Your essential update on health for the week.
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.
Configuring for coronavirus
A potentially long moratorium on electives; cancelling face-to-face outpatients; a new largely remote/digital “home treatment” service; widespread repurposing of clinical space; rapid retraining and redeployment of staff; driving down admission thresholds; and a hard line on discharge out of hospital… we could go on.
Across the board, coronavirus is profoundly re-shaping the way services are provided and it’s likely to have significant longer-term implications too.
More on that another day.
But focusing in on one immediate example, on Thursday we revealed the NHS has begun planning for the potential suspension of all non-emergency elective procedures, which could last for several months.
Senior sources told HSJ NHS England had asked trusts to risk stratify elective patients in readiness for having to suspend non-emergency work to free up capacity.
HSJ understands trusts have been told to firm up plans for how they would incrementally reduce and potentially suspend non-emergency operations, while also protecting “life saving” procedures such as cancer treatment.
Some trusts want to move fast on this to prepare for covid-19 — but others a lot more wary, especially where they think their acute work is anyway split from their elective, so the latter can for now carry on relatively uninterupted.
Meanwhile, HSJ revealed that Keith Willett, NHS England strategic incident director, warned chief nurses to plan for an increase in intensive care capacity of up to seven-fold as the NHS ramps up preparations for coronavirus. Professor Willett later insisted he had said “several-fold”, not “seven-fold”.
Elsewhere, the UK’s four chief medical officers and the General Medical Council have written to all UK doctors to reassure them they won’t face reprisal (within reason) if they end up working outside their areas of expertise during the coronavirus outbreak.
The letter is intended to support doctors to be flexible and not resist new ways of working, with senior figures expecting many clinicians working in other specialties or locations as the NHS grapples with the spread of the illness.
And Sir Simon Stevens used his platform at the chief nursing officer’s summit event to call on third-year undergraduate trainee nurses to join the NHS’ fight against covid-19, adding NHS England was working with the Nursing and Midwifery Council to “see how many of the 18,000 [relevant] undergraduates are available”.
Sir Simon also suggested the Care Quality Commission would need to suspend the majority of its routine inspections during the outbreak, while the NHS Confederation shortly afterwards called for it to stop routine work immediately. The CQC has previously said it will not yet cancel all routine inspections, but that it will take a pragmatic approach.
Capacity for covid-19
Several managers who are involved in planning for the covid-19 storm contacted HSJ to ask about the role of independent sector healthcare providers. Here, there is a desire for a national framework or guidance.
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.
Balancing the books
There were a lot of very large numbers in Rishi Sunak’s first Budget.
The important ones for the NHS were:
- A £5bn contingency fund has been set for the NHS and other public services to respond to the covid-19 outbreak;
- A £1bn lift to the Department of Health and Social Care’s budget for capital investment in 2020-21, compared to previous plans;
- An additional £1bn in revenue, most of which relates to pledges around primary care funding from the Conservative manifesto; and
- Part of that revenue increase will also cover changes to pension taxes for senior doctors, apparently removing the risk of sudden major tax bills from all who earn less than £200,000.
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.
Turning art into science?
How do you spot the next Mid Staffs?
This is a question that has preoccupied many NHS leaders and their government masters since the scale of the care failings at Stafford hospital began to become clear.
In truth, the NHS has always operated in the dark about where the most serious failures will emerge. Increased regulatory scrutiny has helped, although the opportunity costs of inspection and reporting overload are hard to calculate. It may be that in a system as complex as the NHS, and organisations as multifactorial as hospital trusts, spotting impending disaster will remain as much an art as a science.
However, Listening into Action thinks it has identified one possible crystal ball. Their analysts’ annual scatter map showing a trust’s comparative performance on the NHS staff survey has long been awaited with trepidation and anticipation by chief executives. LiA has now attempted to refine its analysis to focus on those elements of the staff survey which are most telling about an organisation’s ability to maintain or improve care quality.