Recommendations & Conclusions
7 items
6
Recommendation
Fourteenth Report: Readying the NHS and…
Not Addressed
Policies designed to create additional capacity quickly, while necessary, have resulted in a lack of transparency about costs and value for money. The NHS boosted its potential maximum capacity for the peak in April by building Nightingale hospitals across the country and signing contracts with independent providers for 8,000 additional …
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Policies designed to create additional capacity quickly, while necessary, have resulted in a lack of transparency about costs and value for money. The NHS boosted its potential maximum capacity for the peak in April by building Nightingale hospitals across the country and signing contracts with independent providers for 8,000 additional beds, which was announced on 21 March. The contract ended on the 28 June. The Department expects to continue these arrangements in anticipation of future peaks. However, we are concerned by the scarcity of information on contracts and costs. When asked, NHSE&I was unable, or unwilling, to provide any estimate of the cost of private sector capacity or the Nightingale hospitals. We are fortunate that the Nightingale hospitals have not been required so far during the pandemic, but it will not be a good use of public money if we continue to let them remain empty while elsewhere the NHS requires additional capacity for normal services. Recommendation: After failing to provide detail in the session, it is imperative that the Department and NHSE&I write to the Committee as soon as possible – and no later than 1 September 2020—with information on the cost of private hospital contracts, how these have been used, and their intentions for how private and Nightingale hospitals will be made best use of in the coming months, including: • details of what the second phase of contracts will provide; • the total cost and pricing mechanisms; and • how capacity in these hospitals will be allocated? They should come to subsequent sessions prepared to disclose cost information on key elements of the pandemic response. Readying the NHS and social care for the COVID-19 peak 9 1 Lessons from the NHS and adult social care response to the COVID-19 pandemic
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Government response AI summary
The government response completely failed to address the recommendation regarding transparency on the costs and utilisation of private hospital contracts and Nightingale hospitals, instead providing information about the Restoration and Renewal of the Palace of Westminster.
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HM Treasury
1
Conclusion
Fourteenth Report: Readying the NHS and…
Not Addressed
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department), NHS England & NHS Improvement (NHSE&I), the Ministry of Housing, Communities & Local Government (the Ministry) and Public Health England on Readying the NHS and …
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On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department), NHS England & NHS Improvement (NHSE&I), the Ministry of Housing, Communities & Local Government (the Ministry) and Public Health England on Readying the NHS and adult social care in England for COVID-19.2
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Government response AI summary
The government response lists various officials responsible for areas like NHS resilience, social care, PPE supply, Test and Trace, and vaccines. It also notes that adult social care provision is a local government responsibility without a single equivalent to an NHS Chief Executive.
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HM Treasury
10
Conclusion
Fourteenth Report: Readying the NHS and…
Not Addressed
Some organisations such as Care England highlighted to us the flawed nature of this policy and reported that, given the absence of testing and inadequate PPE, social care felt abandoned.21 When we challenged the Department and the NHS on such a reckless and negligent policy, the Department told us that …
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Some organisations such as Care England highlighted to us the flawed nature of this policy and reported that, given the absence of testing and inadequate PPE, social care felt abandoned.21 When we challenged the Department and the NHS on such a reckless and negligent policy, the Department told us that when the NHS issued its guidance in March COVID-19 was not widespread.22 NHSE&I said it has always been the case that they want to discharge people who are clinically fit and staying in hospital could be harmful for the elderly.23 When asked why those discharged had not been tested, it told us it was following testing advice provided by Public Health England.24 Public Health England clarified that, at the start of the outbreak, testing was limited to 3,500 tests a day nationally and so it had agreed with the NHS and the Chief Medical Officer priority groups for testing: those in intensive treatment units; those with respiratory infections; and limited testing in care homes to diagnose outbreaks. Public Health England also told us that “what was becoming clear in the back-end of March and certainly from the beginning of April was that there was an asymptomatic phase, which means that people can transfer the virus without ever having symptoms, or a significant pre-symptomatic phase, which is where the virus could be shared”.25 It is clear that the availability of test and testing should have been ramped up much more quickly after the NHS had declared Level 4 National Incident (its most severe incident level) on the 30th January 2020.
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Government response AI summary
The government response only restates the committee's conclusion that discharging patients without testing was an appalling error, without providing any further information or action.
