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NHS’ Recovery from Covid – Full of Complexity, Uncertainty and Controversy


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UPDATED

18 MAY 2020


Our recent analysis of a letter from Sir Simon Stevens, the Chief Executive of NHS England, clearly shows that resuming routine will be anything but an easy task.

The latest guideline on restarting non-Covid 19 services is already in place by the NHS England and it’s explicitly lenient about leaving it to the regions to choose their own pace for resuming routine care, at least, for the next 6-8 weeks (intermediate period).

When anxiety will grow among plenty of acute trusts to get going, health economies will have to take into consideration multiple factors to decide what, when and how to reintroduce as well as figure out ‘at what rate’.

“Covid Load” of a region is not what only matters as there are other factors including availability of blood stocks (it’s really worrying that blood donation has slumped) and anaesthetic agents that will put a constraint on ability to restart operation.

Further service restructuring to introduce a new system sampling and testing will need to be in place to set covid areas apart from non-covid ones. Some trusts with ready-made “cold” elected areas will be able to make a quicker move.

Non-healthcare issues have high relevance too. The guideline puts a strong emphasis on importance of getting ready for emergency service as people start attending A&Es again. If government decides to lax lockdown, it will have the biggest impact on A&E attendance.

A&Es will fill up once more after the next few weeks and therefore, the government is highly cognizant that the time gap will serve as a window to restart electives in the areas where the regional dynamics approves it.

It could mean that elective patients in the West Country will undergo surgery whereas their counterparts in the West Midlands won’t.

The pace of return is also a subject to how much as well as the way the NHS uses the private sector and the additional capacity, most particularly the Nightingale Hospitals that has born out of its earnest effort in the past few weeks.

The NHS has done a blanket deal with private sector providers but that will expire at the end of the next month. At this point, NHS needs to decide if or not they will renew the deal. It is expected that the health economy will roll out their proposals on how they will utilize the capacity immediately.

The Nightingales are largely empty. At present, the plan is to use the facility as covid-19 capacity – for either serious care or temporary step-down afterwards. Sensitivity of coronavirus testing regime will determine if the facility will be allowed to continue that way.

This particular variable is very important for the chore question – that finds no answer in the new guidelines – of how much staff and beds the NHS either in any given area or overall, needs to allocate free for the possible second peak.

The centre is expected to blunder on the side of caution. The decision to instruct clinical commissioning groups to ask no question for the foreseeable future to keep fully funding care packages exhibits that NHSE and the government – they are surely partners in the task –continue to work in “whatever it takes” zone.

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