Readying the NHS and social care for the COVID-19 peak
Public Accounts Committee
Closed
Inquiry
On Monday 22 June, in the next of our new series of work on NAO reports into the Government’s response to the Covid-19 pandemic, we will question the Permanent Secretary and Finance Director at the Department for Health and Social Care; the Chief Executive of the NHS; NHS England; Public …
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6
Recommendations
20
Conclusions
1
Report
1
Oral session
2
Letters
1
Event
Activity timeline 5 events
18 Nov
2020
2020
16 Oct
2020
2020
29 Jul
2020
2020
21 Jul
2020
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22 Jun
2020
2020
Oral evidence
Oral evidence sessions 1 session
22 Jun 2020
View on parliament.uk
Reading the NHS and social care for the COVID-19 peak
Amanda Pritchard · NHS England
Catherine Frances · Department for Levelling Up, Housing and Communities
Professor Paul Johnstone · Public Health England
Rosamond Roughton · Department for Health and Social Care
Sir Chris Wormald · Department of Health and Social Care
Sir Simon Stevens · NHS England and NHS Improvement
Steve Powis · NHS England
Reports 1 report · click to expand
| Title | HC No. | Published | Items | Response |
|---|---|---|---|---|
| Fourteenth Report: Readying the NHS and social care for the COVI… | HC 405 | 29 Jul 2020 | 26 | Responded |
Recommendations & Conclusions
26 results
2
Recommendation
Accepted in Part
Fourteenth Report: Readying the NH…
Discharging patients from hospital into social care without first testing them for COVID-19 was an...
Discharging patients from hospital into social care without first testing them for COVID-19 was an appalling error. Shockingly, Government policy up to and including 15 April was to not test all patients discharged from hospital for COVID-19. In the period …
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Government Response
The government agrees with the recommendation, stating that updates were provided in October 2020. They will ask the SAGE Care Homes Working Group to keep discharge evidence under review and referenced existing Adult Social Care plans for patient testing prior to care home discharge, with a target implementation date of Spring 2021.
HM Treasury
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3
Recommendation
Deferred
Fourteenth Report: Readying the NH…
This pandemic has shown the tragic impact of delaying much needed social care reform, and...
This pandemic has shown the tragic impact of delaying much needed social care reform, and instead treating the sector as the NHS’s poor relation. This Committee has highlighted the need for change in the social care sector for many years, …
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Government Response
The government agreed with the recommendation for social care reform but deferred specific plans and timelines, stating it is actively considering proposals and will provide an update after the forthcoming spending review, while prioritising immediate winter care needs.
HM Treasury
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4
Recommendation
Accepted
Fourteenth Report: Readying the NH…
Public confidence is likely to be further undermined without an open and honest debate about...
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 …
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Government Response
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.
HM Treasury
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5
Recommendation
Accepted
Fourteenth Report: Readying the NH…
Staff in health and social care cannot be expected to be ready to cope with...
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 …
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Government Response
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 programs offering 1:1 support, apps, and helplines are also mentioned.
HM Treasury
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6
Recommendation
Not Addressed
Fourteenth Report: Readying the NH…
Policies designed to create additional capacity quickly, while necessary, have resulted in a lack of...
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 …
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Government Response
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.
HM Treasury
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1
Conclusion
Not Addressed
Fourteenth Report: Readying the NH…
On the basis of a report by the Comptroller and Auditor General, we took evidence...
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 …
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Government Response
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.
HM Treasury
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7
Conclusion
Accepted
Fourteenth Report: Readying the NH…
There have been serious and widespread concerns about the lack of timely testing for both...
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 …
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Government Response
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.
HM Treasury
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8
Conclusion
Accepted
Fourteenth Report: Readying the NH…
Similarly, procuring and distributing PPE involved a range of bodies, including the Department, Public Health...
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 …
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Government Response
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.
HM Treasury
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9
Conclusion
Accepted
Fourteenth Report: Readying the NH…
On 17 March the NHS told trusts to discharge urgently all medically fit hospital patients...
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 …
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Government Response
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 be forced to admit residents if they cannot cope safely. The SAGE Care Homes Working Group will keep evidence on discharge under review.
HM Treasury
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10
Conclusion
Not Addressed
Fourteenth Report: Readying the NH…
Some organisations such as Care England highlighted to us the flawed nature of this policy...
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 …
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Government Response
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.
HM Treasury
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11
Conclusion
Not Addressed
Fourteenth Report: Readying the NH…
We remained concerned that the Department had continued its policy of discharging people untested into...
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 …
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Government Response
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.
HM Treasury
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12
Conclusion
Not Addressed
Fourteenth Report: Readying the NH…
This Committee has warned before that the Department lacked an effective overall strategy or plan...
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 …
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Government Response
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.
HM Treasury
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13
Conclusion
Acknowledged
Fourteenth Report: Readying the NH…
We heard how frequently social care had taken second place to the NHS’s needs, particularly...
