1/19 Now that we've passed the first peak of covid demand, is our health and care system ready for the next phase, if lockdown starts to ease? Good time to reflect in a twitter thread, identifying where we can have confidence and where the areas of concern might be.
2/19 Usual preamble. We are not the Government, we are not @NHSEngland and we have no operational responsibilities in the detailed running of the NHS. We are the membership organisation and public voice of the 217 NHS Trusts and their leaders. Detail here: nhsproviders.org/news-blogs/pre…
3/19 Two big questions for the next phase if the Government starts to ease lockdown. 1. Will our health and care system have sufficient capacity to provide the right of quality of care for all those who need it – both coronavirus and non-coronavirus patients alike? (Tweets 5-11).
4/19 2. Can we quickly identify any further outbreaks of coronavirus and contain these, avoiding a second peak as far as possible? (Tweets 12-18). Separate answers to each question in thread, drawing on reflections of what has worked well so far and what has been a problem.
5/19 As long as the NHS retains sufficient surge capacity and Government is careful about how lockdown is eased (recognising huge uncertainties in latter), NHS should have sufficient capacity for next phase. However, we need a proper and honest debate about how NHS prioritises.
6/19 …There are a number of complexities behind how quickly the NHS can “restart all ordinary care” alongside treating covid patients & retaining surge capacity. I am looking forward to Thursday’s @CommonsHealth oral evidence session to share trusts' concerns here.
7/19 There’s a really important, and difficult, debate about NHS priorities that we must now have as a nation. Where should the NHS focus if it can’t do everything in this next phase? What is the right balance between the needs of covid-19 patients and other healthcare need?
8/19 And NHS capacity depends on consistent, reliable, access to personal protection equipment (PPE). Although the position is improving, we are still not at a point where we can guarantee that every frontline health and care worker will have the PPE they need when they need it.
9/19 Trust leaders are also really worried about social care. This crisis has shown the tragic and dire consequences of politicians' complete failure to deliver on their oft made promise to create a sustainable social care system. We must now stabilise social care…
10/19 Social care needs consistent access to PPE & testing...appropriate emergency funding that reaches frontline...effective monitoring of where pressures are greatest & rapid mobilisation of support. Although an extra 'pressure', NHS must play full part in stabilisation...
11/19 ...NHS community services & GPs planning to bring forward some of ‘enhanced healthcare in care homes’ initiative to May. This means a significant, new, extra burden we need to navigate. NHS nationally and locally will be challenging itself on how it can go further to help.
12/19 Much greater doubt on whether health & care sector ready to identify & contain further virus outbreaks. Long list of questions here. Testing regime can’t currently meet most basic need - ensuring all NHS/care staff & patients with symptoms can quickly & easily access a test
13/19 As @NHSProviders has consistently said, testing isn’t just about testing capacity, important though that is. There are major questions over strategy (what is it, especially in this next phase?); co-ordination (what should be done nationally and what locally?)….
14/19 ...Test access: have we got the right testing facilities in the right place? Test crtieria - who’s being tested and have we got the right priorities? And track and trace resource: have we got enough in the right places and is it properly trained and ready to go?...
15/19 ...Do NHS services (trusts, 111, GPs, pharmacies) know what role they are going to play in the next phase? (They don’t know at the moment). Will the public know what they are meant to do, supported by clear and effective public communications? (It's too early to tell)…
16/19 ...And many questions on new tracing app. Will it work effectively? Will it get sufficient take up? Has it got right data storage approach? Are appropriate protections in place to generate required public confidence? Long list overall. Not many +ve answers at this point.
17/19 However, two helpful signs on testing in last few days. Appointment of @didoharding to oversee testing regime and next phase of test, track, trace welcome. She understands NHS front line needs & has extensive, large organisation, operational leadership experience…
18/19 ...@DHSCgovuk has now recognised it has to decentralise some control over testing regime: theguardian.com/world/2020/may…. Pleased to see local Directors of Public Health will have greater control over testing in care homes - e.g. prioritisation. More decentralisation needed!
19/19 Summary. We need a major debate on how the NHS is going to strike the difficult balance between covid and non covid patients in this next phase. And there is a huge amount of work to do on test, track and trace to be confident we can swiftly control any new outbreaks.
