only minimal capital, can still be salvaged in some form.