Recommendations & Conclusions
11 items
4
Recommendation
Fourteenth Report: Readying the NHS and…
Accepted
Public confidence is likely to be further undermined without an open and honest debate about current capacity and tangible plans to address gaps, for example, in testing and PPE. Government has had to and will continue to have to make quick decisions with sometimes imperfect information as the pandemic develops. …
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Public confidence is likely to be further undermined without an open and honest debate about current capacity and tangible plans to address gaps, for example, in testing and PPE. Government has had to and will continue to have to make quick decisions with sometimes imperfect information as the pandemic develops. Yet too often the basis for decisions or changes, such as on PPE, has been unclear; sometimes seemingly based upon what the system could cope with, rather than clinical advice and ‘what was right’, and at other times without regard to the reality on the ground. On PPE, guidance was changed 40 times without consulting service providers, leading to confusion on the ground. There has been a lack of transparency around the availability and supply of PPE, and a tendency for Government to over- promise and under deliver. After squandering the opportunity to build up supplies in January and February, it remains to be seen whether the Department can meet its intention to have a 90-day PPE stockpile. Testing for COVID-19 is vital for controlling the virus and informing and assuring the public. It will be essential as ‘track and trace’ is rolled out, yet testing capacity was insufficient for much of the pandemic and, as highlighted by the UK Statistics Authority, public reporting has been inconsistent and lacking transparency. Recommendation: Among other measures, the Department should assess the capacity it needs, particularly for PPE and testing, and how it will meet this, to 8 Readying the NHS and social care for the COVID-19 peak cope with a second peak; and report transparently and consistently on progress. It should write to the Committee by September 2020 with further details of its assessment and plans.
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Government response AI summary
The government agreed with the recommendation, stating it has secured sufficient PPE for winter, building four-month stockpiles, and has significantly increased daily COVID-19 testing capacity to over 500,000 by October 2020.
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HM Treasury
5
Recommendation
Fourteenth Report: Readying the NHS and…
Accepted
Staff in health and social care cannot be expected to be ready to cope with future peaks and also deal with the enormous backlogs that have built up unless they are managed well. We are deeply concerned about the frontline workers and volunteers who have endured the strain and trauma …
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Staff in health and social care cannot be expected to be ready to cope with future peaks and also deal with the enormous backlogs that have built up unless they are managed well. We are deeply concerned about the frontline workers and volunteers who have endured the strain and trauma of responding to COVID-19 for many months. Failure to protect staff by providing adequate PPE has impacted staff morale and confidence, while a lack of timely testing, until after the pandemic had passed its first peak, led to increased stress and absence. These same staff will be called upon in the event of a second peak and the NHS will need extra staff to deal with the backlog of treatment. While the NHS says it is providing much needed support to staff, details are limited, and we remain concerned about the Department’s ability and capacity to safeguard the mental health and well-being of the thousands of health and social care staff and volunteers from the lasting effects of the pandemic. Recommendation: The Department and NHSE&I should identify and agree with relevant professional bodies specific actions to support health and social care staff to recover from the impact of the first peak and how they will monitor and provide further support to staff through to the end of the pandemic.
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Government response AI summary
The government agrees with the recommendation and states it has implemented several measures, including publishing wellbeing guidance for social care, supporting "Our Frontline", and launching the NHS People Plan 2020-21 which focuses on staff recovery and was developed with professional bodies. Existing NHS COVID-19 support …
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HM Treasury
7
Conclusion
Fourteenth Report: Readying the NHS and…
Accepted
There have been serious and widespread concerns about the lack of timely testing for both staff and the public and inadequate PPE provision particularly in social care.13 When we queried the arrangements for ensuring access to testing, we were told that several bodies were involved, including the Department, Public Health …
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There have been serious and widespread concerns about the lack of timely testing for both staff and the public and inadequate PPE provision particularly in social care.13 When we queried the arrangements for ensuring access to testing, we were told that several bodies were involved, including the Department, Public Health England and NHSE&I. For example, NHS laboratories tested patients and some NHS staff, while other parts of the testing programme were run elsewhere.14 NHSE&I told us it had followed Public Health England’s strategy on whom to test.15 Public Health England clarified that its testing policy in March was based on the limited testing capacity at the time as agreed with the NHS and the Chief Medical Officer.