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HM Treasury
11
Conclusion
Fourteenth Report: Readying the NHS and…
Not Addressed
We remained concerned that the Department had continued its policy of discharging people untested into care homes even once it was clear there was an emerging problem.26 The number of first-time outbreaks in individual care homes peaked at 1,009 in early April. Between 9 March and 17 May, around 5,900 …
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We remained concerned that the Department had continued its policy of discharging people untested into care homes even once it was clear there was an emerging problem.26 The number of first-time outbreaks in individual care homes peaked at 1,009 in early April. Between 9 March and 17 May, around 5,900 care homes, equivalent to 38% of care homes across England, reported at least one outbreak of the disease.27 The Department defended the decisions it took as rational based on the information it had at the time and stated its belief that the clearest correlations between social care outbreaks and other issues related to staff with the disease rather than patients discharged from hospital. However, it also acknowledged “that is not the same as saying that we would do the same again”.28 19 Q13 20 C&AG’s Report, paras 3.19–3.20 21 RSC0001 Care England submission 22 Qq 21–22 23 Q 16 24 Qq 14, 16–18 25 Qq 20, 84 26 Qq 19, 21–23 27 C&AG’s Report, para 3.15 28 Qq 23, 43 12 Readying the NHS and social care for the COVID-19 peak Delays to reforming adult social care
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Government response AI summary
The government response provided is a restatement of a PAC conclusion regarding discharge policy, and does not specifically address the content or concerns raised in conclusion #11.
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HM Treasury
12
Conclusion
Fourteenth Report: Readying the NHS and…
Not Addressed
This Committee has warned before that the Department lacked an effective overall strategy or plan to integrate health and care and that poor outcomes could arise as a result.29 As Care England told us, for too long “adult social care has been kicked into the long grass by governments of …
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This Committee has warned before that the Department lacked an effective overall strategy or plan to integrate health and care and that poor outcomes could arise as a result.29 As Care England told us, for too long “adult social care has been kicked into the long grass by governments of all stripes.”30 Despite numerous white papers, green papers, consultations, and independent reviews over the past 20 years, meaningful integration of health and social care was yet to occur going into the pandemic.31 The Department noted that the experience with COVID-19 had heightened the need for reform.32
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Government response AI summary
The government response provided is a restatement of a PAC conclusion regarding delayed social care reform, and does not specifically address the content or past warnings raised in conclusion #12.
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HM Treasury
24
Conclusion
Fourteenth Report: Readying the NHS and…
Under its reasonable worst-case scenario, the Government expected over 4% of the population might require hospital admission for COVID-19 and 30% of those would require critical care. NHSE&I told us that the number of COVID-19 patients admitted to hospital had risen from a few hundred in mid-March to 18,000 two …
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Under its reasonable worst-case scenario, the Government expected over 4% of the population might require hospital admission for COVID-19 and 30% of those would require critical care. NHSE&I told us that the number of COVID-19 patients admitted to hospital had risen from a few hundred in mid-March to 18,000 two weeks later.69 As NHS Providers stated, the healthcare sector responded at pace to ensure that the NHS had enough capacity for the expected large number of COVID-19 patients.70 The additional capacity secured by NHSE&I included new Nightingale hospitals as well as contracts with independent providers for an additional 8,000 beds, 18,700 staff and 1,200 ventilators. The contracts were to run until 28 June but could be extended. Use of the Nightingale hospitals so far has been limited.71
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HM Treasury
25
Conclusion
Fourteenth Report: Readying the NHS and…
Between mid-March and mid-April, the NHS and armed forces are to be commended for increasing the number of beds available for Covid-19 patients from 12,600 to 53,700 in 63 C&AG’s Report, para 3.16 64 RSC0012 National Institute for Health Research (NIHR) Health Protection Research Unit in Merging and Zoonotic Infections; …
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Between mid-March and mid-April, the NHS and armed forces are to be commended for increasing the number of beds available for Covid-19 patients from 12,600 to 53,700 in 63 C&AG’s Report, para 3.16 64 RSC0012 National Institute for Health Research (NIHR) Health Protection Research Unit in Merging and Zoonotic Infections; University of Liverpool, Institute of Infection and Global Health, and University of Oxford, Nuffield Department of Primary Care Health Sciences submission; RSC0010 NHS Confederation submission; RSC0004 NHS Providers submission; RSC0005 Association of Anaesthetics submission 65 Qq 98–101 66 Qq 102–105, 108–111; C&AG’s Report, para 4.30; RSC0010 NHS Confederation submission; RSC0004 NHS Providers submission 67 Q 57 68 Qq 102, 105, 111 69 Qq 14,109, 116 70 RSC0004 NHS Providers submission 71 C&AG’s Report, paras 10, 2.6, 2.7, 4.4; Ev Independent Healthcare Providers Network submission Readying the NHS and social care for the COVID-19 peak 17 a very short space of time. The additional capacity inside existing NHS hospitals helped to ensure that at no point during the pandemic did the number of patients exceed the number of available beds.72 Independent and Nightingale capacity created a ‘buffer’ on top of that, and NHS Providers also welcomed the private sector support which had been offered to date.73 We recognise the need to have moved at speed to set up these arrangements. However, we were also concerned about the trade-offs with securing value for money and an apparent lack of transparency. We asked NHSE&I about the use and cost of the capacity secured through independent hospitals. NHSE&I told us that “several hundred thousand patient treatments”, such as chemotherapy and diagnostic tests, had been delivered as well as equipment. Despite the open book accounting arrangements in the contract, NHSE&I would not provide even a rough estimate of costs until these had been audited and said it might be “several weeks” before it could share the data with u
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HM Treasury