Daily Insight: Restoration reconsidered

As coronavirus takes hold across much of the country, the restoration of elective activity is likely to be short lived in many areas.

Liverpool University Hospitals Foundation Trust is the first to abandon its restoration, with a surge in covid admissions forcing leaders to scale back theatre work and prepare staff for redeployment to critical care teams.

No trust wanted to be the first to take such measures, but LUH now has more than 250 beds occupied by covid patients (around 15 per cent), which is the highest in the country and around the same number it had on 2 April.

The extent to which electives will be reduced is unclear at the moment, but reading between the lines, it is likely to be substantial.

The most concerning part of a message sent out to staff was the ambition to maintain urgent and cancer surgery “where possible”, which suggests they could easily come under threat as well.

Further lockdown measures were announced today to try to break the circuit of the virus, while testing for asymptomatic staff has also been announced, along with the “mobilisation” of some Nightingale facilities.

But will the new lockdown measures work? Will there really be enough testing capacity? And will trusts really be prepared to send staff to the Nightingales this time around?

A perfect storm

It was recognised early in the pandemic that patients with eating disorders, who can be immune compromised, may be at risk of covid-19 infection.

At the time, the chair of the Royal College of Psychiatrists’ eating disorder faculty warned in HSJ that patients who were the most severely ill were getting the least support due to covid-19 restrictions.

She also warned that ED units across the country were having to run below full capacity due to limitations of poor estate and covid-19 infection risks for this cohort of patients.

This situation appears to have created the perfect storm for a few patients who were transferred, at NHS England’s requests, to a new eating disorder unit run by St Andrew’s Healthcare.

The unit was a low secure ward up until April 2020 when the provider adjusted the service to treat patients with personality disorders and eating disorders, following a CQC inspection for which it later received an inadequate rating. The new ED service has also since been heavily criticised by the CQC.

In response to HSJ’s queries the provider said it agreed to admit patients from acute hospitals, before staff had had extensive ED training because of the urgent pleas from NHS.

This story raises so many questions. Why were there no adequate well-established ED inpatient units to admit these patients? Did NHSE not carry out any quality checks on the unit? Why does the CQC’s registration system allow for a provider to change its service but not be subject to the same scrutiny as a new unit? Why did St Andrew’s not fully train staff before the unit was opened?