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Government response AI summary
The government agrees with the committee's observation and states it has secured enough PPE for winter 2020-21, strengthened supply chains, and built stockpiles. It also significantly increased daily COVID-19 testing capacity to over 500,000 by October 2020 through lab expansion and new technologies.
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HM Treasury
8
Conclusion
Fourteenth Report: Readying the NHS and…
Accepted
Similarly, procuring and distributing PPE involved a range of bodies, including the Department, Public Health England, local NHS providers and care homes, yet until the appointment of Lord Deighton in mid-April no one took the lead in making sure there was sufficient PPE.16 Public Health England told us that it …
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Similarly, procuring and distributing PPE involved a range of bodies, including the Department, Public Health England, local NHS providers and care homes, yet until the appointment of Lord Deighton in mid-April no one took the lead in making sure there was sufficient PPE.16 Public Health England told us that it was responsible for holding and adjusting the PPE stockpile on behalf of the Department, but did not make policy decisions on its contents, management or use.17 When challenged on its part in ensuring sufficient PPE supply, the Department explained that it had worked with NHSE&I, alongside the Foreign Office and others, to source international supply, but it stressed the difficulties it faced given worldwide demand. We noted the significant increases in PPE supplies since Lord Deighton’s appointment.18 9 Q 10; C&AG’s Report, para 1.3, 1.13 10 C&AG’s Report, para 1.3 11 Qq 58, 63, 118–119; C&AG’s Report, paras 10–13,18 12 Qq 11, 120 13 Committee of Public Accounts, NHS capital expenditure and financial management, Eighth Report of Session 2019–21, HC 344, 8 July 2020, para 22; C&AG’s Report, paras 19, 20; RSC0010 NHS Confederation submission; RSC0004 NHS Providers submission; RSC0001 Care England submission 14 Qq 18–20, 23–26, 34, 98 15 Qq 17–19 16 Qq 62, 75, 79, 87–88 17 Qq 75 18 Qq 62, 87–88 Readying the NHS and social care for the COVID-19 peak 11 Discharging people from hospitals to care homes
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Government response AI summary
The government states the recommendation has been implemented, having regularly reviewed leadership structures during the pandemic and clarified Senior Responsible Officers for various workstreams of the COVID-19 Battle Plan.
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HM Treasury
9
Conclusion
Fourteenth Report: Readying the NHS and…
Accepted
On 17 March the NHS told trusts to discharge urgently all medically fit hospital patients with COVID-19 to maximise inpatient and critical care capacity. On 2 April, the Department told care homes that they needed to make their full capacity available and could admit patients with COVID-19 by isolating suspected …
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On 17 March the NHS told trusts to discharge urgently all medically fit hospital patients with COVID-19 to maximise inpatient and critical care capacity. On 2 April, the Department told care homes that they needed to make their full capacity available and could admit patients with COVID-19 by isolating suspected or confirmed cases. Some Local Authorities were pressurising Care Homes to take patients discharged from hospitals.19 Yet until 15 April there was no policy to test patients for COVID-19 before discharging them to care homes. By this point 25,000 people had been discharged from hospitals to care homes and the Department does not know how many had COVID-19.20
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Government response AI summary
The government agrees with the committee's implicit recommendation regarding patient discharge safety, despite disagreeing with the committee's historical conclusion. It states that since April and September 2020, all individuals are required to be tested prior to discharge to a care home, and no provider can …
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HM Treasury
16
Conclusion
Fourteenth Report: Readying the NHS and…
Accepted
By comparison, because testing capacity was limited during the earlier stages of the pandemic, the Department said it had sought clinical advice on where that capacity was best deployed. Eligibility for tests changed as capacity increased and the Department noted that testing was the area which had evolved the most …
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By comparison, because testing capacity was limited during the earlier stages of the pandemic, the Department said it had sought clinical advice on where that capacity was best deployed. Eligibility for tests changed as capacity increased and the Department noted that testing was the area which had evolved the most over time.46
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Government response AI summary
The government states that it has significantly increased UK daily swab test capacity to over 500,000 by October 2020 through various measures like expanding labs and introducing new technologies.
