Source · Select Committees · Public Accounts Committee
Fifty-Third Report - Covid 19: supporting the vulnerable during lockdown
Public Accounts Committee
HC 938
Published 21 April 2021
Recommendations
2
DHSC and NHS Digital took too long to identify all clinically extremely vulnerable people.
Recommendation
DHSC and NHS Digital took too long to identify all clinically extremely vulnerable people. Individuals were not formally eligible for the central support of food boxes and medicines delivery offered through the shielding programme until they were on the Shielded …
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HM Treasury
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Conclusions (25)
3
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. As well as NHS Digital using national data to identify clinically vulnerable people, GPs and hospital doctors were quite sensibly asked to …
4
Conclusion
Government chose a centrally-directed system to support clinically vulnerable people as it did not have confidence all local authorities and supermarkets could meet people’s needs, particularly for food. MHCLG spoke with some local authorities and supermarkets early on to assess their capacity, but could not do a full assessment of …
5
Conclusion
MHCLG and DHSC do not know whether 800,000 clinically extremely vulnerable people slipped through the net and missed out on much needed support. DHSC explains that it took a ‘multi-channel’ approach to engaging with those affected. Through this approach, it focused first on sending letters, then an email, then calls …
6
Conclusion
Missing or inaccurate telephone numbers in NHS patient records undermined government’s efforts to contact 375,000 people. The contact centre relied on telephone numbers in NHS patient records when calling people to check their needs. Over 20% of the 1.8 million telephone numbers passed to the contact centre from NHS records, …
1
Conclusion
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (DHSC), Ministry of Housing, Communities & Local Government (MHCLG), Department for Environment, Food & Rural Affairs (Defra), and NHS Digital about protecting and supporting clinically extremely vulnerable …
7
Conclusion
As its understanding of the disease has grown, DHSC has developed a new risk assessment tool, QCovid, to identify people at risk based on wider factors which make them at more risk from COVID-19. DHSC described the tool as having technical, clinical and academic elements.10 QCovid identifies people who have …
8
Conclusion
DHSC told us it recognised that advising people to stay inside and away from society does have risks as well as benefits. Of those surveyed, some 36% reported worsening mental health and wellbeing while shielding.14 Charities also told us of the impact of lockdown on people not categorised as clinically …
9
Conclusion
The list of medical conditions that the chief medical officers developed to define clinically extremely vulnerable people was shared with NHS Digital on 18 March 2020. DHSC tasked NHS Digital to use patient data to identify those affected and create a list of people to be advised to shield (the …
10
Conclusion
NHS Digital created the first iteration of the list of some 900,000 people within two days using readily accessible data sources—hospital, maternity and prescribed medicines data. By 12 April 2020, three weeks after shielding began, a further 420,000 people had 7 Q 17; C&AG’s report para 2.3 8 Qq 13, …
11
Conclusion
As well as NHS Digital using patient data to add people to the shielding list, GPs and hospital doctors were asked to review the list and use their clinical judgement to add or remove people. GP and hospital doctors’ additions brought the total to 1.8 million by 18 April and …
12
Conclusion
DHSC acknowledged that there are advantages with NHS data systems—such as having large amounts of data—and disadvantages, for example challenges in connecting and using legacy systems.24 We asked NHS Digital what would help to identify patients earlier. NHS Digital told us this would require a technical solution, faster access to …
13
Conclusion
NHSE&I asked GPs and hospital doctors to add or remove people from the list, based on their clinical judgement, and as their patients’ conditions or treatments changed over time.26 However, the extent to which the list grew between 12 April and 15 May 2020 varied hugely in different areas, with …
14
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 …
15
Conclusion
NHS Digital told us that for the people whom it had identified and added centrally to the list, in line with the clinical criteria set by the chief medical officers, there is very little variation by area.30 DHSC acknowledged that it has seen variation in regions, and in local areas …
16
Conclusion
We asked DHSC if it had created a postcode lottery of support, and if people with certain conditions in some areas, would have different support to people in other areas with the same conditions.32 DHSC told us that it did everything possible to ensure that it had consistent application of …
17
Conclusion
Government quickly needed to ensure that those shielding had reliable access to food, medicines and care. It chose a national system of support run by central government.36 MHCLG considered that a centralised offer was more likely to guarantee delivery of food boxes in every part of England at the start …
18
Conclusion
Defra was chosen to lead on providing food to people shielding because, according to MHCLG, it had the expertise and relationships with the food industry.42 Defra consulted with supermarkets and wholesalers, to understand their capacity to provide people with food, nationally and quickly. Defra told us that it was very …
19
Conclusion
In August 2020, the government conducted an early lessons learned review of the programme which noted that, should shielding be needed again, a local support model could improve flexibility and potentially be more cost-effective.46 MHCLG told us how it started to move to a locally-led model over summer 2020 as …
20
Conclusion
This locally-led model focused on providing eligible people with priority access to book supermarket deliveries, rather than Government providing standard food parcels.48 Defra told us that almost everybody that signed up for food box support was matched and prioritised by a supermarket, and that these half a million people have …
21
Conclusion
Government used a range of ways to engage with clinically vulnerable people, to advise them to shield and how to register to access support.51 Government wanted all affected to register whether they needed support or not. NHSE&I and DHSC were initially responsible for advising people to shield, and began sending …
22
Conclusion
DHSC and MHCLG explained that for the 800,000 vulnerable people that the contact centre could not reach, their contact details were passed to local authorities, as it was thought local authorities might be better placed to contact these people and identify their need for support.54 These details were given by …
23
Conclusion
We asked MHCLG how many extra people took up the offer of support after being contacted by local authorities. MHCLG confirmed that it did not collect this information and explained that it is difficult to disentangle how many people registered support needs via contact with local authorities from those who …
24
Conclusion
The DWP contact centre relied on telephone numbers in NHS patient records to call clinically vulnerable people who had not yet registered their needs. In some 375,000 cases out of the 800,000 people that the contact centre could not get hold of, or over 20% of the 1.8 million people …
25
Conclusion
MHCLG considered that it established a communication strategy that took all reasonable steps to reach people.58 DHSC explained how it used a ‘multi-channel’ approach to communicate with clinically vulnerable people: its preference was to contact people using letters first as it considered letters used the highest-quality contact records, followed by …
26
Conclusion
DHSC told us it is trying to improve contact information by asking clinically extremely vulnerable people to ensure their GP records are up to date and will continue to update the records as patients improve their record keeping with their doctor. DHSC also noted that increasing numbers of patients are …