Your essential update on health for the week — this week focused on the coronavirus outbreak. 

HSJ Catch Up

This weekly email gives HSJ subscribers a vital update on the biggest stories in health. If you have been out of the office or otherwise just too busy to keep up, HSJ Catch Up will ensure you are still in the know.

Good news, bad news

It is, of course, good news that the NHS is in a position to mothball the flagship Nightingale Hospital in London.

That there were fewer hospitalisations than feared and fewer beds needed is to be celebrated.

Indeed, the success of the capital’s acute trusts in expanding capacity is laudable and we were not overwhelmed like the Italian hospitals.

But even so, the number of deaths in the capital is sobering. Considering London sustainability and transformation partnerships had two of the top three rankings for excess care home deaths, did the efficiency in treating and discharging people lead to more deaths in the community?

Some have asked whether the Nightingale should have been used as a step-down facility for people to recover or as a facility for patients who might have had covid and were risky to send back to an ill-equipped care facility.

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 grew to nearly 2.2 million. But HSJ has discovered over 100,000 people have been taken off the list too, flagged by GPs as not needing to be shielded. 

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.

Charities warn of cash crisis effects

As the NHS looks beyond the peak of coronavirus cases to restart electives, concerns about the economy as a whole continue to grow.

Health charities have told HSJ that they are struggling to maintain services that help ease the pressure on the NHS, such as nurse-led helplines and clinical and non-clinical staff working on the frontline.

At the start of April the government announced £750m of funding to help charities but a Commons report today said that due to the lack of transparency on how to access this funding it’s “inevitable” that charities will miss out on support.

It’s also small beer given that the NCVO said charities will lose approximately £4bn in projected income in the three months from March 2020.

Rise of the covid crooks

It is depressingly inevitable that global crises attract exploitative and opportunistic criminals.

One increasingly concerning element of this is occurring in cyber space – where hackers are attempting to steal patient information or research material being drawn up in response to covid-19.

Such has been the rise in attacks against healthcare organisations that the UK and US’ cyber defence chiefs have seen fit to issue an advisory document for healthcare staff.

No blame, just answers

If there is one person who knows what makes a good – or bad – public inquiry it is former Department of Health permanent secretary Dame Una O’Brien.

Between 1998 and 2001, she was secretary to the Bristol/Kennedy Inquiry, which was then the largest public inquiry into the NHS.

Ms O’Brien (as she was then) took up the top job at the Department of Health in 2010 and, therefore, oversaw the setting up of both Mid Staffs/Francis inquires – as well as dealing with their recommendations. Since leaving the civil service she has served on the public inquiry investigating the causes of a public sector spending scandal that led to the collapse of Northern Ireland’s power-sharing executive.

Dame Una calls for an inquiry into the government’s response to the coronavirus crisis, “with powers to compel production of documents; take evidence on oath and require statements from witnesses”. She adds that “the public need to be confident that all relevant documents, minutes, emails, texts and even Zoom records are handed over to the inquiry in a timely way.”

However, the inquiry cannot be a “prosecution” or “a blame game”.

Auction site’s portal is a lottery

The vast majority of GPs and community providers are still waiting on an online PPE portal from the Department of Health and Social Care and tech giant eBay. When it’s rolled out, the website should give organisations better access to central stocks of protective kit and other covid-19 related products.

But so far, the portal is available to just 2 per cent of the country’s 58,000 primary care, social care and other community organisations.

In the meantime, GPs and community providers continue to make do with often expensive and restricted stocks from existing suppliers, drops from local resilience forums and emergency packages from a national hotline. Experiences of PPE provision in the community vary widely, and it’s hoped the new portal will help improve distribution. But it could be some time before most smaller providers see any benefits.