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HM Treasury
17
Conclusion
Fourteenth Report: Readying the NHS and…
Accepted
Concerns about the transparency of Government’s reporting about the measures it has taken, particularly around PPE and testing, have been widely publicised.47 We heard from stakeholders in the health and social care sector who highlighted issues with inadequate and unreliable PPE supply.48 For example, despite the fanfare around a large …
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Concerns about the transparency of Government’s reporting about the measures it has taken, particularly around PPE and testing, have been widely publicised.47 We heard from stakeholders in the health and social care sector who highlighted issues with inadequate and unreliable PPE supply.48 For example, despite the fanfare around a large consignment of PPE being secured from Turkey, it did not contain the volume expected nor meet required standards.49
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Government response AI summary
The government states it is confident in its PPE supply for winter 2020-21, having strengthened and diversified supply chains, ordered over 32 billion items, and built stockpiles. It has also established a distribution system, including expanding the PPE portal for social and primary care, to …
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HM Treasury
18
Conclusion
Fourteenth Report: Readying the NHS and…
Accepted
Testing for COVID-19 is fundamental to controlling the virus, and to informing and reassuring the public.50 Yet, while Government’s announcement of its 100,000 daily test target by the end of April had a galvanising effect to start with, NHS Providers reported that it had ended up being a distraction from …
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Testing for COVID-19 is fundamental to controlling the virus, and to informing and reassuring the public.50 Yet, while Government’s announcement of its 100,000 daily test target by the end of April had a galvanising effect to start with, NHS Providers reported that it had ended up being a distraction from developing the right kind of capacity and testing approaches in all areas of the country.51 The UK Statistics Authority publicly criticised the Government for the way it counted tests and has urged greater clarity about how testing targets are defined, measured and reported.52 Similarly to PPE, we heard how unkept promises on tests had led to a loss in confidence among some providing NHS services.53 43 Q 32 44 RSC0001 Care England submission 45 Qq 90–91 46 Qq 20, 25 47 For example, BBC news on its Panorama programme on PPE and BBC statement on Panorama, Monday 27 April: Has The Government Failed the NHS? 48 RSC0001 Care England submission; RSC0002 Local Government Association submission; RSC0004 NHS Providers submission; RSC0005 Association of Anaesthetists submission; RSC0010 NHS Confederation submission 49 HSJ, Exclusive: Turkish delivery contained just a few hours’ worth of gowns, 23 April; The Guardian, Coronavirus PPE: all 400,000 gowns flown from Turkey for NHS fail UK standards, 7 May 50 Qq 24–26 51 RSC0004 NHS Providers 52 Sir David Norgrove letter to Matt Hancock regarding COVID-19 testing 53 RSC0010 NHS Confederation submission Readying the NHS and social care for the COVID-19 peak 15
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Government response AI summary
The government states it has significantly increased UK daily swab test capacity from 2,000 in March 2020 to over 500,000 by October 2020, through lab expansion, new partnerships, additional staff, and cutting-edge technologies.
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HM Treasury
21
Conclusion
Fourteenth Report: Readying the NHS and…
Accepted
There have been numerous media reports of PPE shortages for health and social care staff and stakeholders have told us how the failure to provide adequate and timely PPE has impacted staff morale, trust and confidence.61 In the period from 6 April to 19 May, more than 80% of local …
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There have been numerous media reports of PPE shortages for health and social care staff and stakeholders have told us how the failure to provide adequate and timely PPE has impacted staff morale, trust and confidence.61 In the period from 6 April to 19 May, more than 80% of local resilience forums reported that PPE was having a high or significant disruptive impact in their area across health and social care services, putting staff and others at risk.62
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Government response AI summary
The government expresses confidence in having secured sufficient PPE for winter 2020-21, detailing strengthened and diversified supply chains, 32 billion items ordered, and the establishment of a robust distribution system including an expanded PPE portal for social and primary care.