We heard how frequently social care had taken second place to the NHS’s needs, particularly in accessing test kits and results, and securing reliable PPE supply for care homes, which had been neither timely nor coordinated.33 When questioned, the Department …
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Government Response
The government agrees with the committee's implied recommendation, stating its current priority is to place equal focus on the NHS and care sectors, and that it is actively considering a range of proposals for long-term social care reform, with updates to follow a future spending review.
HM Treasury
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14
Conclusion
Acknowledged
Fourteenth Report: Readying the NH…
This Committee has also challenged the Department before over not delivering on its overarching responsibilities...
This Committee has also challenged the Department before over not delivering on its overarching responsibilities towards the care market, and having no credible plans to ensure the sector was sustainably funded.38 We note it was not until June 2020 that …
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Government Response
The government agrees with the committee's implied recommendation, stating its current priority is to place equal focus on the NHS and care sectors, and that it is actively considering a range of proposals for long-term social care reform, with updates to follow a future spending review.
HM Treasury
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15
Conclusion
Acknowledged
Fourteenth Report: Readying the NH…
The Department stressed that it had to respond quickly to the COVID-19 pandemic often with...
The Department stressed that it had to respond quickly to the COVID-19 pandemic often with “imperfect knowledge”, which was why its approach had altered over time.43 But Care England told us that PPE guidance had changed no fewer than 40 …
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Government Response
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 ensure access.
HM Treasury
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16
Conclusion
Accepted
Fourteenth Report: Readying the NH…
By comparison, because testing capacity was limited during the earlier stages of the pandemic, the...
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 …
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Government Response
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.
HM Treasury
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17
Conclusion
Accepted
Fourteenth Report: Readying the NH…
Concerns about the transparency of Government’s reporting about the measures it has taken, particularly around...
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 …
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Government Response
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 ensure access.
HM Treasury
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18
Conclusion
Accepted
Fourteenth Report: Readying the NH…
Testing for COVID-19 is fundamental to controlling the virus, and to informing and reassuring the...
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 …
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Government Response
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.
HM Treasury
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19
Conclusion
Acknowledged
Fourteenth Report: Readying the NH…
We were keen to know how the Department would ensure sufficient stockpiles of PPE and...
We were keen to know how the Department would ensure sufficient stockpiles of PPE and testing capacity as it rolls out its ambitious ‘track and trace’ programme and the NHS resumes routine services while continuing to deal with COVID-19 this …
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Government Response
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.
HM Treasury
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20
Conclusion
Acknowledged
Fourteenth Report: Readying the NH…
NHSE&I explained that the NHS was carrying 100,000 staff vacancies going into the pandemic.58 It...
NHSE&I explained that the NHS was carrying 100,000 staff vacancies going into the pandemic.58 It said the workforce had been boosted by around 20,000 students; retired NHS staff; and a further 600,000 volunteers (working across a range of public services, …
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Government Response
The government responded to the committee's observation about NHS staff vacancies and the student nurse programme by referencing the NHS People Plan for 2020-21, which aims to support NHS staff in their recovery from the pandemic.
HM Treasury
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21
Conclusion
Accepted
Fourteenth Report: Readying the NH…
There have been numerous media reports of PPE shortages for health and social care staff...
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 …
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Government Response
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.
HM Treasury
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22
Conclusion
Accepted
Fourteenth Report: Readying the NH…
Testing for NHS workers (with symptoms) only began from 27 March, with eligibility extended to...
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 …
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Government Response
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.
HM Treasury
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23
Conclusion
Accepted
Fourteenth Report: Readying the NH…
We were concerned about the NHS needing to call on the same staff who have...
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 …
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Government Response
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.
HM Treasury
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24
Conclusion
Fourteenth Report: Readying the NH…
Under its reasonable worst-case scenario, the Government expected over 4% of the population might require...
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 …
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HM Treasury
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25
Conclusion
Fourteenth Report: Readying the NH…
Between mid-March and mid-April, the NHS and armed forces are to be commended for increasing...
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 …
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HM Treasury
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26
Recommendation
Acknowledged
Fourteenth Report: Readying the NH…
Access to NHS services has reduced significantly during the COVID crisis, potentially creating huge pent-up...
Access to NHS services has reduced significantly during the COVID crisis, potentially creating huge pent-up demand, which will add to the substantial waiting lists that existed before the pandemic.77 NHSE&I told us that access to emergency and critical services, such …
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Government Response
The government agreed with the committee's recommendation (implied to be about resuming services and managing demand) and responded by outlining initiatives for staff wellbeing and support through the NHS People Plan, without detailing specific plans for addressing patient backlogs or pent-up demand.
HM Treasury
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Correspondence 2 letters
16 Oct 2020
Correspondence from Julian Kelly, NHS Chief Financial Officer, re Readying the NHS and social care for COVID-19, dated 18 September 2020
Parliament page
21 Jul 2020
Correspondence from Public Health England in relation to the Committee's inquiry Readying the NHS and social care for the COVID-19 peak, dated 2 July 2020
Parliament page