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Sir Simon Stevens, NHS Chief Executive, and Amanda Pritchard, NHS Chief Operating Officer, have detailed, in a letter to various key figures across the NHS, the third phase of the NHS’ response to COVID-19 and its subsequent priorities.

Initially entering its first phase on the 30th of January 2020 after NHS England and NHS Improvement declared a Level 4 National Incident in light of the global pandemic, the NHS rapidly shifted how it operated, including changing the priorities and availability of services it provides.

At the peak of the coronavirus crisis, in April 2020, a letter was issued to the heads of all NHS Trusts, Clinical Commissioning Groups (CCGs) and councils outlining prioritisation measures within community health services throughout the pandemic.

Controversially, the letter detailed that work deemed medium and lower priority relating to ‘wheelchairs, orthotics and prosthetics and equipment’ services for children and young people would be stopped.

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This led to criticism from key figures in the industry about the long-term impacts on people’s health, including CECOPS’ Brian Donnelly, who said that service users could “reap the results of this long after COVID-19.”

In June 2020, a letter was distributed throughout the NHS confirming it had entered the second phase of its COVID-19 response, largely outlining the partial restoration of key services, while also retaining the surge capacity in the event of another major outbreak of coronavirus.

Two months on, the NHS has initiated phase three, setting out priorities for 2020/21.

Sent to chief executives of all NHS trusts and foundation trusts, CCG accountable officers, GP practices and Primary Care Networks (PCNs), providers of community health services and NHS 111 providers, the letter starts by thanking all in the NHS for their continued efforts throughout the pandemic.

Although the national alert level for coronavirus currently sits at three, Sir Simon Stevens and Amanda Pritchard emphasise that they continuously review the situation and “will not hesitate to reinstate the Level 4 national response immediately as circumstances justify it.”

The level 3 alert signifies that the virus remains in general circulation with localised outbreaks likely to occur.

As part of the health service’s third phase, the letter details that the NHS will now prioritise on meeting the needs of non-COVID patients which have been building during the outbreak.

“This will continue to require excellent collaboration between clinical teams, providers and CCGs operating as part of local ‘systems’ (STPs and ICSs), local authorities and the voluntary sector, underpinned by a renewed focus on patient communication and partnership,” the letter highlights.

In particular, the letter says the three key priorities for the remainder of the year will be accelerating the return to near-normal levels of non-COVID health services, preparing for winter pressures alongside probable coronavirus spikes, as well as focusing on implementing learnings from the first wave of coronavirus.

Accelerating return of non-COVID health services

Calling the period prior to winter the “window of opportunity”, the NHS is now attempting to bring back as many services as possible, including all cancer services and as many elective activities, while it has capacity.

Recognising the challenge of rapidly tackling the backlog of patients, the letter says: “In setting clear performance expectations there is a careful balance to be struck between the need to be ambitious and stretching for our patients so as to avoid patient harm, while setting a performance level that is deliverable, recognising that each trust will have its own particular pattern of constraints to overcome.”

Patients with the most clinically urgent needs will be treated first, with the next priority given to those patients that have been waiting for the longest, “specifically those breaching or at risk of breaching 52 weeks by the end of March 2021.”

In addition, the letter highlights the importance of continuing to deliver remote consultations and assessments with patients, where clinically possible, to reduce infection risk and support social distancing.

Restoration of community services and adoption of discharge to assess

Importantly, the letter notes that all community services are to resume activity to usual levels where clinically appropriate.

Notably, it states that community health teams should fully resume appropriate and safe home visiting care for all those vulnerable/shielding patients who need them.

Highlighting the significance of teleconsultations or telephone consultations with patients, where possible, the letter adds: “CCGs should work with GP practices to expand the range of services to which patients can self-refer, freeing-up clinical time.”

Furthermore, community health and social care partners are to adopt the new discharge to assess processes from 1 September 2020.

This will see new or extended health and care support funded for a period of up to six weeks following a patient’s discharge from hospital. During this period, a comprehensive care and health assessment for any ongoing care needs, including determining funding eligibility, must take place. The fund can also be used to provide short term urgent care support for those who would otherwise have been admitted to hospital.

Alongside the discharge to assess model, CCGs must resume NHS Continuing Healthcare assessments from 1 September 2020 and work with local authorities using the trusted assessor model.

In addition, any patients discharged from hospital between 19 March 2020 and 31 August 2020, whose discharge support package has been paid for by the NHS, will need to be assessed and moved to core NHS, social care or self-funding arrangements.

More integrated care

Stressing that collaborative working between the NHS, local authorities and voluntary sector partners have been vital for tacking the pandemic, the NHS Chief Executive and Chief Operating Officer detail how a move towards closer integration will proceed in the coming months.

In particular, the letter confirms that current financial arrangements for CCGs and trusts will largely be extended to cover August and September 2020, however, there will be a move towards a revised financial framework for the latter part of 2020/21.

In late July, rumours circulated that the NHS would become responsible for social care in England – a claim refuted by the government.

A shift to closer working across different health and social care systems is on the cards as England moves towards comprehensive Integrated Care System (ICS) coverage by April 2021.

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