HSJ Weekly Catch Up: Processes scrapped, CEOs surveyed and testing tested

‘The next PPE’

In the words of one senior NHS manager at a large London trust this week: “Ventilators are going to be the next PPE.”

Last week, the NHS endured one round of severe distribution problems when procurement staff were left to plead on Twitter for more personal protective equipment.

During the next few weeks demand for ventilators — essential to helping covid-19 patients breathe — is going to rocket.

But several trust leaders have told HSJ they do not know if and when the ventilators they need will arrive.

While NHS Providers says it has received assurances the ventilators will arrive, the government has not publicly committed to dates.

PPE shortages caused huge problems for NHS staff. Ventilator shortages could mean worse for many patients.

Meanwhile, staff across London have been asked to volunteer to redeploy to the new hospital being built in the cavernous Excel exhibition centre in east London.

The NHS in London isn’t alone in having a staffing rethink. The National Institute for Health and Care Excellence has streamlined operations to free up front-line staff that normally sit on its committees to focus on covid-19 guidance and other critical therapeutic areas.

Testing, testing

There has been lots of talk about testing for covid-19 — and for whom — but less noise about the time spent waiting for tests.

But now sources from NHS trusts in the Black Country, south London and Essex have told HSJ they have waited between three and seven days for covid-19 tests to be completed by Public Health England’s labs.

Thankfully, turnaround times are likely to improve now that trusts have also begun to conduct covid-19 tests in their own labs.

Meanwhile, a major bulk-purchase of antibody home-testing kits, which should be just days away from being added to the NHS’ armoury, should also help ease the pressure.

Matt Hancock announced on Tuesday the government has bought 3.5 million home testing kits. Then, on Wednesday, Sharon Peacock, director of Public Health England’s national infection service, told MPs these would be available within days. 

CEO concerns revealed

The results from HSJ’s exclusive snap survey of trust chief executives laid bare the challenges the NHS is facing as it gears up for (hopefully) a once in a lifetime battle.

The three biggest areas were staff testing, workforce shortages and running out of personal protective equipment.

Meanwhile, thirteen of the 22 trust chief executives running organisations with ICUs warned they would run out of intensive care capacity by next week as the number of coronavirus cases continue to rise.

The need to dramatically increase the number of critical care beds and ventilator machines to cope with a surge in covid-19 patients has been well aired over recent weeks.

Less talked about is how the NHS is going to get adequate numbers of additional doctors and nurses to staff the new units.

The answer, which was revealed first to trusts in London, is to dilute the numbers of trained critical care staff looking after each patient.

HSJ understands trusts in the capital have been told to base their staffing models for ICU on having one critical care nurse for every six patients, supported by two non-specialist nurses and two healthcare assistants.

Under the normal guidance intensive care “requires a registered nurse/patient ratio of a minimum 1:1”.

Usual rules don’t apply

With coronavirus dominating the NHS’ planning, it was probably inevitable some of the normal processes and procedures would go out the window.

Board meetings seem to be one of the first areas were adjustments have been made. As HSJ has reported, some trusts and clinical commissioning groups are holding them without the public present, others are doing them remotely, and some have cancelled or postponed imminent meetings.

Meanwhile, last week payment by results was binned, this week NHS England took, in one fell swoop, the power to purchase and organise healthcare around England.

CCGs are still on the pitch, but with tariff negotiation out the window, and much more business conducted directly from centre to providers during the crisis, few are arguing that the local purchasing function is necessary right now.

Of the CCG role, one reader comments: “Wow. Well they won’t get the powers back now.”

Another casualty is the national data opt out policy, an initiative designed to ensure patient data is not shared for commercial, planning or research purposes if requested by the patient.

Compliance with the opt out was supposed to be achieved by the NHS before 31 March. But NHSX and NHS Digital have announced the deadline will be extended for six months until September to help free up staff time for covid-19 work.