The must-read stories and debate in health policy and leadership.
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What’s in your basket?
We revealed on Wednesday the Royal College of Emergency Medicine and NHS Providers — pivotal voices in the row over the future of the four-hour accident and emergency target — are both now signalling they are open to dropping it.
The news comes at a crucial stage and suggests it is very likely NHS England and the government will be able to forge ahead with plans to ditch the four-hour standard. NHSE’s intentions are expected to be set out in the final recommendations of its targets review due this month.
This represents quite a turnaround from RCEM, which only last month said there had been no evidence from recent trials of potential new urgent and emergency care metrics that there was a “viable replacement for the four-hour target”.
A week is a long time in politics, and a month, it would appear, is a long time in the clinical standards review.
So, what comes next? There is consensus that no one single metric can do the job and there needs to be a basket of metrics.
HSJ bureau chief James Illman explores what that basket could contain in this week’s Performance Watch. While many of the constituent items have been trialled, decisions on which ones will make the cut remains a live debate.
The various interested parties have signed up to what amounts to a direction of travel rather than a definitive and evidence-based plan. It is something of a leap in the dark, though not one that’s been taken without thought.
NHS England has declared coronavirus a “level 4 incident” — the highest possible risk rating — allowing it to take command of all NHS resources across England.
In a letter sent by NHS England and Improvement strategic incident director Keith Willett and incident director Stephen Groves on Tuesday — the day before the number of UK cases jumped to 85 — the centre also warned all acute providers they could soon be called on to treat covid-19 cases.
NHSE’s regional teams have been directing all health service resources in England through its regional teams since the decision to move to level 4 was taken a month ago — although it was only made public in Tuesday’s letter.
Organisations have also been told not to stockpile medicines, devices or consumables, and to allocate a 24/7 point of contact to act on all coronavirus alerts.
Acute trusts are being told to identify how they would segregate areas, review critical care and where possible implement alternative models, such as remote consultations.
The actions will also require intensive care units to test thousands of patients for the disease.