We have moved out of a period of COVID-19 critical planning and response and into a longer period where our health and care system must remain both prepared for any future peaks and effectively providing essential services and other high quality care and treatment for the people of Wales.
To maintain momentum and to ensure the system continues to focus its attention on the provision of a wider range of services, in May I issued an NHS Wales COVID-19 operating framework for quarter 1 (2020/21). The document highlighted four types of harm that could emanate from Covid-19 which we had to remain focused on and guard against:
- Harm from COVID-19 itself
- Harm from an overwhelmed NHS and social care system
- Harm from a reduction in non COVID-19 activity
- Harm from a wider societal actions / lockdown
Since publication of the Quarter 1 framework there have been important developments including both the continued easement of lockdown measures in Wales in recognition of the R value and the Test, Trace, Protect (TPP) programme launched at the beginning of June.
In recognition of this I have published a Quarter 2 framework which will drive the next stage in our systems focus on ensuring both a continued effective response to COVID-19 whilst providing other essential services in a careful and balanced manner.
In developing the framework professional advice has been sought and received from a variety of stakeholders, including NHS Chief Executives and Medical Directors. The advice I have received continues to highlight that our approach must proceed progressively, with caution and in a flexible and agile manner.
This framework is an evolution of Quarter 1 and is set under the themes which existed in the previous framework. Workforce and Wellbeing continues to be a key priority and theme for Quarter 2 as many frontline and support staff will be feeling the impact of the initial crisis for months to come as well as potentially gearing up again for further peaks in demand.
New ways of working – Plans in Quarter 2 should continue to continue to build on and embed the new ways of working adopted in the early stages of the pandemic.
Managing COVID 19 – It will always be difficult to guarantee that health and social settings will be COVID free, however patients using the NHS must be confident that hospital environments are as safe as possible.
As new information and evidence about the virus continues to emerge, updated guidance needs to be developed, issued and implemented at pace, in particularly in relation to infection prevention and control. I am therefore pleased to confirm the establishment of a Nosocomial Transmission Group for this purpose and Health Boards and Trusts will need to progress the implementation of guidance on infection prevention and control, including environmental factors and social distancing which emerges from this group.
Until an effective vaccine is available NHS Wales must remain prepared for additional peaks in demand arising through COVID-19. I will be looking for plans to offer assurance on surge requirements that also take account of capacity requirements for essential services, as well as potential winter pressures.
Proposals for the requirement for Field Hospitals as part of the surge capacity along with demonstrating clinical models and value for money should be set out within the plans.
“Essential” services – Essential services continue to be the focus of the operating framework for Quarter 2 to include updates on:
- Cancer services.
- Diagnostic and imaging services.
- Restoration of solid organ transplant services.
- Mental Health.
- Implementing a phased re-introduction of screening services.
- Implementation of plans for the South Wales Trauma Network (by early autumn).
- Plans for physical and emotional rehabilitation
There will be no separate requirement placed upon Health Boards and Trusts to develop winter plans this year, but organisations will need to assure me that they are progressing winter preparedness in their quarter 2 plans and using the National Unscheduled Care Programmes six goals for urgent and emergency care to support with this planning.
“Routine” services – The framework recognises that delivery of routine services is a matter for local decision making based on an assessment of whether this can be done safely. However one area that will require additional focus is that of Children’s Services.
Primary care – During May further guidance was issued to support continued recovery of primary care services across all contractor professions. In Quarter 2 I will expect to see a particular focus on both the development of plans to support clusters in the safety netting of those at risk and people who are symptomatic or have tested positive to COVID-19 and Implementation of the care homes Direct Enhanced Services (DES).
Our aim continues to be to implement safe, phased, risk-based re-establishment of essential dental services, given the easement of other lockdown measures and the knowledge that some practices were ready to re-introduce more treatments the Red alert was lifted on the 22 June.
Optometry practices have also been asked to complete the self-assessment tool and move to the recovery plan Amber phase from Monday 22 June.
Quarter two plans should reference the progress that can now be made across both dentistry and optometry in opening these services up further.
Social Care Interface – The framework continues to signal the need to provide extended support to care homes to reflect the additional needs of residents with COVID symptoms, and the additional operational consequences on staff, supplies and occupancy levels.
I will be looking for Health Boards to ensure that there are plans in place regarding interfacing with care homes and social care.
The NHS Wales Quarter 2 plans will be submitted by 3 July.
NHS Wales COVID-19 Operating Framework for quarter 2 (2020/21) and two annex documents are attached at the respective links below: