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
ABHI's NHS Restart Briefing document can be downloaded here. The document provides an outline of the current situation relating to the NHS retsart. It details how the situation has progressed, and describes ABHI's extensive activities to date. (June 2020).
Royal Collage of Surgeons of England: Recovery of surgical services during and after COVID-19 & Specialty guides for patient management during the coronavirus pandemic.
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 - 3rd August 2020.
Timeline of the latest news and guidance
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.