Exclusive: U-turn on mass expansion of covid care units as no funding available

In late May, NHS England announced the “first” Seacole Centre in Surrey, for patients recovering from coronavirus, and asked other local systems to draw up proposals for similar units ahead of a possible second peak of the virus over winter.

The policy was designed to provide significant extra bed capacity to help get covid and other respiratory patients out of hospital more quickly, while offering effective rehab care.

In the North West region, for example, leaders were asked to draw up proposals for up to 900 recovery beds dispersed across multiple localities, to replace the largely unused and “unsuitable” Nightingale facility in central Manchester. It was suggested capital funding was available to build new modular units, or to repurpose existing buildings.

But multiple well-placed sources have now told HSJ that capital bids for new Seacole units have been rejected.

In a statement, NHSE said: “Work with local NHS and social care providers suggests that these expanded rehab services can largely be provided in existing physical facilities as well as people’s own homes, so government has not allocated extra capital in year for this purpose.”

However, local leaders told HSJ that some of the plans to use “existing physical facilities” still required some capital funding to make them suitable for rehab care. One trust executive in the North West said: “If there’s no capital it means we can’t go ahead.”

Another senior NHS source in the region said: “These new units made absolute sense with our A&E issues every winter, social care even more fragile than usual, and covid coming on top.

“But they’ve done a complete one-eighty [degree turn] now. It’s wasted loads of effort, planning and thinking, with no plan B. The Nightingales won’t work if that’s the thinking.”

Other local sources suggested there is potential to use care home capacity instead, as many care home beds are currently empty. However, it is unclear to what extent this is being pursued.

The Department of Health and Social Care declined to comment.

The NHSE statement added that £500m of additional revenue funding for rehabilitation services had now been confirmed by the government for the rest of 2020-21, which it said was “available as part of enhanced hospital discharge, as originally planned”.

This is expected to pay for care for up to six weeks after hospital discharge, not limited to covid patients, and for some other schemes; but falls well short of what the NHS requested from government, HSJ understands.

Ruth Ten Hove, director at the Chartered Society of Physiotherapy, said: “The message we have been given is that people can now do their rehab online (through a new NHS website). We were involved in the website and it can get good outcomes. But it’s not for everyone and using that alone will widen health inequalities and digital exclusion.”

The website currently offers self-management rehab programmes, but will be expanded in September to allow patients to create guided rehab programmes with input from a health professional.

The CSP said it expects to see increased need for rehabilitation in four areas: people recovering from covid, deconditioned shielders, people with long-term conditions who have deteriorated, and people waiting for surgery such as hip and knee replacements, whose condition is worsening.

Last week’s phase three system guidance from NHS England said: “Community health services crisis responsiveness should be enhanced in line with the goals set out in the long-term plan, and should continue to support patients who have recovered from the acute phase of covid but need ongoing rehabilitation and other community health services.”

It did not mention the increased need of rehabilitation for those who do not have covid.

Kamini Gadhok, chief executive of the Royal College of Speech and Language Therapists, said: “NHS England hasn’t approached us about what a local rehabilitation pathway should look like. This is a concern as the needs of patients are significant – with some having cognitive problems and difficulties with communication as well as with eating, drinking and swallowing due to long-term ventilation and sedation.

“Our members have told us that some patients have been discharged from hospital without follow-up appointments in place, and others, who do not have English as their first language, often don’t respond to follow-up calls when they return to the community.”