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

Shielding takes a step too far

For one small group of the population the government mantra “stay at home, protect the NHS, save lives” has had a deal more urgency than the rest of the country.

They are the most vulnerable to the virus courtesy of a pre-existing condition or immunosuppression and have been sheltering at home in near total isolation from the outside world, cocooned from the virus as far as possible. Some have been in this position for six weeks now.

The shielded patients list started at around 900,000, built from a swift effort by NHS Digital to identify people with one or more conditions stipulated by the chief medical officer as most at risk. It has since grown to nearly 2.2 million, with new conditions added to the CMO’s list and GPs identifying people missed from the central list in need of shielding.

But HSJ has discovered over 100,000 people have been taken off the list too, flagged by GPs as not needing to be shielded. They are being taken off the list in batches, HSJ understands, having spent potentially weeks in seclusion.

Cold comfort

There was good news and bad news when Sir Patrick Vallance was asked by MPs about the likelihood of a second peak of covid-19 cases in the winter.

The government’s chief scientific adviser said the UK should be able to avoid a second wave of infections – if test, track and tracing and social distancing are effective.

But he told the Health and Social Care Committee that the winter ahead is going to be “extremely difficult” with flu and other respiratory infections circulating.

His warning comes as facilities such as the Nightingale Hospital in London are being mothballed ahead of the additional pressures expected later this year.

Southern discomfort

Surrey Heartlands integrated care system has been lauded for some of its innovative thinking. It was the second place to get a devolution deal – after Greater Manchester – and has benefited from substantial transformation funding.

But the new clinical commissioning group which underlies that ICS is struggling with its finances. It was formed from four existing CCGs this April and will be starting work with a £62m deficit from 2019-20.

This was £37m adrift from where the CCGs were meant to be – and, worryingly, this was largely due to a failure to deliver promised quality, innovation, productivity and prevention savings. Year-end delivery was at less than 50 per cent and some elements of the planned savings seem to have remained unidentified throughout.