The Restart of Planned Care Update
Restart continues to be high on our agenda; you will have seen Peter’s Week in HealthTech that outlined our recent meeting with senior NHS England officials. You may also have seen, by now, the latest update from NHS England on their third phase of the Coronavirus response.
Published on 31st July, the Phase 3 letter moves the NHS from incident Level 4 (national) to Level 3 (regional) and sets the system three broad challenges:
- Accelerating the return to near-normal levels of non-COVID health services, with a series of increasing objectives, culminating in a target of 90% of pre-COVID capacity by October for electives.
- Preparation for winter demand pressures, alongside vigilance for further probable COVID spikes, locally, and possibly nationally.
- Take account of lessons learned during the first COVID peak to lock-in beneficial changes.
The letter also reinforces some of the actions previously announced, such as continuation of block contracts, which will “flex meaningfully to reflect delivery (or otherwise) against these important patient treatment goals”.
Many in the system have seen block contracts as an important factor in enabling the collaborative working that has been a major success of the response. Some are arguing that the NHS should never return to the previous tariff regime, this would be in line with the direction of travel we were seeing prior to the pandemic, with tariff arrangements proposing a move to a “blended” system.
Annex 2 contains important information indicating future payment models after the current phase of payments via block contracts concludes at the end of September. Whilst final details are still to be agreed, the letter describes how the framework is likely to operate. Importantly, the revised framework will retain simplified arrangements for payment and contracting, but with a greater focus on system partnership and the restoration of elective services.
For the majority of other high cost drugs and devices, in-year provider spend will be tracked against a notional level of spend included in the block funding arrangements with adjustments made in-year to ensure that providers are reimbursed for actual expenditure on high cost drugs and devices. This will leave a smaller list of high cost drugs which will continue to be funded as part of the block arrangements.
Collaborative working and pooled waiting lists are also highlighted in the letter, stating that these should be managed at system, as well as Trust level.
The continuation of the contract for the independent sector is also recognised coming off the back of the government announcement of extra funding to maintain the independent sector capacity until the end of the NHS financial year. We have previously highlighted to NHS England that independent sector capacity was not being fully utilised, so are pleased to see that local organisations will be accountable for delivering against weekly usage plans.
Another issued raised in our discussion with NHS England was that of the 14 day self-isolation period as a barrier to patient presentation. We were pleased to welcome the announcement from NICE last week that they were revising their guidance which required people having planned care to isolate 14 days prior to admission, to now advising that they have a test within three days before admission, and self-isolate from the day of the test until the day of admission. The NHS England letter highlights this and states that Trusts should utilise the new streamlined requirements set out in the guideline when scheduling patients.
From our discussion there are two critical areas where NHS England are looking to gain greater insight of international best practice; increasing Endoscopy capacity, and running COVID and non-COVID services within a “District General Hospital” type setting. If members have practical examples of how other countries have developed protocols and processes that enable safe restart in these areas, it would be great to hear from you.
The Phase 3 letter also highlights the need to get diagnostics capacity back to higher levels as a key step in the care continuum.
Moving from national policy to day-to-day activities, as government starts to ease general restrictions, we have also updated our guidance on industry access to NHS premises. You can find the latest guidance here which recommends a “Virtual First” approach, reflects new social distancing rules and the latest on track and trace. We have also added further updates to our NHS Tracker. Thanks again to Lottie who has now managed to review all of the Trusts and Health Boards, with around 60% providing specific information on the restart in recent Board papers.
Some themes have emerged from these Board papers too, with most Trusts indicating they commenced planned care activity in June or July, and most (but not all) theatres now open. The independent sector is however a crucial part of realising the necessary capacity. They also highlighted the 14 day self-isolation period as a significant factor in patient denial rates, so the aforementioned changes to NICE guidance should start to have a positive impact on patient flows. However, bottlenecks still exist, not least in Endoscopy, which as I outlined above, is a national priority and is reflected in many Board papers as a rate limiter.
We hope the tracker continues to be a useful resource to you and we will be keeping it updated as the system ramps back up to capacity. We are hearing reports of increased activity, but concerns remain about a ceiling effect from the necessary changes to protocols to ensure staff and patient safety. To address this, our continued work with NHS England will focus on best practice from the UK and comparable health system from around the world, where barriers to patient care have been safely removed to enable health system to address outstanding care issues and make inroads into the waiting list.