HSJ Weekly Catch Up: Making capital of the crisis, remote control and a data black hole

Not going to waste

There is a phrase among leadership types about “never letting a good crisis go to waste”, and that seems to be what London’s NHS leadership have been thinking too.

As reported by HSJ, NHS Improvement and England’s top team in the capital are hoping to move to a significantly different system by November 2021.

The new system would see the five integrated care systems (which still do not legally exist) as the principal organisational units of care in the capital, with the same leadership team that brought them through the covid-19 crisis.

What would that mean practically? One elective waiting list per ICS rather than per hospital trust, shared back office and support services. Effectively it would boil London’s trusts down into five big providers, each commissioned by the one big clinical commissioning group in that ICS. 

Keen to be remote

One of the changes system leaders are most eager to keep is remote consultation via Skype/Zoom/Other (it was one of the things mentioned in the document above).

The NHS was fortunate in the signing of one contract that allowed a lot of remote consultations to go ahead.

Outpatient attendances are another big target for NHS planners. There were 96.4 milion of them in 2018-19, a 3 per cent increase year-on-year and up 59 per cent from a decade ago.

Sir Simon Stevens said nearly two years ago that the outpatients model was “obsolete” and targeted a 25 per cent reduction – so the old system could soon be replaced entirely with remote consultations.

Or replaced by nothing at all: 22 per cent of appointments go unattended, which fuels some of the interest in “patient initiated follow-ups”, ie “come in for a follow-up if you want one, but it won’t be automatically scheduled”.

Regionalised spread

Coronavirus spread appears to be persisting at a higher rate in parts of the north of England – prompting warnings that the mortality gap between those more and less deprived will get bigger.

Figures seen by HSJ indicate the covid-19 hospital admission rate in the North West is falling far more slowly than elsewhere, and has been higher than all other NHS regions for nearly three weeks.

The political challenge is that local leaders in areas with more visible spread and impact are proving more wary about loosening the lockdown and changing the message.

Ticked off on testing

The UK Statistics Authority has given the health and social care secretary a ticking off over government’s reporting of covid-19 test numbers and called for greater transparency on how they present the data.

The watchdog’s intervention follows HSJ’s revelations that the government changed the way it counted the number of covid-19 tests in order to hit its target of 100,000 tests per day by the end of April.

UKSA Sir David Norgrove on Monday wrote to health and social care secretary Matt Hancock to outline the concerns.

The letter said: “We urge government to update the covid-19 national testing strategy to show more clearly how targets are being defined, measured and reported.”

Lost in a black hole

Data from tens of thousands of tests carried out outside the NHS has “disappeared into a black hole” due to a technical error.

Trusts had only been receiving data from NHS lab tests, which make up less than half of total tests now being carried out.

An internal email, seen by HSJ, said no new national testing programme data had been reported since the start of last week.

The Department of Health and Social Care said the error had been fixed but the data fault made it harder for NHS organisations to respond to the spread of covid-19 in their areas.

No stock answers

NHS procurement teams are confused and concerned by the suspension of a host of intensive care consumables from NHS Supply Chain’s online catalogue.

They must now contact an NHSE/I “clinical consumables group lead” to order the products – a position many haven’t heard of.

As well as adding to the myriad supply routes procurement teams are currently juggling, this new system raises some big questions about the supply of these products. Are stocks running low, and if so, how low? Have suppliers issued stock warnings? Why, weeks after the critical care peak, are these products now being restricted? And what will this mean for restarting business as usual care?

The patient 1,000

It may be some time before we have solid data on how the health service changed during the peak of the covid-19 response in April, including its impact on elective care.

However, HSJ analysis suggests up to 10,000 people may be waiting more than a year for elective treatment as a result of the pandemic. At the end of March 7,364 patients were waiting 48-52 weeks for treatment, on top of 3,097 already waiting a year.

With the slowdown and eventual suspension of non-urgent electives, it therefore seems the number of year-plus waiters could have passed 10,000.

Against all odds

There are few good things to come out of the covid-19 crisis but perhaps one has been a significant improvement in ambulance response times.

March was horrendous for many ambulance services – especially London Ambulance Service Trust – and performance against the key category 2 response time was the worst ever at more than 32 minutes (the target is 18).

But ambulance services have pulled out all the stops since then. Many have taken on extra staff (including final year paramedic students), enlisted help from the military and firefighters, and asked previous employees to come back: all of this has helped to mitigate the impact of widespread staff sickness.

This work has paid off. The number of incidents that ambulance services had to deal with in April was down 9 per cent on March (and slightly down on April last year) but performance has been transformed. Against categories two, three and four response times were the best since the current system of categories was introduced.