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

Risk assessment ongoing

NHS England initially recommended covid risk assessments for all BAME staff as long ago as April which, although too late to help many, was at least a fairly rapid response to the emerging evidence about some racial and ethnic groups seeing greater infection and mortality, and came while cases were still running high.

It took until June, though, for all trusts to be told to carry out the assessments for all at-risk staff and given a month to do so, with a cut-off of 22 July implied.

Yet information seen by HSJ shows that at the last count — taken on 17 July — more than a quarter of black, Asian and minority ethnic NHS staff had not had their risk assessment completed. For some trusts, the figure was well below half completed. For at-risk groups as a whole, the completed figure was also a lot lower than three-quarters.

Meanwhile, it looks very much like the deadline has now been put back to 31 July. Yet a tweet by NHS England’s chief people officer Prerana Issar last week implying this was the case has been deleted; and NHSE stresses that, while trusts have till the end of the month to report up to the centre, the deadline for acting has not itself been moved.

With the second interim People Plan slated for publication this week, and likely to make a big deal of the NHS’s efforts to look after and retain its staff, Daily Insight hopes the severe struggle of some of its BAME workers through the crisis is not lost.

Taking back control of electives

A blanket requirement for patients to self-isolate for 14 days before elective treatment to stop the spread of covid-19 has been dropped under new guidelines published today. 

The move, backed by NHS England and Improvement, is set out in new National Institute for Health and Care Excellence guidance on elective care and diagnostic services. It follows trust bosses warning the blanket restriction was impeding their ability to get a grip on the elective backlog.

It also comes with NHSE&I set to publish the long-awaited “phase 3” guidance for the restoration of the NHS’s non-coronavirus services which will also set out the orders for how the system can regain a grip on its spiraling waiting list.

While the blanket requirement has been dropped, some patients will still be “advised” to self-isolate for at least a few days – and for a full 14 days for higher risk patients. See the caveats in the full story here.

The news follows trust leaders raising concerns to HSJ that the 14-day isolation guidance, set out in May by guidelines from Public Health England and NHSE/I, was making it even more difficult to catch up on elective backlogs. In some cases it was putting patients at risk by making them wait longer for treatment, they said.

Senior sources also cited problems around patients not wanting to isolate and cancelling operations, and the impact on patients if their procedure had to be cancelled after they had isolated.

NHS Providers told HSJ: “This [the relaxation of the blanket requirement] is very welcome for two reasons: it means capacity can be increased and we can get through the backlog quicker; and also we can make sure the people who really need to have their operations or procedures carried out can be seen as quickly as possible.”