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.

Access granted

Access to NHS IT systems and its content is a highly touchy subject, which can give ministers sleepless nights.

In an unusual development, experts working at the National Cyber Security Centre — part of the Government Communications Headquarters — have been granted legal powers to order the NHS to hand over information about its IT systems and networks until the end of 2020.

According to the directive, GCHQ can only request this information where it relates to the “security” of the NHS’ systems, and a spokesman for the agency told HSJ it had “no desire” to receive patient data.

Meanwhile, a further 3,000 overseas healthcare workers have had their visas extended by an extra 12 months, as they help the country fight the covid-19 pandemic.

The Home Office announced the decision covers midwives, radiographers, social care workers and pharmacists, working both in the NHS and in the independent sector.

Getting back to business

NHS England set out a six-week action plan and priority areas for the restart of a raft of non-coronavirus services on Wednesday.

The tone of the orders was understandably cautious. Hospitals were told to “release and redeploy” capacity back from being ready for covid-19 patients, to space suitable for other care, “over the next six weeks”.

But it warned it would be “prudent [to] retain extra capacity that has been brought on line — including access to independent hospitals and Nightingale hospitals”.

Turning to finances, NHS England and Improvement last month set out new guidance for paying suppliers and services during the pandemic. It highlighted that suppliers were at risk with the associated economic downturn so reliable payment times for services and goods were vital to keep the procurement machine moving.

A month later, the regulator has doubled down on this advice, strongly advising trusts and commissioning groups to pay invoices in seven days of receipt. In peacetime, the target for invoice payment is 30 days and many trusts have, historically, failed to hit that objective. 

With finance teams reorganised to focus on cash flow among other areas, can the NHS meet this stricter deadline?

Rest assured

The government’s announcement of a payout of £60,000 to the families of those NHS staff who die of coronavirus has been widely welcomed.

It’s particularly important for those workers who are not in the NHS pension scheme — which provides good death-in-service benefits — and those families would suffer financially if they died.

But the devil is in the detail. Despite the Department of Health and Social Care listing many NHS organisations whose staff might be eligible, it has now become clear that many workers — including managers — are unlikely to be covered because they work in areas without covid-19 outbreaks.

Death-in-service is not the only payout the government has covered. As part of its drive to have thousands of ventilators manufactured to help the NHS in the next weeks and months, Cabinet Office minister Michael Gove has indemnified companies whose machines are approved for use in the NHS from legal claims in the event of faulty equipment.

Meanwhile, despite having been over a month since the shielding guidance was released, there are still problems making sure everybody is on it that should be. New conditions have been added in the last few days — namely those receiving dialysis and people who have had their spleen removed — complicating matters further. 

The list is now expected to balloon from the initial 1.5 million patients to 2 million by the end of the month. With hospital consultants, GPs and patients themselves all able to make additions to the shielding list, conflict has arisen as to who needs to shield and one senior GP has described the system as a “mess”. 

Known unknowns

Uncertainty and fear are key features of the impact of coronavirus, and they will sadly not be eased by the high degree of known unknowns about observations from children’s intensive care doctors.

They are observing a set of symptoms similar to serious cases of covid-19 but not the same, and in which some cases are testing positive for the virus, but some not. This has been increasing over the past two to three weeks.

A small number of children are thought to have been affected, but concern has been sufficient enough to share a warning with many GPs and children’s intensive care doctors, to ensure they take cases seriously and refer them appropriately.

Unfortunately, there is no certainty as yet about whether the syndrome is covid-19 related — such as a different presentation or strain — or a different infection with similar characteristics.

Meanwhile, many NHS managers are struggling with how best to protect their black, Asian and minority ethnic staff from coronavirus. With growing evidence people from a BAME background are particularly adversely affected by covid-19, BAME staff may be feeling vulnerable.

Somerset Foundation Trust has taken the radical step of declaring all BAME staff are “at risk” and inviting them to discuss their position with their manager, including any conditions which would put them at greater risk.