Exclusive: NHSE set to require ‘named coordinator’ for 2m people shielding

The draft NHS England guidance, leaked to HSJ, lists nine points the NHS “should” put in place to look after this group of more than 2 million people who are listed as extremely vulnerable to coronavirus. These include some cancer patients, those with severe respiratory disease such as cystic fibrosis, and those who have had organ transplants.

The document, marked “draft” and drawn up over the past fortnight, said the “NHS has already significantly changed how it operates to address [the] risk” that shielding people may be less likely to access services they need.

In some cases some of the nine items are already in place but where they are not the NHS should “implement [them] now”, it says.

On the named coordinator, the document says: “For most patients this will be someone from their GP practice. In some cases where the main ongoing care is with a specialist, it may be a secondary care or community health team. For children and young people, it may be paediatricians at secondary or tertiary hospitals. In some cases, it may be appropriate to identify a (clinical or non-clinical, eg social prescribing link worker) care coordinator who can coordinate activities between different healthcare teams.”

It adds that the requirement to take ”a multidisciplinary approach to care” for patients who are shielding “may involve upskilling some staff, or clinicians working in innovative ways across disciplines” especially on safeguarding and “regular mental health checks”.

It says: “Systems (sustainability and transformation partnerships/integrated care systems) have the overall lead responsibility for ensuring the [nine] actions are fully in place in their geography.”

It is not clear if the guidance has been finalised, but it is expected to be published in coming weeks.

The nine proposed actions include:

• Putting in place “a lead, named care coordinator or single point of contact to help support patient-led follow up or provide regular check ins”. 
• Reviewing personalised care plans with “priority… given to care which supports quality of life, autonomy, dignity and daily functioning”.
• “Provide NHS care at home, wherever possible; virtually or online by preference”.
• To provide safe NHS care in infection-controlled clinical settings, where home care is not possible. This should include “safe ‘door-to-door’ transport” and “advance warning” given when someone shielding is to attend an NHS site, including when arriving in an ambulance in the case of emergency.
• Ensure patients continue to access regular checks, screening and treatment where needed. It said ”careful consideration should be given to the benefits of [physical] intervention for [audiology, dentistry and eye care] against the potential risks”.
• Coordinating activity across primary, community, mental health and hospital care ”to deliver more than one check or treatment when visiting someone’s home”, which is to include safeguarding checks.

The document says providing NHS care at home should focus on “supporting those who may have greatest challenges in accessing care remotely, to reduce health inequalities”. It adds: ”Where remote service delivery is not possible, it should be via safe (i.e. infection controlled) general practice or community health service home visiting where clinically necessary. Systems should consider expanding all relevant home-based services, such as a home-visiting phlebotomy service.”

Concerns have been raised to HSJ that some of the measures would require significant additional resources, such as mental health expertise and digital health capacity.

The paper says it was informed by an advisory group. HSJ understands the group has only a single single patient representative member.

A spokeswoman for NHS England said: “It is absolutely right that those people who are choosing to shield themselves are given the support they need, and further guidance will be published shortly following discussion with key stakeholders.”

The Department of Health and Social Care declined to comment.