West Yorks and Harrogate NHS Commissioners to discuss Integrated Care System’s response to Covid-19

The West Yorkshire and Harrogate Joint Clinical Commissioning Committee is meeting virtually at 11am , Tuesday July 7th.

On the agenda are the West Yorkshire and Harrogate Integrated Care System’s response to Covid 19 and implications for the NHS Commissioners and its “refreshed” “Improving Planned Care” programme.

Update 19 July: It turned out there was no comment on the Integrated Care System’s response to Covid 19, even though huge questions need to be asked about PPE, testing, care homes, the Nightingale hospital in Harrogate etc. Our questions were read out but not answered and it was agreed a written answer would be sent. Info here about the discussion of the “refreshed” planned care plans.

Update 7 August: Here is the written response to our questions:

Our questions about the response to Covid-19

What, in the view of the Joint Clinical Commissioning Committee, have been the effects on their ability to respond to the Covid-19 Pandemic, of:

  • the decade-long cuts to NHS funding, hospital beds and clinical staff – including Intensive Care Unit beds and staff?
  • the government’s failure to promptly authorise and direct widespread testing and tracing, from the start of the pandemic?
  • the government’s failure to source and provide adequate PPE?

In particular, with regard to the effects of a decade of NHS cuts, what is the view of the Joint Clinical Commissioning Committee on:

  1. NHSE’s order to decant loads of people from hospital to care homes without testing, at the end of March, leading to lots of people in care homes dying of Covid 19? Your report says, “Our integrated teams and primary care networks ensured that safe discharge and support was in place and operating in line with clinical decisions made in each of our hospitals.” Is that really borne out by the evidence of high numbers of infections and deaths in care homes?
  2. The costly block contracts with private hospitals that – at least in the case of Calderdale and Huddersfield hospitals trust- we understand were barely used?
  3. The Harrogate Nightingale hospital. Your report says, “we led the development of NHS Nightingale Yorkshire and the Humber”. But it was a costly white elephant, not used for Covid19 patients, and is now being used for cancer diagnosis. How are patients from the other side of West Yorkshire going to get there?

With regard to the failure to carry out mass testing and tracing from the start…

What work was carried out by the West Yorkshire and Harrogate Integrated Care System programme for test, track and trace? As far as I know, apart from Pillar 1 tests in hospitals for NHS staff and patients etc, testing and tracing has been carried out by the hastily set up parallel privatised system – with the exception of recent local outbreaks in workplaces and schools where apparently public health contact tracers have done a high proportion of the work.

Relatedly, what in the Joint Clinical Commissioning Committee’s view, have been the effects of the failure to follow statutory duties for reporting notifiable diseases? As you know, these require GPs to notify local Public Health about all patients with Covid-19 symptoms. But the government directed the public to report symptoms to 111, not to GPs; and there has been no process for 111 to pass information to GPs about Covid-19 symptomatic patients. The upshot has been that neither local public health people nor GPs have had any idea about the spread of Covid 19 in their areas. And are now reliant on the new parallel privatised test and trace service that still isn’t giving Public Health adequate data for outbreak prevention and control and still doesn’t give GPs any info.

How has this affected NHS Commissioners’ ability to respond to the Covid-19 pandemic?

With regard to the government’s failure to provide timely, adequate PPE…

There have been massive problems with lack of PPE, for reasons to do with the mess created by the 2018 redisorganisation of the NHS Supply Chain, the government’s failure to act on the 2016 Cygnus pandemic planning exercise which identified the need for an adequate stockpile of PPE, the government’s delay in procuring additional supplies of PPE and the chaotic and ill informed contracting process when they did belatedly get round to this.

What is the Joint Clinical Commissioning Committee’s view of the impact of these failings on their ability to respond to the pandemic?

Other questions we’ve not asked (as you can only ask one) about phases 2 and 3 of Covid-19 response

The report says we’re now in phase 2 of the response to Covid-19. This is about stabilisation and preparing for phase three, when they can “reset” what they do

“for a world where we live with the virus”.

This begs the question of why West Yorkshire and Harrogate Integrated Care System isn’t aiming to eliminate the virus, as countries like New Zealand, Greece and Ireland are.

‘Understanding the wider impact on different groups of people, including Black Asian and Minority Ethnic Communities (BAME), older people, people with learning disabilities and/or mental health concerns and other vulnerable people’

This is one of their phase 2 priorities. Why are they only doing that now?

At the beginning of March, I specifically asked the Integrated Care System Board whether tackling socio-economic health inequalities was part of their emergency preparedness plans for Covid19, and what measures were being carried out to make sure that people in poor/deprived communities have equal access to covid19 care.

Their reply was

“The NHS in West Yorkshire and Harrogate, and Public Health England (PHE) are well prepared for outbreaks of new infectious diseases. The NHS has put in place measures to ensure the safety of all patients and NHS staff while also ensuring services are available to the public as normal.NHS 111 has an online coronavirus service that can tell people if they need medical help and advice on what to do. This information is being shared widely across all communication channels and public services, and beyond.”

If they were so well prepared at the beginning of March, why are they only now seeking to understand the wider impact on different groups of vulnerable people?

Local planning process and ‘commissioning futures’

The report also states,

“A local planning process has now been put into place to quickly gauge what we can and should do in the coming weeks.”

Who has put this planning process in place and who is participating in it?

“Alongside stabilisation and reset, the main development which will influence the Joint Committee’s future priorities and approach is the commissioning futures work, for which Esther Ashman has been appointed Programme Director.”

What is the commissioning futures work?

An end to walk in access to integrated urgent and emergency care

A priority for the Integrated Care System’s “reset” is to stop walk in access to integrated urgent and emergency care, as a Covid-19 infection control measure. Instead access will be through:

  • Telephone/on line triage via 111/999/General Practice
  • Referral to Emergency Departments/Urgent Treatment Centres via triage
  • Alternative/enhanced pathways via triage/Directory of services
  • A pre bookable model

More cuts and privatisation of elective care

They’re also talking about restarting commissioning threshholds for MusculoSkeletal (MSK) and eye care. Commissioning thresholds is code for more about cuts being imposed on people’s access to elective surgery, through the so-called Evidence Based Interventions policy.

There is a whole paper for the Joint Clinical Commissioning Board about the next stage of the so-called Evidence Based Interventions policy, under the somewhat misleading title ” Improving Planned Care: Programme Refresh”.

It turns out this “refresh” is because of the huge reduction in planned care during the Covid-19 emergency, which nationally has left tens of thousands of patients without care – including cancer patients who will now die as a result.

The intention is now to “reset” NHS and social care services to work out how to deal with this huge backlog of patients and how to treat new ones.

Turns out there’s now an “Alliance Board” running the “Improving Planned Care” Programme. Its priorities are to address:

  • access to diagnostic testing and elective surgery
  • referral and proactive approaches to managing planned care

Here’s a report on the meeting’s discussion of the Covid-19 “reset” – ie cuts and privatisation of elective/planned care.

Updated 17.7.2020 with links to information about delays to cancer diagnosis and treatment during the Covid 19 crisis. Updated 19.7.2020 with link to blog post “West Yorkshire NHS planned operations to be “reset” at 30-40% of pre-Covid19 level”

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