The must-read stories and debate in health policy and leadership.
Confirmed covid cases in the community fell again on Tuesday, offering further hope that the current wave could have peaked. Most experts are highly cautious about saying so – there is likely to be further growth following ‘freedom day’.
Meanwhile for the NHS, covid admissions continue to rise, as does the number of people in beds with covid, and the share of beds occupied by covid – a crunch indicator for the service, having a big impact on hospitals’ ability to keep the wheels on, and whether they need to cancel elective care, for example.
We revealed on Monday evening that, as of that morning, eight hospital trusts had hit the point where one in 10 of their beds is occupied by a patient with coronavirus — a point at which it is going to get very difficult.
These are not necessarily the hospitals with the most covid patients. At smaller hospitals, growing covid admissions can be quick to make a big dent in limited capacity, especially in the very small intensive care units which are available. There is less flex for redeployment of staff.
The North East is under particular pressure, as are parts of Yorkshire. Among those who had hit 10 per cent were the Queen Elizabeth Hospital, Gateshead, South Tyneside and Sunderland Foundation Trust, North Tees and Hartlepool FT, Barnsley Hospital, and the Rotherham FT.
Many in that region and elsewhere will be quick to point out that covid is far from all they are dealing with. Emergency attendances are high – higher than a normal summer – and emergency admissions not much lower. There is a lot of paediatric demand, which complicates things further. There is pressure not to cancel planned care, and a lot of staff are either isolating or on holiday.
Let’s hope covid has genuinely hit its ‘summer peak’, and that autumn brings some relief.
The new health and care bill is the latest attempt to improve the interface between the NHS and local government, which are too often out of sync.
But the gulf between the two sides looks too wide to bridge in some systems, at least in the short term.
In the large and unwieldy Cheshire and Merseyside Integrated Care System, the nine local authorities have issued a series of “red lines” and pre-conditions to health service leaders, which they say must be met for the system to be successful.
There have already been tensions between the sides in recent months, so the move has inevitably been interpreted as a threat to refuse to work with the ICS, if the demands are not met.
A version of the document, titled Red Lines for the Cheshire and Merseyside ICS, has been published in the meeting papers for Knowsley Council’s health and wellbeing board.
Among the list of “pre-conditions” are that NHS spending in each of the nine boroughs should be “determined in partnership with local government”; and there should be “strengthened partnerships” between councils and primary care, to form what is described as “care communities”.
Several senior NHS leaders, speaking on the condition of anonymity, said the document was unhelpful and would only raise tensions further.
One said: “I find it amazing they have taken the time to write this. It feels confrontational and like a land grab, particularly with primary care.
“Why didn’t they write one about their green lines and lay out their aspiration to cooperate?”