As we move past the COVID-19 peak and the NHS starts to re-establish planned care pathways, the need…
The Restart of Care
The Trust Tracker
The latest NHS England data on COVID-19 hospital activity here.
Royal Collage of Surgeons of England: Recovery of surgical services during and after COVID-19 & Specialty guides for patient management during the coronavirus pandemic.
A report from The Institute for Public Policy Research entitled State of health and care: The NHS Long Term Plan after Covid-19 shows the scale of the damage done by the pandemic across several major health conditions and recommends a £12 billion package changes to ‘build back better’.
NHS Confederation: NHS Reset - A new campaign aiming to contribute to the public debate on what the health and care system should look like post COVID-19.
As part of the campaign, this report has been published outlining the key challenges and suggesting changes in policy and practice that will be required as the NHS prepares to restart a wide range of services. It addresses issues of funding to manage ongoing demands from COVID-19, as well as increased unmet demand; Capacity and the need for ongoing arrangements with the private sector; A lighter-touch regulation and performance management regime; System working and the need for legislation; Managing public expectations with clear and consistent communication that it will take many months, possibly longer, to return to pre-COVID-19 levels of activity.
COVID-19 Trust statements. We are aware that some requirements set for company representatives visiting hospitals have changed. Given the changing nature of this situation, this update is not definitive, but the LSI National Credentialing Register is maintaining a list of Trust statements that they are aware of. Last updated - 4th August 2022.
Timeline of the latest news and guidance
8th February 2022
The government has announced the NHS recovery plan which forecasts that elective waiting lists are likely to continue growing until March 2024, it will take until July 2022 to eliminate the two-year elective waiters, and that NHSE had committed to eliminate 52-week elective wait breaches – which currently stand at over 300,000 – by 2025. However, it acknowledges that predicting the amount of incoming ‘lost referrals’ returns to the system is incredibly challenging and the accuracy will have significant bearing on whether the plan also waters down the existing but long-missed diagnostic target. The current standard is that 99 per cent of patients needing a diagnostic test should receive it within six weeks of a request being sent. The plans say that by March 2025 the NHS will deliver at 95 per cent against this benchmark.
Much of the plan’s key themes – like better use of the private sector, surgical hubs, virtual wards and patient-initiated follow-ups – have been well trailed or already have targets set in the planning guidance, and the plan was broadly welcomed by both NHS Providers and NHS Confederation, although both trusts stressed the enormous pressure the system was under. The King’s Fund highlighted the need more staff to make the plan a reality. To facilitate better workforce planning Health Education England will be merged with NHSE.
12th January 2022
HSJ: In a letter from Amanda Pritchard to Sajid Javid, NHS England has outlined the financial arrangements associated with its latest private sector deal. It is guaranteeing to pay independent providers around £225m between now and March to reserve capacity in case of a covid admissions surge – but the figure could rise to up to £525m if the capacity needs to be fully utilised.
The agreement was made between NHSE and several private providers who will reserve and then potentially supply capacity to mitigate the impact on elective work if the NHS saw a surge in admissions. A 10% premium over tariff will be paid for all work The firms included in the deal are Practice Plus Group, Spire Healthcare, Nuffield Health, Circle Health Group, Ramsay Health Care UK, Healthcare Management Trust, One Healthcare, Horder Healthcare, Aspen Healthcare, and KIMS Hospital.
10th January 2022
HSJ: The NHS has agreed a three-month nationwide agreement with the independent sector to provide surge support during any COVID surge, when triggered in a particular area the local independent providers will suspend their private activity and make their facilities and staff available to the NHS system.
’Surge’ status will need to be signed off by NHSE and will be triggered in areas where covid patient numbers or staff absences “threaten the NHS’s ability to provide urgent care”. It is anticipated that the surge measures will only be used “in extremis” and that currently such levels have not yet been breached.
16th December 2021
HSJ: Some hospital trusts in London are beginning to cancel non-urgent elective procedures and redeploy staff, as absences due to the rise in covid cases increase ahead of an expected wave of admissions from omicron. The staff freed up could be redeployed to fill gaps to keep the most urgent activity going.
Whilst National guidance acknowledges routine electives were likely to be cancelled, they still state that “capacity should be maintained as far as possible, recognising the requirement to release staff to support the vaccination programme and respond to the potential increase in covid-19 cases”.
Covid cases have been rising rapidly in London, most of them now omicron, particularly among working age adults, and covid admissions are also on the up.
15th December 2021
Sir Jim Mackey, the newly appointed national director of elective recovery has told the Commons public accounts committee that the NHS is working to increase physical capacity, train more staff, and to increase “resilience” of planned care. But he said it would be “two to three years before there is a material increase in capacity” and the focus of the health service over the next 18 months would be on long waiters.
ABHI understands that the Elective Recovery Plan is likely to be published at the end of January (although the current Omicron wave may impact this). The plan will include extra funding for theatres and will provide an additional 566 elective beds across England, although Mackey has been clear that money really isn’t the issue, it is the workforce. He also stressed the need to separate elective from emergency care, to try to stop the latter from spilling over and causing planned care cancellations.
10th December 2021
NHS E/I CFO Julian Kelly has said a return to some activity-based payment tariffs would be essential to meet the goals which had been agreed with the government in exchange for £9bn of additional funding next year. Prior to covid, the NHS was in the process of introducing a blended payment model, including an element based on activity levels (known traditionally as ‘payment by results’) as well as a fixed, or block, element.
Speaking at the Healthcare Finance Management Association annual conference Mr Kelly added that “It is a really important part of the contract that we have with government that we, if at all possible, meet the goals for activity that they have agreed with us as part of giving us £9bn. And we still think a strong volumetric element to paying for elective work is going to be central to that.”
It was announced that the centre will issue a one-year revenue allocation in the planning guidance, expected to be published later this month, rather than the full three-year budget. However acknowledging the need for capital investment a three-year capital allocation to each system will be issued.
10th December 2021
The waiting list continues to grow steadily with latest figures (October 2021) for England showing 5,975,216 at month end. Patients are both joining the waiting list and being discharged from clinic at near pre-covid rates, but admissions for treatment are still constrained below pre-covid rates, with the net result that the waiting list is growing rapidly.
There is still no sign of any surge in referrals caused by “missing referrals” since the pandemic started coming back for treatment. Nor is there any noticeable increase in patients being removed from the waiting list, despite the incentives. Analysis of activity and removals from the waiting list do not show any significant change, suggesting that the Elective Recovery Fund incentive is outweighed by the ongoing pressures on the NHS.
As ever further excellent analysis is available via the HSJ.
8th December 2021
The Private Sector is expected to play a significant role in addressing the increasing backlog in elective care. NHS England chief executive Amanda Pritchard told a King’s Fund conference last week the amount of elective activity the NHS was sending to the private sector was “higher than it was pre-covid”. However, HSJ analysis shows, the total number of RTT “clock stops” recorded by independent sector providers was down by 4 per cent over the previous six months, compared to pre-covid levels. This is countered by NHSE referring to unpublished “weekly activity returns” data for November, which apparently show activity at 113 per cent of pre-covid levels.
It could be that the unpublished data represents a more contemporary picture and hence we will start to see an increase in private sector use feeding through into published data. However, the Independent Healthcare Providers Network have confirmed that the RTT data was a fair reflection of activity levels being referred to the independent sector.
Furthermore, the RTT data suggests a significant deterioration in activity being sent private from the major surgical specialties, although with a significant increase from ophthalmology masking decline in other areas such as trauma and orthopedics.
NHSE has highlighted that it is extending the “increasing capacity framework’ under which independent providers offer care to NHS patients at nationally agreed prices by two years. New contracts worth up to £10bn under the framework will run from April next year until December 2024.
1st December 2021
The NAO has published a report, “NHS backlogs and waiting times in England“, which provides a good account of the performance of the NHS in the lead-up to the pandemic and the subsequent impact of COVID-19 on elective work and cancer services. Finally, it looks at the challenges to the NHS in addressing the backlog and the financial support provided by government. A short summary is provided here.
22nd November 2021
NHS England selected 12 integrated care systems earlier this year to be part of an “accelerator programme” to help recovery of elective activity have failed to achieve their pre-covid activity levels, let alone the §20% levels that were initially outlined as the benchmark for the extra money. HSJ analysis of activity data published by NHS Digital showed performance ranged from 97 per cent down to 86 per cent and only one system (who was not part of the programme) achieved activity above pre-pandemic levels. Overall the accelerator areas did perform marginally better than others, at an average of almost 90 per cent of pre-covid procedures, compared to the national average of around 87 per cent. On outpatient appointments, the accelerators delivered 96 per cent, against the national average of 95 per cent.
Further analysis from HSJ here.
25th October 2021
The Treasury has today announced that £5.9 billion will be injected into NHS England in a bid to resolve the backlog of appointments which currently (Oct 21) stand at a record 5.7 million people and growing by 100,000 a month.
- £2.3 billion will be put toward improving diagnostic services and 100 community diagnostic centres have now promised to ease access to CT, MRI and ultrasound scans.
- £1.5 billion will be used for increased bed capacity, equipment and new surgical hubs to tackle waiting times for elective surgeries.
- £2.1 billion of the £5.9 billion total will be invested in technology and data in a bid to improve efficiency and security. IT improvements will focus on fast broadband provision and implementation of digital patient records.
30th September 2021
NHS England has lowered the elective activity target which trusts have to meet to win incentive payments from the £1bn Elective Recovery Fund. Planning guidance for the second half of 2021-22, issued 30/09/21, states providers will be at tariff rates and on top of their block contract if they carry out more than 89% of the level of planned activity performed before the pandemic. Trusts achieving elective activity above 94% of pre-pandemic levels will receive the normal tariff price, plus 20 per cent, for activity above that threshold. Both the 89% and 94% are reduction on the previous eligibility levels which stood at 95% and 100% respectively.
27th September 2021
HSJ: Trusts and ICS miss out on millions after NHSE changed funding rules for the elective recovery fund from the original target of 85 per cent up to 95% with many declaring little or no additional income.
7th Sepetmber 2021
Within the Build Back Better report on Health and Social care there are significant statements on tackling the waiting list situation, confirming the previously reported role of surgical hubs, remote monitoring and AI as well as generally acknowledging innovation as a “driving force to get the NHS back on track”.
19th August 2021
BBC: Welsh Government Health Minister Eluned Morgan, has announced more than £500m of extra funding to help health and social services in Wales to recover from the pandemic. £411m will go towards the "significant costs" of dealing with Covid until April 2022 with a further £140m for tackling the waiting list backlogs, and rebuilding after Covid.
18th August 2021
HSJ: NHS England has asked all acute trusts to audit their medical staff to better understand the specific workforce gaps the health service is facing, linking the exercise to getting elective work back to, and above, pre-covid levels, and begin catching up on backlogs, amid concerns staff shortages in certain trusts and systems are holding back service recovery. In a letter sent by NHS national director Pauline Philip, trusts were told the centre would use the data to identify action that could be taken to “maximise” workforce availability.
8th August 2021
New estimates of the future NHS waiting list have been put forward, this time by the Institute for Fiscal Studies. Their estimates range from 8.5 million to 10.5 million in July 22 but by July 2025 estimates diverge to between 4 and 14 million. The capacity of the NHS being the critical factor in the final outcome. They also have an interactive tool that you can use to play-out your own scenarios.
30th July 2021
HSJ: Pressures are growing on London Trusts as they address the latest surge of covid patients and mounting non-covid activity, according to Professor Geoff Bellingan, medical director for surgery and cancer at UCLH. According to HSJ he told a board meeting “We are creaking across London, we’re already [doing] inter-sector transfers for critical care and I would be most surprised [if] we’re not cancelling more elective surgery next week.”
Anaesthesia has been a key pinch point for trusts nationwide when tackling successive waves of covid, as there are not enough anaesthetists to both staff ICUs full of covid patients and operating theatres running elective lists. UCLH is already 14 anaesthetists below establishment and “summer holiday leave will only add to the staffing risk”, the trust’s board papers warned.
26th July 2021
A report from the Nuffield Trust highlights the possible implications of the current wave on the NHS.
By May this year the waiting list for planned NHS treatment was 5.3 million, the highest since records began – but numbers treated each week have not returned to pre-pandemic levels. The NHS has been tasked with fully resuming services, but this will be difficult to achieve while Covid rates remain high. As well as the factors noted above, patients waiting for complex surgery that might require admission to intensive care are likely to be particularly impacted. Covid patients typically require longer stays in intensive care than surgical patients, so each additional Covid patient admitted can result in several postponed operations.
Growing numbers of patients mean Covid wards are already being reopened, and planned operations are being cancelled. If hospital cases continue to rise, as expected given the rapid growth in cases, it will once again result in other services being reduced, in and out of hospital.
21st July 2021
HSJ: Trusts in the West Midlands are coming under increased pressure from rising COVID admissions and unprecedented pressure on urgent and emergency care which are being compounded by staff absences and the need to maintain separate pathways. NHSE Regional Directors have characterised it as “…potentially, what will be the most difficult period since wave one of the pandemic…”. HSJ have speculated that this could require redeploying staff and reducing elective care. In a letter to the Trusts NHSE “… recognise that our requirement will have to draw on your reservists and impact on routine surgery. We expect any decisions about systematic reductions in routine surgery need to be taken at an integrated care system level and in consultation with ourselves.”
20th July 2021
HSJ: Royal Devon and Exeter Foundation Trust completed the purchase of the site of the Exeter Nightingale earlier this year. The facility will be used for several types of elective care as the NHS grapples with an increasing backlog of patients. They include diagnostics and orthopaedic, ophthalmology and rheumatology procedures.
16th July 2021
HSJ: In a further sign of the impact of rising COVID-19 cases, several hospital trusts in the north of England, where COVID-19 bed occupancy and new admissions are highest, have re-imposed restrictions on visiting patients. Hospitals affected are in areas such as Morecambe Bay, South Tyneside, Sunderland and Merseyside.
14th July 2021
HSJ: The Newcastle Upon Tyne Hospitals Foundation Trust cancelled some elective activity last week to “protect urgent care”, with further procedures cancelled this week as patients continue to come into the emergency department and assessment suite who need to be admitted into hospital. It comes as the North East has become the new epicentre of the current covid wave, with areas such as Newcastle, South Tyneside, Sunderland, Hartlepool, and Gateshead suffering the highest rates of the virus in the UK.
9th July 2021
NHS England has re-engineered the criteria for access to the Elective Recovery Fund (ERF). The activity thresholds have been reviewed, taking account of progress to date and Q2 plans, and income earned and actual costs incurred, whilst also being mindful of expectations about staff availability in the coming months and the future path of the pandemic.
As a result, the thresholds for earning ERF are being adjusted to 95% of 2019/20 activity levels from 1 July 2021.
ERF will be paid at 100% of tariff above the 95% threshold, and at 120% of tariff above 100% of 2019/20 activity.
Local systems are asked to deliver continued further significant reductions in the number of patients who have waited more than 52 weeks through Q2, and to work with NHSE/I regional and national teams to take a regular, forensic approach to analysing and understanding the long waits position, which will in turn help to determine our approach for H2.
8th July 2021
There are some early signs that elective procedures are coming under pressure from a combination of a surge in COVID cases and other pressures in A&E. The surge is forcing hospitals to cancel operations, including cancer surgery, because they are treating growing numbers of patients with Covid and losing staff who are having to isolate. Leeds NHS trust has had to call off some planned non-urgent operations this week to help it cope with an influx of patients seriously ill with Covid. Other hospitals and ambulance services are coming under serious pressure too in what NHS staff believe is an unfolding third wave of Covid.
In the first three weeks of June 2021, emergency attendances were nine per cent higher than in the same weeks in 2019 [pre-Covid and attendances in the second week of June reached record levels. There is growing concern that this demand will spill over to the point where it could have a detrimental impact on the elective recovery and the service’s ability to deal with the current covid wave.
Theories put forward for the rise include difficulties in accessing GPs, health problems delayed during covid now presenting to ED, hotter weather, and the mental health implications of extended lockdown measures. There have been particularly sharp rises among children. With HSJ being told this appeared to be mostly due to resurgence of respiratory infections as lockdown restrictions are lifted, but may also reflect some delayed presentations.
All this is against a backdrop of a record high waiting list at the end of May of 5.3 million people. The number of people admitted to hospital for surgery and routine treatment is returning to pre-pandemic levels, in May, 242,064 people were admitted, compared to 295,881 in May 2019 , indicating the service is operating at 80% of normal activity.
The Independent Healthcare Providers Network, has indicated there were 20,000 fewer appointments delivered in May this year than in the same period in 2019 — a 15 per cent fall in productivity – whilst the RCS said the specialties with the highest proportion of waits two years and over are trauma and orthopaedics, general surgery, and ear, nose and throat.
24th June 2021
HSJ: Downing Street is setting up a new unit in the Cabinet Office to oversee ‘recovery’ in the NHS and other health priorities, and ‘intervene where delivery is slowing’. HSJ report the main focus for the NHS is expected to be on reducing elective waiting lists, delivering the “40 new hospitals” promise, and increasing nurse and GP numbers, though the unit will inevitably study other NHS long-term plan objectives.
14th June 2021
National Health Executive: According to data from NHS England, the number of operations and elective care carried out, returned to near pre-pandemic levels, with activity at 90%. In April 1.1 million patients began receiving treatment, and 1.8 million patients were able to have diagnostic testing. As previously reported the data also showed cancer referrals and treatments were up over the same period last year and treatment rates now back to usual levels.
10th June 2021
Entirely predictably, the hospital waiting list in England has now exceeded 5million, but a glimmer of good news is that the number facing waits of over a year has dropped for the first time since the pandemic began and now stands at around 385,000, down by 50,000 on the previous month. NHSE also highlighted that as well as the progress on long waits, the numbers being seen by cancer services and mental health were now back to pre-pandemic levels. However we mustn’t get carried away, analysis by HSJ points out that this is reduction in long waits largely an artefact of the reduced referrals caused by the first COVID shut down in 2020. This somewhat techie blog from GooRoo outlines that steps that will need to be taken over next 7-8 years to address the fall out from the pandemic on elective care.
7th June 2021
HSJ: HSJ reports that non-covid emergency patients appear to be returning in their droves - perhaps because lockdown is easing, viruses are returning, GPs are (arguably) still harder to access, and some health problems have been stored up for way too long. And the health service is again restoring planned care. Discharges are getting gummed up. This surge, combined with thousands fewer beds than normal, is leading to dozens of acute trusts operating at very high levels of bed occupancy in the past month.
28th May 2021
BBC: The Royal College of Surgeons (RCS) is calling for a network of hospital sites focused on routine surgery, such as hip and knee replacements, calling for a "New Deal for Surgery" to to help weather future pandemics and ensure surgery is available on the NHS all year round. To deliver this it is recommending there should be around 40 centres based in existing NHS buildings to carry out non-urgent surgery supported by an extra £1bn a year of government funding and a longer-term commitment to train more staff.
25th May 2021
HSJ: Since the first COVID peak in 2020 the NHS has had access to unlimited central funding to pay for discharge care packages and a new six-month budget has recently been approved, although capped at £475m. NHS England is asking government for this funding to become recurrent. The funding has been credited with improving patient flow in hospitals, reducing length of stay and improving local relationships around responsiblity for discharge costs. This freed up thousands of hospital beds during the winter covid wave. The case for the fund to be extended is being put forward as part of discussions ahead of the Treasury’s spending review.
21st May 2021
HSJ: HSJ is reporting that discussion are ongoing with hospitals to prepare for a potential further surge of covid, with planning assumeing a fourth wave between September and January and cases reaching around half the level of first wave of the virus last year. Trusts have been asked what resources they would need to run at 80 per cent of previous volumes of elective work if this scenario occurred. They are also taking into account that it is likely to come on top of greater non-covid emergency care demand, which has been lower then normal over the past 15 months.
18th May 2021
An interactive map of local NHS waits around England in March 2021, showing the pressures, with links to all the details by organisation and specialtyHere is the local picture on 18 week referral to treatment, fully updated with the latest RTT waiting times data released by NHS England.
14th May 2021
HSJ: As the NHS emerges from the pandemic with huge treatment backlogs prioritising patients is going to be even more difficult. This week NHS England Planning Guidance outlined the prioritisation process for those needing endoscopies or other diagnostics.
13th May 2021
HSJ: The full extent of the elective backlog starts to emerge with recently release NHSE data showing referrals are up year-on-year, for the first time since covid restrictions began. But activity is not. The main problem so far has been covid restrictions on NHS activity. These have made it difficult for the NHS to treat urgent patients quickly enough, let alone tackle the longest waiting times. But all this time, pent-up demand has been building in the community as patients kept away from the NHS during the pandemic. It is this pent-up demand that is now showing signs of coming back.
BBC: In England, nearly 5 million people are now on a hospital waiting list - 9% of the population - the highest number since records began, in 2007. A similar proportion are waiting in Scotland, while in Wales it is 17% and Northern Ireland 23%. Most worrying, the numbers waiting over a year have rocketed - in England, from 1,600 before the pandemic to 436,000 at the end of March 2021.
10th May 2021
Some 4.7 million people are now waiting for routine treatment and there is concerned in government that the situation in the health service will “get worse before it gets better”. The Government has pledged an extra £63bn to the NHS this year and £22bn next year but the Prime Minister will make clear that more money is likely to be needed to tackle the backlog of treatment.
There are no new specific spending commitments, but the statement says that, “despite significant constraints on public spending… The PM will make clear more funding will be required for NHS recovery in the years ahead”.
6th May 2021
- Number of systems to get funding for committing to deliver more elective activity
- Selected ICSs to receive up to £20m to reach 120 per cent of normal activity
- Large chunk of funding would likely be spent on outsourcing to private sector
NHS England has designed a new “elective recovery accelerator” programme to encourage ICSs to be more ambitious with their plans to restore planned services. It is anticipated that one or two ICSs will be chosen in each region will be offered between £10m and £20m upfront funding if they commit to delivering 120 per cent of their pre-covid elective activity levels by July.
A significant proportion of that funding would likely be spent on additional outsourcing to private providers capacity, or insourcing arrangements, which involves a private provider using NHS premises, equipment and management systems to deliver extra capacity. This follows the recent NHSE planning guidance which established New national baselines for elective activity, surpassing these baselines already triggers some additional payments. The new programme now offers additional upfront funding for committing to substantial extra activity.
Elsewhere, the Royal College of Emergency Medicine has raised concerns that A&Es are very busy and that losing control on emergency activity levels could derail the elective recovery.
28th April 2021
HSJ: System-led elective recovery is one of the key themes from the NHS England and Improvement’s 2021-22 planning guidance. In depth analysis from HSKJ shows the challenge of recovering services from the covid crisis is the big task for NHS leaders for the foreseeable future. The status of elective backlogs at an ICS level is a critical piece of the jigsaw to fully understanding the challenge facing the NHS in recovering its elective position. The analysis shows not only the deterioration of each system’s waiting list over that 12-month period, but also draws some comparisons into how different areas are faring. It is important to stress that making direct comparisons is problematic without taking account of several significant caveats. For example, population demographics, deprivation, and geography are not taken into account in this analysis. The analysis could provide a benchmark to measure each ICS’ progress moving forward.
The data reveals that all systems have seen their level of long waiters grow, but it’s important to note some have actually seen their total waiting lists shrink over the last year. This likely reflects a dip in referrals. This will be a key factor in whether backlogs can be reduced over the coming months as referrals are expected to pick back up again.
15th April 2021
HSJ: Inpatient elective hospital activity was down by around 50 per cent this January and February compared to the year before. The number of patients admitted for routine operations in February was 152,642, according to official NHS data, published today. This is 47 per cent fewer than the 285,918 admitted in February 2020, just before covid hit planned care. This follows a similar drop in January year-on-year, when the number of people treated fell from 304,888 in 2020 to 139,378 in 2021. The number is, however, significantly higher than last spring, during the first UK wave of covid, when a national moratorium on elective work was put in place. Only 41,121 operations were carried out in April 2020, compared with 280,209 in April 2019.
14th April 2021
HSJ: Speaking at the HSJ Leadership Congress, Sir Simon Stevens has said the service should ensure as much elective work is done as possible, while covid prevalence is low, while at the same time thinking about “different ways of doing things”. Commenting on the extent of the backlog, Sir Simon agreed that it is very important capacity is maximised to expand elective activity as covid comes down and there is an opportunity to think innovatively, and radically, about pathway redesign such as initiatives like the community diagnostic hubs. On the pace of return to elective activity the its was commented that the impact of covid infection control measures, service separation, and workforce issues was unclear and will vary from organisation to organisation, but overall the focus will be on “priority two” cases as well as those who have been waiting he longest.
HSJ: From 14/04/21 acute trusts are due to report a new elective weekly data collection to provide a timely view of the waiting list across the country. The waiting list minimum dataset will provide a much richer set of information than the existing weekly referral to treatment patient tracking list, including detail of procedures patients are waiting for and clinical priority (P-code).
NHSE/I will be creating further resources to support the transition including a dashboard tool that systems, regions and providers will be able to access.
Reaction to the new data ask was mixed with some Trusts unconvinced the significant additional burden would be worth the benefit while others viewed it as a means to help manage data at an integrated care system level. However there is no doubt significant improvements to data collections to ensure local and national system leaders can get a better handle on local waiting list issues can and should be made.
7th April 2021
The Times: The SNP have outlined plans to increase NHS activity in Scotland to 10 per cent above pre-pandemic levels within one year as part of recovery efforts if re-elected to power next month. They aim to hold that level of the remainder of their term in office. To achieve this they have highlighted three areas
- Invest in, and recognise, the contribution of the magnificent NHS staff who care for us.
- Enable more people to get the right support closer to their home.
- Build and maximise hospital capacity so more patients can be treated more quickly.
25th March 2021
Boris Johnson has warned that the UK could soon be hit by a third wave of coronavirus infections similar to that currently being experienced by other European countries. “A further wave of [covid-19] in the UK is inevitable". "Though whether this is in the next few months or later in autumn is not certain,” said Paul Hunter at the University of East Anglia in a statement. “How the current surge in cases across several European nations will impact on the UK is also not certain at present,” said Hunter. How much vaccines prevent transmission of the virus is one key factor, he said: “although none of the current vaccines can really prevent transmission, they certainly suppress transmission and will go a long way towards reducing the impact of any future wave.” This is also supported by statements from Chris Whitty warning that easing of restrictions could lead to a further surge. The implications of this can be seen in modelling at Trust level with one trust’s projections suggest it is on the way – and is likely to arrive soon and it could be dealing with a peak of patients nearly as high as the first wave as early as June – and that is in a “reasonably optimistic” scenario. The forecasts are heavily reliant on factors such as the efficacy of the vaccine and how the public behaves over the next few weeks. The positive news is that, by the end of the summer, some sort of herd immunity from a mix of vaccination and people who have had covid and recovered could drive admissions to very low levels.
18th March 2021
HSJ: The NHS will get an additional £6.6bn over next six months, on top of Budget settlement to to meet the additional costs of the coronavirus pandemic and elective recovery programmes in the first half of 2021-22. Whilst welcome, it is a dramatic drop from the £18bn available for the impact of covid this year. The premise for the additional funding is, in part, to start working on the elective recovery. Matt Hancock has also said there would be £594m towards hospital discharge services to provide better care and free up bed capacity.
HSJ: Trust leaders have warned that the NHS needs to focus on staff recovery over coming months rather than elective recovery, postponing ratcheting up elective recovery efforts and other long-term priorities until the second quarter. This is against a backdrop of expected national guidance being issued later this month and the discussing short-term funding which is expected to be announced very shortly.
15th March 2021
HSJ: HSJ analysis of NHS sitrep data shows the number of adults in critical care has fallen close to pre-covid-19 levels in two NHS regions but levels remain up to 40 per cent higher in the other five regions. The analysis shows hospitals in all regions across England are getting closer to normal levels of critical care patients compared to the same time last year i.e. just before the first UK wave of the pandemic.
However the uneven spread means that while many hospitals have been able to turn attentions to recovering elective surgery, some are still caring for significantly more critically ill people than usual, nearly two months after the peak of the third wave. London and the East of England — two of the hardest-hit regions in the second wave —are both still around 40 per cent up on this time last year.
11th March 2021
HSJ: Around 8 per cent of patients are now waiting a year or more for elective care in five specialties, as the number of very long waiters again increased significantly. The number of patients who have been on the overall NHS waiting list in England for 52 weeks or more rose from 224,205 in December to 304,044 in January, according to NHS England data. This is up from 1,613 last February before the pandemic hit. The five specialties in which over 8 per cent are waiting more than a year are: general surgery, orthopaedics, ear nose and throat, oral surgery and plastic surgery
3rd March 2021
HSJ: The NHS’s London regional team has issued guidance setting out strategic planning priorities for its integrated care systems. These include:
- Planning for a third wave of COVID-19 later in 2021
- Ensure staff get immediate rest and respite
- Set out plans to “desurge critical care”
- Plan for elective recovery.
Under the elective recovery section, the presentation said ICSs should set out how their long waiter backlog — those waiting 52 weeks or more — will be “eliminated through the effective use of residual elective capacity”. It added that ICSs should ensure “maximum separation of emergency and elective pathways, particularly through utilisation of fast track surgical hubs”. The guidance is entitled “Spring recovery planning” giving some indication of timeline. A national framework for tackling the NHS’ growing elective waiting list expected later this month which will also include access rules for the £1bn support funding.
1st March 2021
HSJ: NHS England provisional data shows people waiting 52 weeks or longer for ophthalmology treatment increased to more than 23,000 in December, compared to just 40 the year before. Experts say ophthalmology procedures have been hit particularly hard by the cancellation of elective work due to covid-19 pressures. On average, roughly 130,000 ophthalmology patients completed treatment per month in England in 2019, most of which would likely have been cataract surgeries. Royal College of Ophthalmologists have expressed concerns that “traditional” ways of working were too “fragmented” to address the challenge and that a “much more innovative” approach is needed to deal with the surgery backlog which could take “two years, maybe longer” to clear.
HSJ analysis shows ophthalmology had the highest increase in 52+ week waiters by proportion for any speciality.
19th February 2021
HSJ: Elective treatment activity levels in January were running at around 60 per cent of the same period last year and this has likely increased slightly in February. With reports that some hospitals plan to be back at 100% by March. However overall the expectation from William Harrop-Griffiths, Royal College of Aneathetistis vice president, is that as we head towards May, June, July, that we’re starting to be able to look at the levels closer to normal planned care, and that with appropriate resourcing and leadership, and without a further covid wave, the NHS could deliver elective care above pre-pandemic levels in September or October.
Measures being considered to support this include creating a group of recently retired doctors, including consultant anaesthetists, who are willing to return to the workforce and can be placed in regions where they are most needed to support stretched services. Also a programme in London is exploring different surgical or anaesthetic techniques to enable more overnight cases to be carried out as day cases.
11th February 2021
To demonstrate both the regional nature of the pandemic impact and the fact that we are not out of the woods yet by any means, HSJ have reported that 25% of trusts saw the number of patients in critical care grow in the past week, despite overall covid-19 occupancy falling. This is against a backdrop where adult critical care occupancy still very high in many areas — 10 trusts still have at least double the number of patients that they normally have space for. The critical care units still seeing increasing pressure when compared to last year are spread nationally, but are predominantly in Yorkshire, Midlands and the North West, where the covid third wave peaked later.
10th February 2021
HSJ: Leaked documents have outlined that NHS England will face an external review in September of the national contracts with private sector established during the pandemic response. Since the start of the coronavirus pandemic, NHS England has had unprecedented national contracts in place for private hospital capacity in England. The total cost has never been revealed, although public contract notices suggest they were worth around £400m per month. The document stated that they “…will need to populate data about the utilisation of the IS from the beginning of the contracts in March 2020 ahead of this review in order to develop the narrative.”
HSJ: Data just published shows the extent of the impact of the latest spike on elective care showing that as cases and hospitalisation rose rapidly in January elective activity was significantly lower than those achieved before Christmas. As would be expected regions more severely impacted by the third wave of coronavirus saw steeper reductions. The upshot of this is that there are now more than 100,000 P2 operations on the national waiting list.
Newly reported data also shows the number of P3 cases, those which must be done within three months, on the waiting list was 162,898 as of late January. But it should be noted that the data suggests the NHS was able to preserve a much higher level of elective activity in the third wave, despite the covid pressures being more severe.
31st January 2021
Guardian: The NHS in England will take “months” to return to normal service after the Covid crisis is finally over, because its workforce is “exhausted and traumatised”, according to a senior hospital trusts boss. After working intensely and seeing huge numbers of patients dying during the second wave “very large numbers” will go on long-term sick leave or leave their jobs, added Chris Hopson, chief executive of NHS Providers. MPs or patients should neither expect nor pressurise the NHS to immediately resume speedy diagnostic and treatment services because that is “not possible”, he added.
29th January 2021
HSJ: The welcome decline in the admission of covid positive patients to English hospitals is accelerating significantly as all regions consistently descend from the peak. The running seven-day total of admissions fell 4,302 (17 per cent) to 20,983 during the period ending 26 January. This is more than three times the fall of 1,397 recorded in the previous week. The national seven-day total is now 21 per cent lower than the peak set on 12 January.
However, this must be looked at in wider context as it is still 9 per cent above the highest weekly admissions total recorded in the pandemic’s first wave. Also whilst admissions are falling the number of patients with COVID in hospitals is still significant and spread across the country, see latest HSJ ‘Heatmap’ for further details.
28th January 2021
HSJ: Good news reported that the number of covid positive patients in English hospitals fell by 1,491 yesterday (27/01/21), the biggest decline recorded since the start of the pandemic. The national total of covid positive hospital patients now stands at 30,846, a drop of 9 per cent on the peak set on 18 January, but still 163 per cent of the mid-April peak. All seven English regions are now seeing a week-on-week decline in the number of their covid hospital patients for the first time. However the national picture masks regional variations. As the demand for intensive care appears to have peaked in the capital over the last fortnight, pressures in the Midlands have continued rising with hospitals there making a final expansion to their critical care capacity that would reach the limit of what they are able to provide.
21st January 2021
HSJ: In the South East, East and particularly London, covid bed occupancy remains extremely high and ICU capacity has been tripled, but admissions are falling. Length of stay is also a growing problem, the improvement in mortality rate from one-third survive in the first wave to two-thirds survive in the second means there is a huge pressure on beds from patients who can’t yet be discharged.
The situation in the Midlands, North and West could soon be the same as in London. They are all still seeing rising numbers of covid inpatients and the Midlands is about to overtake London as having the highest weekly admissions in the country with the North West, North East and Yorkshire regions all now ahead of those in the East. The outstanding question is whether London will have recovered in time to support them as they have supported it.
14th January 2021
HSJ: NHS England has told local leaders to outline plans to use up to 100 per cent of their private sector capacity from next week. The terms of the current three-month national contract with 14 independent providers only give the NHS access to the same capacity that it used in October and November, when covid pressures were far less severe. This has resulted in some hospitals not being able to access the additional capacity they need. However, national leaders now appear ready to trigger “surge” arrangements under the contract, which would provide full access. Higher activity levels in the private sector would trigger additional payments. It is understood the Treasury has close oversight over the national private sector contracts.
BBC: Numbers waiting for hospital treatment in England hit record high
A total of 4.46 million people were waiting to start hospital treatment in England at the end of November 2020, the highest number since records began.
The figure is up from 4.42 million in November 2019 and 4.45 million in October that year - the previous highest number since the data was first recorded in August 2007.
The number of people having to wait more than 52 weeks to start hospital treatment in England was 192,169 in November 2020 - the highest number for any calendar month since May 2008 - according to the figures from NHS England. In November 2019, that number stood at just 1,398. The total number of people admitted for routine treatment in hospitals in England was down 27% in November compared with a year ago.
13th January 2021
The current situation of high levels of COVID bed occupancy, ongoing reports of critical levels in ICU (with at least one hospital declaring CRITCON 4) and case numbers continuing to rise, is a clear sign that elective and non-urgent procedures are not going to get back to normal anytime soon. This has seen hospitals reconfiguring to take on new roles and systematic transfers of COVID patients to other hospitals, or regions, as well as further dilution of ICU staffing ratios. The Nightingale hospitals are also now either on standby or in use. All NHS regions have now passed the previous April peak for COVID patients.
Chris Hopson, the chief executive of NHS Providers, has told the Health and Social Care Select Committee that peak demand on hospitals might not be reached until "early to mid-February" leading to a "more extended period of pressure" on the NHS than had initially been hoped, also that it is "pretty clear" the COVID infection rate "is not going to go down as quickly as it did" during the first lockdown last spring.
Whilst London and the South East remain the key areas hit, the pattern is changing, and other areas such as the South and North West are starting to see growing case numbers and the West Midlands is also fearing being overwhelmed having redeployed over 200 doctors to ICU.
In some areas the situation is so bad that even urgent (P2) cancer cases are being delayed and there is ongoing ‘discomfort’ with the role of the private sector in supporting the NHS since the cancellation of the national block contract.
The light at the end of the tunnel is of course the vaccine. We now have three approved (and more in the pipeline), with enough on order (but not delivered) to vaccinate the whole population. The vaccination programme plans to ‘jab’ the top priority groups by mid February.
4th January 2021
HSJ: NHS leaders are holding fresh talks with private healthcare groups to try to secure surgery for urgent cancer patients in London, as the covid-19 second wave causes hospitals in the capital to make widespread cancellations. In recent weeks, pivotal independent sector providers have declined to do the procedures for the payments on offer. Following the end of the block contract with the private sector London now only has small, spot contracts in place for this work.
1st January 2021
HSJ and BBC: Staff absences and the new COVID variant are creating a "challenging situation", according to NHS Providers. New analysis by Imperial College London has confirmed the new variant of coronavirus has a much quicker rate of transmission than the original strain, increasing the R rate by between 0.4 and 0.7. Analysis by HSJ shows the increasing proportion of beds being filled by COVID patients with over 50% in some of the hardest hit trusts.
30th December 2020
HSJ: Covid bed numbers are now increasing at a rate of around 700 a day on a weekly basis, with the last four days showing an average rise of over 1,000 a day. If this rate continues, the English NHS would be on course to record 30,000 covid hospital patients by the end of the first week of January. This is being driven in part by a return to growth in the midlands and the north.
Over the last seven days, the number of covid positive patients in Midlands’ hospitals rose by 15 per cent to 3,876 in the seven days to 30 December, surpassing the previous record on 3,430 set in mid-April. A similar pattern has been seen in the north west and north west and Yorkshire regions, where covid positive hospital patients have increased by 12 and nine per cent respectively over the same period.
29th December 2020
HSJ: Acute Trusts across the south east of England are getting hit hard with at least a third of beds are set to be filled with covid patients by new year’s eve across three connected health systems. The areas are Kent and Medway, east London, and mid and south Essex. A fourth linked health system, north central London, is set to have three of its four acutes record covid bed occupancy of over a third.
Sky News: Hospital admissions near first peak as doctor warns full UK vaccine rollout could take a year. The number of people being admitted to hospital is nearing the level of the first peak in April and the problem could continue to get worse through January and February, it has been warned. Dr Adrian Boyle, from the Royal College of Emergency Medicine, advised the situation was "very tough" and added that the problem was particularly acute in London but "this could easily spread".
28th December 2020
The Times: A leading surgeon Jackie Taylor, president of the Royal College of Physicians and Surgeons of Glasgow, has said that non-urgent care will have to be paused amid signs of a new surge in coronavirus cases. The suspension of non-urgent hospital appointments was likely to be the cost of allowing household mixing in Scotland on Christmas Day. The World Health Organisation has said that the virus may run out of control if 5 per cent of tests are positive over a two-week period. The rolling average of positive cases has been above 5 per cent in Scotland since December 11.
22nd December 2020
HSJ: In light of the increasing levels of covid 19 within the system, NHS England’s control over clinical commissioning groups has been extended to enable it to ‘commission healthcare from independent sector providers’ during the ongoing covid pandemic. The new direction from the Department of Health and Social Care extends the powers that NHSE was given in March this year by another three months. The direction was previously due to end on 31 December 2020 and will now finish on 31 March 2021.
21st December 2020
HSJ: All seven NHS England regions are now struggling under covid inpatient demand not seen since the peak of the pandemic in April. At the same time, deaths of covid positive hospital patients have started to rise once more. The number of covid positive inpatients in English hospitals rose 2,256 to 16,183 over the seven days to 19 December. The 16.2 per cent increase compares to one of 7.4 per cent in the previous seven-day period, underlining the accelerating nature of the pandemic.
This is having an impact of non-covid services care with cancer surgery in London under threat as rising covid admissions put pressure on services that no longer have back-up capacity from the independent sector. NHS England ended contracts with HCA, The London Clinic and the Cromwell Hospital at the end of August, after concerns about underutilisation. Under the previous deal with the private sector, rules were in place to make sure low-priority private patients were not treated ahead of NHS patients who needed surgery urgently. HCA and The Cromwell have confirmed the contracts were ended in August and were not renewed.
18th December 2020
HSJ: Covid admissions and occupancy are rising nationally, with the number of covid-positive patients in hospital rising in 80 per cent of England’s health systems. In England’s 126 general acute hospital trusts:
- 78 (62 per cent) saw their number of covid patients grow in the week to 15 December (Tuesday) — in 35, it grew by more than 20 per cent.
- 89 (71 per cent) saw their number of new covid cases in hospital (admissions and diagnosed in hospital) grow in the week to 15 December (Tuesday) — in 59, it grew by more than 20 per cent.
The data shows the virus’ impact on the NHS is growing in nearly all areas.
This is starting to hit elective performance, and the NHS in Kent - one of the largest trusts in England - has postponed non-urgent procedures after coronavirus cases rose beyond figures seen in the spring. Health bosses have warned the NHS is under significant pressure, with nearly 90% of hospital beds in England full. Also Whipps Cross Hospital in north east London, part of Barts Health Trust, one of England’s largest hospital trusts, has been forced to divert ambulances and cancel operations, after seeing a very steep increase in covid-19 admissions over the past week.
9th December 2020
HSJ: Covid hospital admissions in England have risen for four consecutive days to 6 December, reversing the trend of 16 consecutive days of a fall previously. Covid hospitalisation is now at the same level as in late April.
This rising national total is primarily driven by areas outside of the the northern regions, which had previously powered the second covid wave with increases in London, South East and Midlands. We are now starting to see elective cancelations in these hotspots. The level of hospitalisation is causing increasing concern about how many covid patients will be treated when the household-mixing restrictions are lifted over Christmas.
30th November 2020
HSJ: Bed occupancy data is indicating that the second wave of covid peaked at 13,767 on 23rd November. The number of beds occupied by covid patients has fallen for five consecutive days across the country. The seven NHS regions saw their hospital occupancy peak at different points. Nationally, fewer beds were occupied by covid patients in the second wave than in the first, in which it peaked at 17,712.
26th November 2020
The Increasing Capacity Framework went live on 26/11/20. Local systems are now free to draw down from that and it is expected that contracts will start to be put in place between now and 1 Jan. The contract runs 20th November 2020 to 19th November 2022 (with 1 x 24-month extension option exercisable by NHS England on behalf of all contracting authorities).
23rd November 2020
In a sign of the rapidly changing picture, and hopefully the impact of lockdown, Covid admissions are continuing to decline across most of the country. However there is rise in London and the South East. While It recently dipped in both London and the South East, interrupting rising trends, both have now returned to sustained growth. But one of the lessons from the first wave is that the decline in hospital admissions is slow, and potentially drag on for months. So, although the virus is in decline, it remains at relatively high levels, and could do for weeks or months to come.
22nd November 2020
The Guardian: NHS intensive care units, are routinely understaffed doctors have warn. A survey by The Faculty of Intensive Care Medicine found four out of five intensive care consultants believe shortages of doctors and nurses have left ICUs too “stretched” to provide the best possible treatment.
