Hospitals’ elective activity must return to near normal pre-Covid levels by October

At the Joint Clinical Commissioning Committee meeting in July, we learned that West Yorks and Harrogate Integrated Care System commissioners have a “reset” plan for up to March 2022 that involves only 60-70% of elective activity levels compared to pre-covid19.

That plan seems to have been overturned by an edict NHS England issued a few days later.

In their Covid-19 Phase 3 letter, NHS England has instructed that elective care needs to resume at much higher levels than the 60% originally proposed for the Covid-19 reset:

“In September at least 80% of their last year’s activity for both overnight electives and for outpatient/daycase procedures, rising to 90% in October (while aiming for 70% in August);
•This means that systems need to very swiftly return to at least 90% of their last year’s levels of MRI/CT and endoscopy procedures, with an ambition to reach 100% by October.
•100% of their last year’s activity for first outpatient attendances and follow-ups (face to face or virtually) from September through the balance of the year (and aiming for 90% in August).”

We asked the Joint Clinical Commissioning Committee: How does this  instruction from NHS England sit with the Joint Clinical Commissioning Committee’s  reset plan to only provide 60% -70% of pre-covid elective care operations etc?

They replied:

‘It will be important for services to operate at as near to a normal level as possible if we are to avoid placing people at additional clinical risk.

A local planning process has been put in place over recent weeks to gauge what we can and should do in the coming weeks with the constraints of current resources and the requirements of infection prevention and control measures such as social distancing and the availability of PPE.

This is informed by a range of scenarios.  Organisations and stakeholders from across our Partnership, including all the acute hospital trusts (West Yorkshire Association of Acute Trusts), West Yorkshire and Harrogate Clinical Forum, public health, the voluntary and community sector ​and NHS England / NHS Improvement, are involved. This includes assessing and planning how many appointments and care procedures could take place in the coming months, whilst keeping staff and patients safe and considering what this may mean for social care and community support.

This planning process will now continue in line with the national guidance issued on 31 July to confirm what can be done’.

NHS England’s national guidance instructed all Sustainability and Transformation Partnerships and existing Integrated Care Systems to come up with development plans by 1st September, that embed and speed up “system” working methods used to respond to and recover from the Covid-19 pandemic. The plans have to be finalised and sent to the quango by 21st September.

This is part of the contentious move for all Sustainability and Transformation Partnerships to become Integrated Care Systems by April 2021.

Update 29 August 2020: All the above now looks like a load of rubbish, in the light of a paper for the 1st September meeting of the West Yorks and Harrogate Integrated Care System Board

This paper, ‘Planning for System Stabilisation and Reset’, says that in July Trusts and Clinical Commissioning Groups estimated that around half the ‘normal’ level of planned procedures could be provided for the rest of the year, around 70% of outpatient attendances, and near-normal levels of non-elective activity.

Given their estimate that they could only provide about half the pre-Covid level of planned procedures, why did the July meeting of the Joint Clinical Commissioning Committee say that their reset plan was to provide 60% -70% of pre-covid elective care operations?

And in response to our question about how they were going to respond to NHS England’s instruction that elective care needs to resume at much higher levels than the 60% originally proposed for the Covid-19 reset, why did they not admit that according to their estimates, this is impossible?

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