Source · Select Committees · Public Accounts Committee
Recommendation 14
14
NHSE&I was not responsible for managing any local variations and did not challenge local clinical...
Conclusion
NHSE&I was not responsible for managing any local variations and did not challenge local clinical decisions.28 DHSC has told us that NHSE&I and NHS Digital considered that ultimately additions were a decision for local clinicians. It noted that the approach to local additions was endorsed by the UK Chief Medical Officer who provided guidance on 18 Q 21; C&AG’s Report, paras 12, 2.5 19 Qq 21–22 20 Q 21; C&AG’s Report, para 2.6 21 C&AG’s Report paras 2.5, 2.10 22 SVL0002 - Written Evidence submitted by Asthma UK and the British Lung Foundation p.3 23 C&AG’s Report, para 2.6 24 Qq 23–24 25 Qq 21–22, 97–98 26 Qq 21, 23, 25; C&AG’s Report, para 2.6 27 C&AG’s Report, Figure 8, analysis of underlying data 28 C&AG’s Report, para 2.9, Figure 8 Covid 19: supporting the vulnerable during lockdown 11 the shielded patient list. DHSC also explained to us how NHSE&I and NHS Digital took steps to try to ensure this process was consistently applied across England. For example, it told us how on 12 April NHS Digital noticed that additions by GPs showed wider than expected variation and identified that GPs were adding patients in bulk using computer searches rather than assessing individual patients. In response, NHSE&I told GPs that there should be no automated process used to compliment or supplement individual clinical identification.29
Government Response
Not Addressed
HM Government
Not Addressed
3: PAC conclusion: Huge local variation strongly suggests that GPs were inconsistent when judging who was clinically extremely vulnerable and should therefore be advised to shield and be eligible for support. 3: PAC recommendation: Within six months, DHSC and NHS Digital should provide to the Committee a detailed explanation for the local variation in growth for the shielded patient list between April and May 2020 including the extent it was due to appropriate clinical judgements and identify lessons for how to support a consistent clinical approach in future. 3.1 The government agrees with the Committee’s recommendation. Target implementation date: October 2021 3.2 Whilst the government agrees with the Committee’s recommendation, it does not agree with the conclusion that there was huge local variation. NHS Digital and DHSC have already written to the Committee with an initial analysis of the local variation in growth of the Shielded Patient List (SPL). This found that most areas fell within the expected distribution, although it is acknowledged that six local areas did add more people to the SPL than the department would have expected. 3.3 NHS Digital and DHSC will conduct further analysis to understand in more detail the drivers of this local variation and identify lessons for the future. DHSC and NHS Digital will write to the Committee setting out these findings by October 2021.