20th November 2020
Latest data from NHS England shows that numbers of admissions for COVID continue to rise. There is however a change on the pattern with admissions and bed occupancy either flattening or declining in health systems in the North West and North East and Yorkshire, which have been hardest hit, this however is being off-set by quickly rising patients numbers in Midlands, Lincolnshire and Humber, Coast and Vale
There are also signs that the pressure of covid is starting to hit the South East with Medway the first acute Trust from that region to see its covid bed occupancy surpass 20 per cent.
Figures issued by NHS England show these rising pressures are compounded by the number of general and acute beds in trusts being nearly 5,600 lower than the same period last year. This is partly due to beds being removed to allow social distance and to aid infection control. Additionally the beds can’t be used as flexibly as before because of the need to segregate covid and non-covid patients, reducing overall occupancy.
4th November 2020
NHS England has returned the system to the highest alert level 4 of emergency preparedness framework, giving greater national control over local resources and decision making. In a press conference Simon Stevens also outlined the status as regards a vaccine slight chance that covid vaccines might begin to be distributed to the NHS before Christmas, although in limited quantities. A wider rollout is expected to take place in first half of 2021 and would require a combination of staff, including GPs, pharmacists, nurses and others, and a combination of venues including new “mass vaccination centres”, which could include the mothballed Nightingale hospitals.
1st November 2020
Guardian: Despite the new national restrictions announced by the Prime Minister over the weekend, Doctors’ leaders have warned that hospitals will be forced to cancel routine operations across England due to pressures from resurgent Covid cases. They have indicated that the situation will deteriorate in the short-term due to 100,000 vacancies impacting on the ability to utilise Nightingale capacity, and the time lag from infection to hospitalisation to impact on transmission rates during November’s lockdown.
23rd October 2020
The Guardian: Organisations representing frontline doctors, including the British Medical Association (BMA), have warned mass cancellations of routine operations in England are inevitable this autumn and winter despite an NHS edict that hospitals must not again disrupt normal care. They also criticised NHS England for ordering hospitals to provide “near normal” levels of non-Covid care in the second wave of the pandemic, and demanded that fines for failing to meet targets be scrapped.
21st October 2020
HSJ: Due to the number of covid patients, Rotherham Foundation Trust has suspended non-urgent electives that require an inpatient bed. The measures were put in place on 19th October for 48 hours and this has now been extended indefinitely.
HSJ: More trusts are reviewing their position as COVID pressures mount. Bradford Hospitals Trust says that the number of covid patients are now at first peak levels and they are suspending some non-urgent surgery and outpatient appointments for two weeks from 20th October. A number of others including University Hospitals Birmingham and Airdale are postponing or prioritising surgery. This follows hospitals in Liverpool, Nottingham and Plymouth cancelling surgery in recent days due to covid. The NHS nationally wants hospitals to carry on as long as possible with planned care, despite rising covid infections and admissions.
17th October 2020
HSJ: Nottingham University Hospitals Trust has cancelled all non-urgent electives due to growing covid admissions and spread inside the hospital. Only category one and two operations will go ahead, with other less urgent procedures being postponed.
16th October 2020
HSJ: Professor Steve Powis has announced that in response to the steep rise of covid cases and hospital admissions in northern England, the Nightingale hospitals in Manchester, Sunderland and Harrogate would be “mobilised in the coming weeks”. This was due to fears that acute hospitals - probably led by those in Liverpool - could soon become overwhelmed. These make-shift hospitals - unlike the London Nightingale - are not expected to treat patients needing ventilation but more likely, if they are to be used, to provide step-down care. There will not be emergency rotas to staff the hospitals as national leaders are very reluctant to disrupt elective and cancer care once again.
14th October 2020
HSJ: The latest NHS England data has shown the number of covid-19 related absences of staff, either through sickness or self-isolation, has risen from 11,952 on 1 September to 19,493 on 1 October. Staff absence has almost doubled in the North West in this time as well – from 2,664 to 5,142 during the same period. This is will have a ‘significant impact’ on the ability of the NHS to deliver critical care services and routine operations. Staffing levels are usually tightly controlled with little spare capacity in the system, therefore any additional sickness is likely to have a significant impact.
12th October 2020
HSJ: Liverpool University Hospitals Foundation Trust has reached a “critical point” in terms of coronavirus pressure and have begun scaling back their elective activity and preparing non- specialist staff to be redeployed to critical care teams. NHS England has also said it is introducing routine testing of asymptomatic staff in the most affected areas, and that Nightingale hospitals in central Manchester, Sunderland, and Harrogate would be put on standby.
6th October 2020
BBC: There could be a "tsunami" of cancelled operations this winter as the NHS copes with rising numbers of coronavirus patients,Members of the Royal College of Surgeons of England have warned.
1st October 2020
HSJ: An editorial piece in HSJ re-emphasises some of the tensions between national ambitions and local realities. Highlighting the need to keep the NHS open for core business as one of the reasons for the disconnect, whilst acknowledging that any unnecessary delays to vital non-covid services is high undesirable and that local factors, such as infection rates, may result in an uneven regional response to service restoration.
28th September 2020
Health systems have been told to set out the “system-level surge/escalation approach” that would be deployed in the event of a “more intense peak of covid demand”, and to show how an increase in covid demand would impact the restoration of non-covid services, including how they would respond to a series of scenarios in which in which the proportion of beds occupied by covid patients is 5 per cent, 20 per cent and 35 per cent.
25th September 2020
HSJ: NHS leaders are preparing escalation plans for a potential “second wave” of coronavirus, but will continue seeking to restore non-covid care until “as late as possible”, Sir Simon Stevens told an HSJ event today.
Front Line NHS leaders are reviewing the escalation plans deployed during the first wave of covid to address what a second wave plan could look like under different scenarios. The aim is to leave any implementation as late as possible as many NHS leaders, and some in government, think repeating a major wind-down would be disastrous for planned care.
19th September 2020
NHS Trusts communicating directly with their local populations on the difficulties of restart
- Open letter from Martin Barkley, Chief Executive on 17 September 2020
10th September 2020
HSJ: London’s NHS is attempting to fast track the creation of centralised surgical hubs for each of its five health systems in a bid to recover spiralling waiting lists and long waits. Moorfields Eye Hospital FT chief executive David Probert will lead the work, while London’s elective improvement programme overall is being led by Tim Briggs. The high volume specialties which will be covered — orthopaedics, ophthalmology, urology, gynaecology, ENT and general surgery — account for 70 per cent of the capital’s total waiting list.
HSJ: Typically, when an elective patient has been waiting 40 weeks since referral, that is a warning to hospital managers that they need to take prompt action to avoid breaching the ”zero tolerance” 52 week waiting time target. HSJ now reports that the 40 week wait has become the norm across England, according to the latest data for the end of July,
7th September 2020
Healthcare leaders have highlighted how a second peak or wave of the virus would compromise the NHS’ ability to achieve the targets outlined by NHSE in the recent Phase 3 restart letter. Talking to HSJ, NHS Providers Chief Executive Chris Hopson said: “There is significant concern about a prolonged second peak that lasts for a long period of time, particularly if it’s combined with the peak of winter pressures and high levels of winter flu. Such a peak would significantly impact on the NHS’s ability to recover services at the current planned rate of recovery.” Whilst NHS Confederation chief Niall Dickson warned against “overpromising” what the NHS can achieve, and that it faced ”a formidable challenge”. Nuffield Trust Chief Executive Nigel Edwards said: “Large numbers of hospital admissions could mean people going back to the sort of restrictions [in service provision] we saw in the early days of covid. The plans to return to normal are very much premised on trying to contain the infection.”
Reporting also in The Guardian, Siva Anandaciva, Chief Analyst at the King’s Fund, said: “… the desire to restore NHS activity levels as soon as possible may be the right one, these new targets may prove to be more skewed towards ambition than realism.”
4th September 2020
HSJ: Plans for up to 150 new community diagnostic hubs (CDHs) to tackle the NHS’ ballooning diagnostic waiting lists are included in leaked NHS England plans. Services will include: CT, MRI, ultrasound, plain X-ray, echocardiography, ECG and rhythm monitoring, spirometry and some lung function tests, phlebotomy and, in some CDHs, endoscopy facilities. The latter could be provided in standalone facilities and that these could also become endoscopy training academies. The CDHs should follow new covid rules allowing them to work at 90% capacity, compared to acute facilities which are currently working at 70% capacity due to the need to deep clean equipment. The hubs should align with new cancer rapid diagnostic centres as well as other existing diagnostic networks.
27th August 2020
The Times: The NHS has a “hidden waiting list” of 15.3 million patients who need follow-up appointments for health problems, according to the first analysis of its kind. The official waiting list, which stands at 3.9 million, shows how many patients are yet to have their first hospital appointment after a GP referral. However, the total number who are on hospital books in England and need appointments is not collated centrally. A new calculation, based on freedom of information requests to NHS trusts and seen by The Times, puts the figure at 15.3 million.
25th August 2020
HSJ: Significant changes to a range of services, including A&E, stroke and maternity, made amid the covid-19 crisis are set to remain into next year, HSJ reports. Trusts have made changes to a range of services in recent months, with the pandemic cited as the key driver for reform. But, despite falling numbers of covid patients in hospitals, a number of key services will not be reinstated this year.
