The must-read stories and debate in health policy and leadership.

Today NHS England confirmed its staff would no longer be prioritised for the vaccine, and instead switched to the initial plan of focusing on the over 80s and care home staff.

Now, most NHS staff are unlikely to get the jab before Christmas, raising questions over how this will logistically have an impact on hospitals who were preparing to vaccinate staff first.

Uncertainty over which vaccine would be approved by regulators has meant there have been various different action plans, dependent on the drug used.

In recent days, NHS plans had assumed NHS staff would receive this vaccine. This is because it is only being sent to 50 “hub hospital” sites, due to the logistical challenges of correctly storing, handling and transferring it, most of which must be done at very low temperatures.

The 50 “hospital hubs” were therefore told the first to get it would mostly be NHS hospital staff and had been planning on that basis until last night.

However, yesterday the NHS was overruled on this after the Joint Committee on Vaccination and Immunisation said over 80s and care home staff must be prioritised.

The U-turn has caused some uncertainty among local NHS leaders, who said the unexpected change to the guidance presents major logistical challenges.

HSJ’s podcast probes delivery of the vaccine

The UK is the first country in the western World to approve the Pfizer/BioNTech covid vaccine and now the baton has been passed to the NHS to successfully deliver it.

This week on the podcast the team unpick this huge piece of news and discuss the incredibly complicated logistics behind rolling out a vaccination programme this big, why it’s essential the government gets the communication spot on and how the NHS is approaching this challenge.

We’ve heard this week from senior NHS people that there is a sense of excitement about being part of bringing the country out of the pandemic crisis, but also in recent days this has been coloured by rapid chopping and changing in the government’s guidance.

One chief executive said: “Of the entire covid period… this is the thing NHS England is being most protective about. They are keen to manage expectations.”

Another told deputy editor Dave West: “I’ve never experienced anything quite so chaotic, or fluid.”

We also discuss the crucial role primary care could have in getting the country and economy back on track.

“It’s complicated and difficult.. but we deliver millions of flu vaccinations a year.. so not THAT complicated and difficult,” says deputy editor Dave West. Only time will tell.

Don’t bank on the planks

Last week’s spending review was the latest missed opportunity to set out a multi-year capital settlement for the NHS.

The seemingly cursed settlement, which the NHS hoped would be in spring 2019, has been a victim of Brexit, Tory leadership contests and a global pandemic.

The settlement is vital to local leaders because it gives them the chance to plan capital projects on a longer-term basis than the current 12-month scramble.

This would particularly help a group of trusts which face huge capital costs this decade due to their hospitals comprising large concrete planks which have outlived their shelf life.

For several trusts, including Airedale, Queen Elizabeth Hospital King’s Lynn and Mid Cheshire Hospitals, building new hospitals is the only sustainable way of managing the problem.

In the absence of a significant capital allocation, Airedale will have to spend £24m in the next three years reinforcing the planks.