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

Capacity for covid-19: answers needed fast

Planning for a coronavirus surge continues to dominate diaries up and down the rungs of NHS management; but plenty of senior figures — staring at the alarming estimated requirement for intensive care capacity — are very concerned about the lack of bright ideas for getting close to meeting it.

The centre has acknowledged the issue but not given any clues as to how they think it will be filled. One local leader describes a “wall of silence”, perhaps because “the answer is inconvenient and scary”.

Minds are turning to how to free up whatever intensive capacity can be released from elective cancellations and make use of surgical space — though it is unlikely to be enough to significantly move the dial — and how to make extreme decisions on thresholds for treatment and admission.

Meanwhile, several managers who are involved in planning for the storm contacted HSJ to ask about the role of independent sector healthcare providers. Again, here, there is a desire for a national framework or guidance.

Sources confirm discussions about such a move are under way.

The private sector is likely to be little use for intensive capacity — of which it has little — and its acute bed base is less than 10 per cent of the NHS’. But, at the straightforward end, there may be a role taking on electives cancelled by the NHS.

Towards the more radical end, independent hospitals could potentially house entire services, perhaps involving urgent planned operations, if there was a move to separate out “hot” infectious covid-19 centres and “cold” non-infected sites.

Another role could simply be releasing its clinical staff to ensure they are working maximum hours at “hot” NHS acute hospital sites.

One HSJ reader suggests: “What we need most of all is some intermediate care beds to free up our acute capacity — which would be easy for the independent sector to provide but probably not very profitable.

“Down the line once our staff start going off sick or quarantined redeploying some nurses and doctors might be a good idea but at the moment our consultants are worried they will lose their practising privileges if they withdraw services from the independent sector in the absence of a national directive.”

Cornwall goes green

Is 2020 (finally?) the year the NHS takes environmental issues more seriously?

After a handful of NHS organisations declared “climate emergencies” last year, NHS England/Improvement got in on the act in January, announcing plans for a new panel to set “practical” green targets for the health service.

But it is not yet known when the panel will make its recommendations, and one region is pushing ahead regardless.

NHS chiefs in Cornwall have committed to an ambition of achieving net zero carbon emissions by 2030, in line with a plan by the county’s unitary authority.

That is a very big ask.

The possibilities of achieving net zero by 2030 were all but dismissed during last year’s general election, forcing the Labour Party to drop their target for making the UK carbon neutral by the end of the decade.

But the Cornish leaders argue they will achieve more by aiming for net zero by 2030 — even if they fail to hit the target — than with a target that stretches out for decades.

However, the county must not take its eye off other problems in the name of saving the planet.

Kernow Clinical Commissioning Group and Royal Cornwall Hospitals Trust have both only recently climbed out of their respective special measures regimes, and finance and certain quality problems continue to challenge the health economy.