Daily Insight: The greatest challenge

Coronavirus update

As the country spent Tuesday grappling with what the latest guidance on covid-19 — announced by the prime minister on Monday night — meant for them, NHS England issued new guidance seeking to steer the NHS and its workforce through uncertainty: effectively new operational guidance for 2020-21.

Elsewhere, its chief Sir Simon Stevens went before the Commons health and social care committee.

In the guidance letter from Sir Simon and chief operating officer Amanda Pritchard declared it “arguably the greatest challenge [the NHS] has faced since its creation”.

The takeaways include:

• NHS staff will be able to stay in NHS-reimbursed hotels to avoid a 14-day household isolation period, although the policy applies on “an entirely voluntary basis”;
• NHSE is asking Public Health England to establish NHS targetted testing as a matter of urgency as more testing becomes available, in an effort to enable those with symptoms to unnecessarily avoid a seven-day isolation period;
• NHS organisations have been asked to “make adjustments” for staff members at increased risk according to new guidance on isolation, which now includes pregnant women; 
• The NHS is aiming to free up 30,000 beds by postponing all non-urgent elective surgery from 15 April and discharging all patients who are “medically fit to leave”; 
• Trusts have been asked to “enhance” their ventilation capacity where possible;
• The payment by results system has been suspended for 2020-21 — and all major policy aside from covid-19 delayed;
• GP payment by performance suspended.

Meanwhile, on Monday it was revealed the Care Quality Commission had decided to call off routine inspections while the NHS is tackling the covid-19 outbreak, and on Tuesday, it was revealed what they would be doing instead.

The regulator will be seconding clinically qualified special advisers to the Department of Health and Social Care, Public Health England and NHS England, while its customer contact centre is also expected to start taking non-clinical covid-19 calls to support NHS 111 next week. 

Earlier this week, Matt Hancock took to Twitter to appeal to manufacturers to turn their hand to producing ventilators.

However, clinical engineers have warned HSJ building fit-for-purpose ventilators may not prove easy for the inexperienced, with Helen Meese, vice chair of biomedical engineering at the Institution of Mechanical Engineers, adding it could “take several weeks, if not months, to ensure the right processes are in place to increase production of these precision parts”.

Mr Hancock has previously said the NHS has access to 5,000 ventilators — but stressed the UK would need “many more times” that number as covid-19 cases rise.

Meanwhile, acute trusts have been given some respite in reporting. In an email sent late last week, Preeya Bailie, director of commercial and procurement at NHSE/I, told trusts to hold off sharing certain procurement metrics until at least May.

The next two procurement league tables, which rank trusts quarterly on several efficiency metrics, will also be delayed until further notice.