Fourteenth Report: Readying the NHS and social care for the COVID-19 peak

Select Committee
Public Accounts Committee HC 405 29 July 2020
Report Status Government responded
Conclusions & Recommendations 26 items (6 recs)
Source View on Parliament website
Government Response (AI assessment · 24 of 26 classified)
Accepted 11
Accepted in Part 1
Acknowledged 6
Deferred 1
Not Addressed 5
Government response
Treasury minutes: Government response to the Committee of Public Accounts on the Fourteenth report from Session 2019-21 · published 18 Nov 2020
Read the government response ↗ Response on the tracker

Recommendations & Conclusions

26 results
2 Recommendation Accepted in Part
Discharging patients from hospital into social care without first testing them for COVID-19 was an...
Recommendation
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 … Read more
Government Response Summary
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
This pandemic has shown the tragic impact of delaying much needed social care reform, and...
Recommendation
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, … Read more
Government Response Summary
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
Public confidence is likely to be further undermined without an open and honest debate about...
Recommendation
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 … Read more
Government Response 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.
HM Treasury
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5 Recommendation Accepted
Staff in health and social care cannot be expected to be ready to cope with...
Recommendation
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 … Read more
Government Response 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 programs offering 1:1 support, apps, and helplines are also mentioned.
HM Treasury
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6 Recommendation Not Addressed
Policies designed to create additional capacity quickly, while necessary, have resulted in a lack of...
Recommendation
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 … Read more
Government Response 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.
HM Treasury
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1 Conclusion Not Addressed
On the basis of a report by the Comptroller and Auditor General, we took evidence...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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7 Conclusion Accepted
There have been serious and widespread concerns about the lack of timely testing for both...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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8 Conclusion Accepted
Similarly, procuring and distributing PPE involved a range of bodies, including the Department, Public Health...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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9 Conclusion Accepted
On 17 March the NHS told trusts to discharge urgently all medically fit hospital patients...
Conclusion
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 … Read more
Government Response 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 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
Some organisations such as Care England highlighted to us the flawed nature of this policy...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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11 Conclusion Not Addressed
We remained concerned that the Department had continued its policy of discharging people untested into...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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12 Conclusion Not Addressed
This Committee has warned before that the Department lacked an effective overall strategy or plan...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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13 Conclusion Acknowledged
We heard how frequently social care had taken second place to the NHS’s needs, particularly...
Conclusion
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 … Read more
Government Response Summary
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
This Committee has also challenged the Department before over not delivering on its overarching responsibilities...
Conclusion
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 … Read more
Government Response Summary
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
The Department stressed that it had to respond quickly to the COVID-19 pandemic often with...
Conclusion
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 … Read more
Government Response 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 ensure access.
HM Treasury
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16 Conclusion Accepted
By comparison, because testing capacity was limited during the earlier stages of the pandemic, the...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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17 Conclusion Accepted
Concerns about the transparency of Government’s reporting about the measures it has taken, particularly around...
Conclusion
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 … Read more
Government Response 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 ensure access.
HM Treasury
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18 Conclusion Accepted
Testing for COVID-19 is fundamental to controlling the virus, and to informing and reassuring the...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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19 Conclusion Acknowledged
We were keen to know how the Department would ensure sufficient stockpiles of PPE and...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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20 Conclusion Acknowledged
NHSE&I explained that the NHS was carrying 100,000 staff vacancies going into the pandemic.58 It...
Conclusion
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, … Read more
Government Response Summary
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
There have been numerous media reports of PPE shortages for health and social care staff...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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22 Conclusion Accepted
Testing for NHS workers (with symptoms) only began from 27 March, with eligibility extended to...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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23 Conclusion Accepted
We were concerned about the NHS needing to call on the same staff who have...
Conclusion
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 … Read more
Government Response 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.
HM Treasury
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24 Conclusion
Under its reasonable worst-case scenario, the Government expected over 4% of the population might require...
Conclusion
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 … Read more
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25 Conclusion
Between mid-March and mid-April, the NHS and armed forces are to be commended for increasing...
Conclusion
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 … Read more
HM Treasury
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26 Recommendation Acknowledged
Access to NHS services has reduced significantly during the COVID crisis, potentially creating huge pent-up...
Recommendation
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 … Read more
Government Response Summary
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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