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HM Treasury
22
Conclusion
Fourteenth Report: Readying the NHS and…
Accepted
Testing for NHS workers (with symptoms) only began from 27 March, with eligibility extended to social care workers (with symptoms) from 15 April, after the pandemic had passed its first peak. In the period up to 15th April up to a maximum of five symptomatic residents in each care home …
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Testing for NHS workers (with symptoms) only began from 27 March, with eligibility extended to social care workers (with symptoms) from 15 April, after the pandemic had passed its first peak. In the period up to 15th April up to a maximum of five symptomatic residents in each care home would be tested, and from the 28th April all symptomatic care home residents were offered testing but this was capped at 30,000 tests per day between residents and staff. From 28 April, all social care workers were eligible for tests, but the Department capped the daily amount of care home tests at 30,000 (to be shared between 54 Qq 51–52, 56–57, 78–79 55 Qq 25, 27 56 Qq 49–50; Public Health England letter from Professor Paul Johnstone to PAC Chair, 2 July 2020 57 Qq 76, 78, 79 58 Q 109 59 Qq 5, 94 60 Qq 96–97 61 Qq 21,23, 26–27; Committee of Public Accounts, NHS capital expenditure and financial management, Eighth Report of Session 2019–21, HC 344, 8 July 2020; RSC0010 NHS Confederation submission; RSC0001 Care England submission; RSC0002 Local Government Association submission; RSC0004 NHS Providers submission 62 C&AG’s Report, para 4.28 16 Readying the NHS and social care for the COVID-19 peak staff and residents).63 Stakeholders told us that failures in testing had also led to increased anxiety and frustration as well as increased absence due to unnecessary isolation. For example, the NHS Confederation told us that the NHS had had an unprecedented level of absence during the first weeks of April.64 When asked about testing staff, the Department said it had made this available in care homes as capacity increased and there were now around 70,000 tests a day available to all care home staff as well as residents. NHSE&I told us it had now started testing asymptomatic staff and referenced Public Health England’s large-scale study testing staff to see if they had COVID-19 now, or had previously had it, which would provide more information on how and when it was best to test.65
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Government response AI summary
The government states it will continue to grow testing capacity and resilience, having already increased UK daily swab test capacity from 2,000 in March to over 500,000 by October 2020 through lab expansion, new partnerships, additional staff, and new technologies.
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HM Treasury
23
Conclusion
Fourteenth Report: Readying the NHS and…
Accepted
We were concerned about the NHS needing to call on the same staff who have already worked exceptionally long hours during the first peak in order to deal with the backlogs of treatment, while also standing ready for a potential second peak.66 NHSE&I explained that it was “encouraging people to …
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We were concerned about the NHS needing to call on the same staff who have already worked exceptionally long hours during the first peak in order to deal with the backlogs of treatment, while also standing ready for a potential second peak.66 NHSE&I explained that it was “encouraging people to take leave, so that they are refreshed going into the autumn and winter, as well as encouraging people who have returned to stay with us and those who have volunteered to continue to offer their support”.67 We asked how the NHS was looking after its workforce given the emotional trauma of treating patients with COVID-19 and the fact that the NHS interim people plan had not referred to treating the mental health of its staff. In response, NHSE&I sought to assure us that staff health and wellbeing was a “primary focus nationally, regionally and locally”. It recognised the need for targeted psychological and mental health support for staff across the health service and pointed to plans to roll out more widely an existing mental health programme for doctors as well as helplines and other support for particular staff groups.68 Securing additional capacity
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Government response AI summary
The government states that the NHS People Plan for 2020-21, published in July 2020, outlines actions by NHS England, Health Education England, and NHS employers to support staff recovery from the pandemic's first peak and ensure their well-being.
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HM Treasury