24th August 2020
HSJ: New financial penalties and incentives for elective activity will be implemented from September following a letter from NHS England to Local leaders. The incentive will be solely based on system-level performance, further cementing the move to ICSs, although prompting concerns from local leaders. Providers have been on block contracts for the first half of the year, but under new rules for the second half of 2020-21, there will be a new marginal tariff rates for activity above or below the expected levels of waiting list activity for each system. The incentive will also be applied (under slightly different rules) to NHS use of the independent sector.
20th August 2020
A procurement notice has been issued on behalf of the London region by Guy’s & St Thomas’ Foundation Trust for providers on an £80m, four month contract, to catch up with treatment backlog. This follows the termination of the contract with some London providers established as part of the initial COVID-19 response and also follows on from a £10bn tender as part of national framework (see previous entry).
17th August 2020
The NHS could spend £10bn on outsourcing work to private hospital groups over the next four years. A contract notice published today said the work would “support the reduction of waiting lists”. Private providers have until 27 August to register their interest in being on the framework to provide “NHS inpatient and outpatient services (including full supporting pathology and imaging and “NHS inpatient non-elective care”). The procurement exercise will be launched in September and awarded in November.
13th August 2020
The latest waiting time data for electives, diagnostics and cancer suggests the chances of NHS England’s ambitions for a return to 90% of pre-covid by October are unlikely to be met and indicated that NHSE’s activity targets for trusts appear more aspirational than achievable. Even if the system does manage to increase elective activity back up to 90 per cent, the waiting list will still be growing as the number of new referrals is now back to exceeding the number of patients starting their treatment.
7th August 2020
HSJ: NHS England this week terminated a number of its block contracts including those with all the inner London private hospitals — established at the beginning of the covid outbreak. NHSE stated the terms of an interim arrangement, due to cover the period from now until a “re-procured national framework agreement” is put in place in the autumn, had not yet been agreed. The agreement is viewed as crucial in the NHS’s efforts to get a grip on its waiting list and spiraling numbers of people with very long waits.
6th August 2020
The Guardian: Leading clinical organisations are urging the NHS not to shut down normal care if a second wave of Covid-19 hits, stating the NHS must never again be a Covid-only service, a claim rejected by NHS England. Hospitals should set up more COVID-Protected sites to enable surgeons to resume common operations such as hip and knee replacements and cataract removals, and make good use of the NHS’s contract with the private sector.
31st July 2020
HSJ: NHS England and Improvement has set out the system’s priorities for the remainder of 2020-21 in a “phase three letter” sent to local leaders. It said the NHS must “return to near-normal levels of non-covid health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter”, when further emergency and covid pressures are anticipated.
29th July 2020
HSJ: The blanket introduction of a block contracts during the coronavirus pandemic, originally put in place until the end of July, will likely be extended to at least the end of September. What will happen in the second half of 2019-20 is due to be set out by NHS England in the coming days. Many trusts are assuming the block contracts will remain broadly as they are.
27th July 2020
HSJ: The blanket requirement for adults to self-isolate for 14 days before planned tests and treatment has been scrapped under updated guidelines set out in new NICE guidance. The guidance still “advises” high-risk patients to self isolate for a full 14 days and for others to follow what it calls “comprehensive social-distancing” rules, in addition to self-isolating for at least a few days.
HSJ: Worst case forecast for neurosurgery is for the waiting list to grow to between 63,000 and 66,000 by December 2020, due to the impact of coronavirus. Analysis of NHS data suggests the waiting list stood at 34,000 in January. Waiting lists vary considerably from region to region, and the forecast is based on multiple variables such as theatre and staff capacity.
24th July 2020
HSJ: A new tranche of commissioning restrictions have been proposed to ease pressure on diagnostic teams and move more treatments to primary care settings. The latest expansion of the evidence-based interventions programmme recommends that 31 procedures should be restricted to only certain types of patients. Proposals include limiting the number of colonoscopies and endoscopies to those deemed at high risk of certain conditions, as well as limiting X-rays for frozen shoulders, MRI scans for arthritic hips and some chest X-rays.
17th July 2020
BBC: The NHS in England will get an extra £3bn of funding to prepare for a possible second wave of coronavirus. The funding will also help ease winter pressures on the health service and will be used to continue using additional private hospital capacity and maintain the temporary Nightingale hospitals until the end of March 2021.Providing additional capacity for coronavirus patients, as well as allowing the NHS to carry out routine treatments and procedures.
16th July 2020
HSJ: NHS providers have been told the block contracts they have operated under during the covid pandemic will be extended by at least another month. The block contracting arrangements, designed to free up management capacity and give trusts certainty over their finances, were put in place for an initial period of four months, from April to the end of July. NHS England and NHS Improvement said the regime will be extended for at least another month, and possibly beyond.
13th July 2020
HSJ: NHS trusts face a “wicked problem” in restoring services and more patients will have to be treated with pain management and other alternatives to hospital-based care. With the presence and risk of coronavirus severely limiting capacity trusts will have to work with GPs to find ways to reduce referrals and transform current pathways. The answer, in significant part, lies with demand management and secondary prevention strategies.
HSJ: Senior managers have warned of the “massive” endoscopy problem if a deal to use private sector capacity is not agreed. Significant amounts of activity is needed to catch up on elective treatment with the number of colonoscopies performed in April and May one-eighth of same period in 2019. Ministers and NHS England are thought to still be in discussions over a new contract between the NHS and independent sector providers.
The current contract remains in place until it is terminated or replaced. It was previously expected to be replaced at the end of June, but no replacement deal — likely to move to more activity-based payment — has yet been announced.
9th July 2020
HSJ: Monthly stats show new patient referrals in May have dropped by almost two thirds year-on-year, around 625,000 against 1.7m last year. New referral figures (RTT) show only a slight increase in new patients compared to April, when just under 500,000 people were referred. Figures suggest work restoring electives remains slow. In April and May English hospitals admitted 96,000 elective patients compared with 585,000 in the same period last year. The overall elective waiting list decreased for the third month in a row (3.9m to 3.8m) considered a result of fewer patients accessing services and fewer referrals overall. Whilst patients waiting more than a year continued to rise from 11,000 in April to 26,000 in May, the highest number for more than a decade.
7th July 2020
A report by the Neurological Alliance found almost 50 per cent of patients with conditions like MS, motor neurone disease and brain tumours had seen their consultant appointment cancelled with no follow up booked in, and many didn’t receive rehab after surgery, or their usual access to physiotherapy to prevent serious deterioration in their condition.
HSJ: NHS England has restored parts of its performance management regime by bringing back key reporting tasks suspended since March to address the backlog of elective demand and mounting referrals into secondary care. Trusts must again report their patient tracking lists which provide detail information on who is waiting for elective care and for how long. The requirement has been reintroduced to enable oversight of waiting lists and waiting times.
6th July 2020
HSJ: The NHS should free up extra capacity ahead of winter and further potential waves of COVID-19, according to Simon Corben, Director and Head of Profession NHS Estates and Facilities. In light of the coronavirus outbreak, the NHS needs to address the ratio between clinical and non-clinical space, reducing the latter down to 20 or 15%, to repurpose as surge capacity, from current levels of around 30%.
2nd July 2020
BOA: A detailed evidence review by Health Protection Scotland and endorsed by NERVTAG (New and Emerging Respiratory Virus Threats Advisory Group) found that transmission of respiratory infection from patient to healthcare worker by drilling, sawing and high speed or ultrasound cutter this source has never been demonstrated. Therefore, unless high speed instrument cutting, sawing or drilling involves the respiratory tract or paranasal sinuses, then the PPE recommendations can be changed from the original guidance. This means that it is no longer considered essential to use FFP3 masks for the surgical component of trauma and orthopaedic procedures.
HSJ: Demand for health services is now rising after activity plummeted across the health service in the early weeks of the pandemic. GPs are already reporting their workload is back to normal levels. Primary care will increase the number of in-person appointments it offers as time goes on, but it will not swiftly return to previous levels.
30th June 2020
Royal College of Physicians: As part of the Health and Social Care Select Committees inquiry into ‘Delivering Core NHS and Care Services during the Pandemic and Beyond’ Professor Andrew Goddard has given oral evidence to the select committee on 30 June. In the session, Professor Goddard provided insight into the challenges facing medical specialties. It shows that almost half of physician specialities, including cardiology, gastroenterology and rheumatology, expect to be working at less than previous pre-COVID activity levels for at least 12 months or more.
29th June 2020
This NHS Providers briefing shares the results of a survey carried out with the chairs and chief executives of trusts. It offers a snapshot view of the sector’s position as trusts emerge from the first peak of the outbreak, and move towards a ‘new normal’. It shares the different approaches trusts have put in place to continue caring for non-COVID patients and highlights the work they are doing to return to a sustainable level of services, and demonstrates the complexity of calculating what a sustainable level of service provision should be.
