Lack of hospital capacity through effects of Covid is going to drive even more restrictions to planned care

Sorry for the delay in uploading this report by the Chair of Leeds Keep Our NHS Public, Dr John Puntis, on the July 2020 West Yorkshire and Harrogate Joint Clinical Commissioning Committee meeting. The report focusses on Covid-19 changes to elective (planned) care, based on discussion of this Improving Planned Care paper at the meeting

Same old stuff but lack of secondary care capacity through effects of Covid is now going to drive rationing even more

This meeting was over in one hour with very little discussion taking place. Public questions from Jenny Shepherd about the Joint Clinical Commissioning Committee’s views on the West Yorkshire and Harrogate Integrated Care System’s response to the Covid19 pandemic were read out, but not discussed as it was quickly agreed that a written response would be sent.

Here are her questions:

There was no comment on the response to covid, even though huge questions need to be asked about PPE, testing, care homes, Nightingale hospital in Harrogate etc.

Improving planned care programme

“A summary of the changes to the Improving Planned Care programme through the response to the Coronavirus-19 pandemic. It outlines changes to deliver integration of the previous WY&H Elective Care and Standardisation of Commissioning Policies programme and the WYAAT Elective Surgery programme and sets out the proposed new priorities for the programme to support the stabilisation and reset of health and care services in West Yorkshire and Harrogate.” https://www.wyhpartnership.co.uk/application/files/9715/9353/7699/84_20_WYHJC_2020-07_Improving_Planned_Care_JCC.pdf

Elective care and standardising commissioning https://www.wyhpartnership.co.uk/our-priorities/improving-planned-care/our-west-yorkshire-and-harrogate-commissioning-policies

Now a single programme fused with West Yorkshire & Harrogate Integrated Care System aka Health and Care Partnership , with a new “Alliance Board” to oversee it:  

“Prior to the pandemic the programme leadership had started the process of bringing together into a single programme the work of the WY&H Elective Care and Standardisation of Commissioning Policies programme and the West Yorkshire Association of Acute Trusts (WYAAT) Elective Surgery programme. The programmes’ response to the pandemic has expedited this and all work will now be done as a single WY&H Improving Planned Care programme. The combined programme has a refreshed leadership team with Jo Webster (Chief Officer, Wakefield CCG) and Steve Russell (Chief Executive Officer, Harrogate and District Foundation Trust) as co-chairs and Dr James Thomas (Bradford CCG) and Dr Sal Uka (Calderdale and Huddersfield Foundation Trust and WYAAT Clinical Lead) providing clinical leadership and integration with the Clinical Forum. The programme held its first Alliance Board on 12 June 2020”

Focus on prevention – shared decision making – shared responsibility for care. (JP: This sounds very much like how to get GPs not to refer to secondary care).

Comments from others present: primary care is not that keen on taking on all this extra work (!) – it sounds like we are handing more work to hard pressed GPs who will not want it  (JP: Quite right!)

Secondary care has to change as well – secondary care does not have capacity to cope – we have to have willing partners.

Tim Ryley Chief Executive, NHS Leeds Clinical Commissioning Group: planned care is not about prevention (JP – this seems to be challenge to comforting group think that somehow demand can be decreased through preventive strategies that are supposed to be integral to the planned care programme, like the STP documents that anticipated a rapid fall in cancer rates).

“Health of our population has to be at the centre of all our plans” (JP – meaning that we have to keep saying everything we are doing is for the best).

“Strategy has to be outcome based – population health management embedded in whole approach.”

“This is our top priority – a fundamental transformation – we are looking at only a return to 30-40% return to pre-covid activity” (JP – this sounds very worrying; a figure of 60% has been talked about nationally for elective surgery; raises huge issues about how private sector is involved) (Ed: I checked with the JCCC about this, they said the 30-40% figure should have been 60%).

Document finishes with little blue box entitled “Options for routine referral pathway” which is worth a look.

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