‘Restoration’ of non-covid NHS services gets under way

Health and social care secretary Matt Hancock used today’s daily ministerial coronavirus briefing to announce that resumption of healthcare which has been suspended due to coronavirus will begin on Tuesday. He said the initial focus would be on the most urgent services, citing cancer and mental health as examples.

They will be reintroduced on a locally-decided basis, depending on the level the virus is currently impacting different areas and trusts, which varies widely, and how easily they can reintroduce the work, he said.

Mr Hancock, asked about the plan by HSJ during the briefing, indicated that a large-scale return would be enabled because the government is setting out to avoid a so-called second peak of the virus spreading, so the NHS will not need to keep tens of thousands of extra beds free in readiness. Experts and governments around the globe are concerned about the prospect of further peaks of the virus spread as they move to release distancing measures. 

Further NHS England guidance on the plan is expected this week. 

Just over 40 per cent of acute beds are currently unoccupied — much greater than normal for this time of year — but many acute hospitals have been reorganised to separate covid and non-covid areas, and make way for large numbers of beds with critical care facilities, and oxygen support.

Mr Hancock announced the resumption of services will be done through a “locally driven approach, system-by-system. The principle is that the most urgent treatment should be brought back first and that it needs to be done according to local demands on the system. There are parts of the country where coronavirus numbers are much lower than others”.

He said he could not give a “concrete answer” to when the bulk of general planned care would return, “but it will take place gradually over weeks, starting from tomorrow”.

NHS England’s national medical director, Stephen Powis, added: “It will occur hospital-by-hospital and region-by-region as infection rates are different, and different organisations have stepped up to manage the surge in slightly different ways.”

HSJ analysis shows which areas have had the most hospital deaths from covid-19, which is linked quite closely to overall hospitalisations.

The plan may frustrate some who are waiting for surgery in areas — such as London, Birmingham, Greater Manchester and Cheshire and Mersey — which still have more coronavirus patients in hospital.

On the NHS’ readiness for a potential second coronavirus peak, Mr Hancock said: “One of the tests we set before we adjust social distancing measures is that we should avoid the risk of a second peak because that means we would have to halt the restoration of the NHS for non-covid treatment. That has an impact itself on the health of a nation, and an impact on the indirect death rate.

“We have to be sure we don’t have that second peak so the NHS is making sure it can reopen where that locally is appropriate given local pressure on the system and taking into account [the capacity] of Nightingale hospitals.”

He added that the eight Nightingales currently confirmed “are not going to be used for non-covid patients” as they are designed for people that need intubation but said “the fact they are there does help us restore the core NHS”. London has said it wants to move covid-19 critical care and step-down patients there so hospitals can move back to normal work. They will all be used in some form initially, the health and social care secretary said, but this could change in future. 

Professor Powis said the government will be “keeping their use under review”.

He added: “We are now in position to reinstate services [that have been] stepped down/interrupted… but it is not a sign the lockdown is about to be reduced, it’s the reverse, the lockdown… has provided the capacity to get back to restarting services such as elective.”