The must-read stories and debate in health policy and leadership.

Configuring for coronavirus

A potentially long moratorium on electives; cancelling face-to-face outpatients; a new largely remote/digital “home treatment” service; widespread repurposing of clinical space; rapid retraining and redeployment of staff; driving down admission thresholds; and a hard line on discharge out of hospital… we could go on.

Across the board, coronavirus is profoundly re-shaping the way services are provided and it’s likely to have significant longer-term implications too.

We are beginning to see the shape of what chief medical officer Professor Chris Whitty has described as having “to reconfigure the NHS quite profoundly”.

More on that another day.

But focusing in on one immediate example, on Thursday we revealed the NHS has begun planning for the potential suspension of all non-emergency elective procedures, which could last for several months.  

Senior sources told HSJ NHS England had asked trusts to risk stratify elective patients in readiness for having to suspend non-emergency work to free up capacity.

HSJ understands trusts have been told to firm up plans for how they would incrementally reduce and potentially suspend non-emergency operations, while also protecting “life saving” procedures such as cancer treatment.

Leading waiting list expert Rob Findlay told HSJ the overall elective list, which at present is around 4.6 million, would likely further deteriorate, but the hardest impact would be felt by the longest waiters.

He said: “It will certainly accelerate the already deteriorating position on 18-week waits, but the effect may be most striking in the rise in 52-week waiters.

“This is because these patients tend to be in the heaviest case mix, like the more serious end of orthopaedics, plastic surgery, or neurosurgery, which require in-patient procedures, rather than day cases.

“This means those patients who are already suffering the most extreme long waits are likely to be most impacted by any suspensions.”