HSJ: Hospitals 'want to cut PPE requirements to speed surgery return'. Requirements on what PPE is used for different situations may be a major restraint on resuming planned care. Some hospitals have sought to water down PPE requirements in order to “accelerate” the return of planned surgery, senior doctors have said, as they issued new guidance aiming to inform the decision.
28th June 2020
Daily Mail: Patients will have to wait up to a year for hip and knee replacements as the NHS imposes strict infection controls, doctors' leaders warn.
26th June 2020
BOA: A message from the British Orthopaedic Association to people waiting for joint replacement and other orthopaedic surgery
24th June 2020
HSJ: Delays in accessing COVID-19 capital funds may affect plans to restore some key services as crucial changes such as segregating hospitals to create “clean” and “covid” pathways have been held up. NHS England says all bids submitted since the immediate response to covid are being considered
23rd June 2020
An analysis by the Labour Party of NHS England data highlights the increasing backlog of care building up in the health service, with a growing number of patients waiting for life saving scans and tests.
HSJ: Health services in at least one region are contingency planning to cope with a second peak of coronavirus demand based on an R number of 1.3 “cited as the reasonable worst case scenario by the military” It is understood other NHS regions are also planning on the basis that a further peak of covid demand on the NHS could be larger than the first. It is not yet clear what these predictions mean for the need to keep acute beds or intensive care capacity free, or for limitations on planned procedures taking place.
22nd June 2020
Pressure is building on government for continued funding for use of the independent sector in the NHS' response to COVID-19 and the restart of elective care. There have been a selection of views from NHS Providers, STP Leads and the FT.
19th June 2020
HSJ: The next phase of the recovery plan is to be outlined in the coming weeks in a letter from Sir Simon Stevens, who is likely to include proposals for creating pooled system-level waiting lists between Trusts, although individual providers’ would ultimately still have responsibility and accountability for their waiting lists, even where this might be “supplemented” by system-wide arrangements.
16th June 2020
Health Select Committee hearing on “Delivering Core NHS and Care Services during the Pandemic and Beyond” featuring Dr Katherine Henderson, President, Royal College of Emergency Medicine and Professor Derek Alderson, President, Royal College of Surgeons; amongst others.
Financial Times: NHS examines new deal with private hospitals to clear waiting lists. Private hospitals taken over by the government during the COVID-19 crisis are in talks about extending the arrangement for up to two years, as the NHS attempts to relieve growing pressure on patient waiting lists.
12th June 2020
HSJ: A leading doctor has warned that endoscopy services will struggle to get back to pre-covid levels and Trusts will need to prioritise patients. Endoscopy procedures are part of the pathway for many conditions, including bowel cancer and stomach ulcers and are aerosol generating. The time taken for droplets to settle in rooms after a procedure can be up to an hour and three quarters, depending on how areas are ventilated, only then can the room be cleaned and another patient seen. This could reduce capacity to a maximum of about 20 per cent of normal activity.
10th June 2020
The Independent: As the NHS tries to recover from the worst of the coronavirus crisis, more than a million laboratory samples from cancer screening services are expected in pathology labs, while as many as 850,000 delayed CT and MRI scans need to be carried out.
BBC: Health bosses fear the Covid-19 crisis could see the number of people waiting for NHS treatment double to 10 million by the end of the year. The NHS Confederation said challenges include a backlog of cases, maintaining social distancing, and staffing.
8th June 2020
The Guardian: Almost two-thirds of Britons with common life-threatening conditions have been denied care by the NHS because hospitals have focused on fighting COVID-19, new research has revealed. A majority of people with cardiovascular illnesses (60%) and brain problems (66%) had their care cancelled, as did 68% of people with arthritis and 78% of very overweight people, who are at greater risk of health problems.
3rd June 2020
BBC: Wales has indicated they are planning to "scale essential activity back up", although moves towards normal activity will be made "slowly and cautiously". Use of field hospitals and private hospitals will be reviewed. Plans for the next month include dividing up hospitals into areas of high and low coronavirus risk to ensure patient safety.
2nd June 2020
HSJ: Health chiefs in London are hoping to extend the block-booking of private hospitals for NHS patients for a further two months, with some pushing for even longer, to create covid-free sites to support a pilot scheme to try to get elective capacity up to 80 per cent of pre-covid levels.
The Times: The public may have to accept rationing from the NHS until a vaccine against Covid-19 becomes available, the Nuffield Trust has warned, with the NHS will aiming for 75 to 80 per cent occupancy to remain prepared for a potential second spike of the coronavirus. It will also be hampered by the need for increased infection control procedures, on top of existing challenges such as outdated buildings and a stretched and exhausted workforce.
28th May 2020
HSJ: London is working towards an 8 June restart for the work deemed “non urgent”.
HSJ: COVID restrictions will cut NHS surgery capacity in half is the view from the centre due to the many constraints of infection control, testing, scheduling and capacity issues. Although estimates as low as 40 per cent and as high as 80 per cent have been put forward (that is, assuming there is no second peak).
28th May 2020
HSJ: Dental practices are being told to reopen from 8 June for all face-to-face where practices assess that they have the necessary infection prevention controls and personal protective equipment requirements in place.
26th May 2020
NHS Providers have said that a lack of vital protective equipment and long waits for coronavirus test results are stopping hospitals from tackling a huge backlog in operations. Reported cases of patients whose surgery has been postponed because of the pandemic are having to face even longer delays because hospitals are waiting for as long as 13 days for the outcome of tests. Approximately 4.2 million people in England are waiting to have a non-urgent procedure.
25th May 2020
HSJ: System leaders are concerned they might have to cancel the lists they have been asked to restart as a second spike comes through. Broadly, the consensus of senior managers is that this is likely to happen and they have been asked to plan for a scenario where it hits in July (electives are supposed to start roughly around 8 June).
22nd May 2020
HSJ: The number of cardiac patients attending emergency departments is higher this month than previous years, as overall attendances continue to rise following the record drop-off since the COVID-19 outbreak, PHE data suggests daily attendances recorded as cardiac problems are broadly in line with the number of cases recorded before the COVID-19 outbreak. The return of cardiac patients bucks the overall trend of lower attendances, although the data also suggests overall attendances are creeping back up following record drop-offs in March and April.
21st May 2020
NIHR have issued a statement on a Framework for Restart. of a diverse portfolio of non-urgent research funded and/or supported by the NIHR - including both non-COVID-19 research and important COVID-19.
21st May 2020
HSJ: Data shows that many ICUs are still running well over their normal capacity with the number of patients being treated still well above normal levels. In addition, the ongoing reliance on keeping surge beds open – with ICUs still spilling over other spaces and calling on staff and equipment from other services — will limit hospitals’ ability to resume normal care, such as planned surgery.
20th May 2020
On their weekly webinar to suppliers, NHS Supply Chain announced they are beginning to increase stock of non-COVID-19 products as the restart resumes, in some cases this may be eight weeks demand. They are working with customers and NHS E/I to assess the demand.
19th May 2020
Writing in HTN, Orlando Agrippa, CEO, Draper & Dash, shared this interesting opinion piece, as he discusses modelling the impact of all planning assumptions in real time, alongside recovery programme support available.
15th May 2020
Work from the University of Birmingham shows that even without a second wave it will take approximately two years to clear the backlog of elective surgeries. The study estimates that even without a second spike, hospitals will still be running at around an average 20 percent reduced capacity until mid-September, when they would be able to resume much higher levels of surgery. During the next phase, beginning in mid-September - which it calls late recovery - surgical capacity will need to increase by 15 percent above normal levels to tackle the backlog.
15th May 2020
HSJ: Independent hospitals have been given the green light to start some private and NHS elective work, despite remaining ‘block-booked’ by the NHS in case of a covid surge.
The private sector will remain block-booked under commission from NHS England. However, the national commissioner has triggered the “de-escalation notice” in the contract.
15th May 2020
HSJ: Interactive maps of local NHS waits around England in April 2020, showing the pressures, with links to all the details by organisation and specialty. RTT and cancer data is for March and A&E data is for April.
15th May 2020
BOA publish guidance on re-starting non-urgent trauma and orthopaedic care.
14th May 2020
NHS England: Operating framework for urgent and planned services within hospitals covering planning, scheduling and organisation of clinical activity, testing of staff and patients, Infection Prevention and Control, monitoring & surveillance and continual improvement.
HSJ: Patients will be told to self-isolate along with their household for two weeks before being admitted to hospital even if they have no covid-19 symptoms under NHS England’s new guidance for re-starting elective care.
11th May 2020
ABHI publish guidance on access for industry staff to NHS premises.
1st May 2020
The Royal College of Anaesthetists, Association of Anaesthetists, Intensive Care Society and Faculty of Intensive Care Medicine publish a strategy document to address restarting planned surgery in the context of the COVID-19 pandemic.
29th April 2020
Simon Stevens publishes letter “SECOND PHASE OF NHS RESPONSE TO COVID19” to NHS regarding restart.
27th April 2020
ABHI announces engagement activity to support the restart of care. ABHI Board subgroup constituted.