NHSE issues plan to restart urgent non-covid care

In a letter to local chief executives (see attached), NHSE bosses said hospitals must “release and redeploy” capacity back from being ready for covid-19 patients, to space suitable for other care, “over the next six weeks”.

But it warned it would be “prudent [to] retain extra capacity that has been brought on line — including access to independent hospitals and Nightingale hospitals”.

That is partly because the service must remain braced, the letter said, for a rebound in emergency admissions, which have fallen drastically in recent weeks. ”This means we need to retain our demonstrated ability to quickly repurpose and ‘surge’ capacity locally and regionally, should it be needed again,” the letter said.

The letter struck a cautious tone on how quickly the service would return to pre-crisis levels of elective work. It said the centre would “continue to provide new ventilators to trusts over the coming weeks so as to sustain critical care ‘surge’ capacity should it again be needed in future, while progressively returning operating theatres and recovery suites to their normal use”.

Local NHS organisations should, it said, “work across local systems and with your regional teams over the next 10 days to make judgements on whether you have further capacity for at least some routine non-urgent elective care”. But this will need to “factor-in the availability of associated medicines, [personal protective equipment], blood, consumables, equipment and other needed supplies”.

The service will also need to provide “covid-19 aftercare and support in community health services, primary care, and mental health”, while GPs are asked “to continue to stratify and proactively contact their high-risk patients with ongoing care needs”.

The letter follows health secretary Matt Hancock announcing at the daily coronavirus briefing on Monday that the NHS would ramp up restoration efforts this week.

NHSE medical director Stephen Powis said at the briefing the process would differ on a regional basis because “infection rates are different, and different organisations have stepped up to manage the surge in slightly different ways”. But there was no indication of how local variation would be accounted for in the guidance.

Other actions in the letter, sent by NHSE chief Sir Simon Stevens and chief operating officer Amanda Pritchard, included:

• Urgent care: “Strengthen 111 capacity and sustain appropriate ambulance services ‘hear and treat’ and ‘see and treat’ models and open up new secondary care dispositions ([same day emergency care], hot specialty clinic, frailty services) that allow patients to bypass the emergency department altogether where clinically appropriate.”
• Cancer: “Local systems and cancer alliances must identify ring-fenced diagnostic and surgical capacity for cancer, and providers must protect and deliver cancer surgery and cancer treatment by ensuring that cancer surgery hubs are fully operational.”
• Mental health: “Establish all-age open access crisis services and helplines and promote them locally working with partners such as local authorities, voluntary and community sector and 111 services.”

The NHS must take “this opportunity to ‘lock in’ beneficial changes that we’ve collectively brought about in recent weeks”, the guidance also said.

“This includes backing local initiative and flexibility; enhanced local system working; strong clinical leadership; flexible and remote working where appropriate; and rapid scaling of new technology-enabled service delivery options such as digital consultations.”