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Detailed results from the report show: - The regions that have seen the sharpest decline in the number of people referred for routine elective care during the first 8 months of the year are London (37% reduction as compared to 2019), North West (35% reduction) and South East (35% reduction). The South West saw the smallest reduction in the number of people referred for elective care compared to 2019 (29%). The North East and Yorkshire saw a 34% reduction and Midlands and East of England both had a 33% reduction. - Those regions that experienced the lowest rates of COVID-19 during the first wave, namely the South West and East of England, are also those that have made the most progress in reopening elective care services. While there are currently only limited signs that more treatment is being postponed in the regions hardest hit by COVID-19, this may change in the future. - Referrals to clinical areas have declined as follows: oral surgery (43% lower than in 2019, representing 177,591 fewer people) trauma and orthopaedics (42% lower, representing 622,593 fewer people). This includes surgery for hip and knee replacements ophthalmology (41% lower, representing 531,660 fewer people). This includes cataract operations thoracic medicine (29%, or 98,546 fewer people) cardiothoracic surgery (29%, or 7,889 fewer people) neurosurgery (29% lower, or 23,872 fewer people); urology (28% lower, representing 186,119 fewer people).

Key aims Reassure patients they have not been forgotten during the coronavirus pandemic. Establish the patient's wishes regarding treatment. Good communication with patient and GP. Produce a validated waiting list that allows operating lists to run effectively. All Trusts are required to complete a clinical validation of patients on an admitted patient care pathway by 23 October, and for it to be captured in NHS e-Review. Trusts will be required to identify four user groups for the system; a user to upload patients to the system, an administrator, a super user to upload and download waiting lists and the outcomes from clinical reviews, and a clinical reviewer who is responsible for reviewing a cohort of patients within a specialty. Letter to healthcare providers and bodies Video software overview

On 1 October 2020, the Health and Social Care Select Committee published its inquiry report into ‘Delivering core NHS and care services during the pandemic and beyond’.[1] [2] Patient Safety Learning contributed to this inquiry earlier in the year with two formal submissions of evidence. The first focused on hospital discharge arrangements, in a joint submission with CECOPS.[3] In the second we looked at the impact of COVID-19 on patient safety, specifically considering non-COVIDcare and treatment.[4] For the latter, our insights on this were partly informed by a webinar we held with patients, healthcare professionals and patient safety experts.[5] We welcome the publication of today’s report, which sets out recommendations in five different areas where action is needed to ensure the safe and effective provision of health and social care services both during and after the pandemic. Communication with patients The report recognises the importance of clear communications with patients during the pandemic. It acknowledges that there have been shortcomings in this area, stating that: “… the patient experience for some has been unacceptably poor, leaving them feeling like they have been left in 'limbo' or 'in the lurch'. Unnecessary anxiety and stress has been caused to those patients due to poor communication not just from their local hospital about the scheduling of appointments or access to treatments, but from national bodies, and on key items of guidance such as on shielding.” The Committee calls on the NHS to review the guidance they provide to trusts on how to communicate with patients about treatment changes and medical guidance in the event of a further spike in COVID-19 cases. We agree with this recommendation and reflected concerns about this issue in our submission to the inquiry. We also believe the NHS needs to consider how it communicates with patients who are impacted by the pandemic backlog of treatment and care. There needs to be honest and transparent conversations with patients about how this may affect their personal circumstances. Managing the backlog of care and treatment Recognising the serious challenge that the NHS now faces in managing waiting times and a backlog of appointments resulting from the pandemic, the report considers this in more detail in the areas of elective surgery, mental health, cancer and dental services. This was also an area of focus in our submission to the inquiry, where we highlighted other areas of concern such as chronic disease management and postnatal support.[4] We have also subsequently looked in more detail at the backlog in elective surgery and the patient safety implications of this.[6] We welcome the Committee’s recommendations that the Department of Health and Social Care and NHS should set out plans to address the backlog, along with steps that will be taken in future to manage the overall level of demand across health services. Patient Safety Learning believes that a strategy is needed to tackle the demand on NHS services in a systemic way; a published strategy that will help to ensure that decisions regarding the priority of cases are made transparently and with patient safety at the forefront. Staff access to Personal Protective Equipment (PPE) and routine testing Another area of focus in the report is the protection of staff from infection during the pandemic. The Committee asks for assurances about future supplies of PPE and presses for routine staff testing of staff in health and social care. We completely agree on the importance of this issue and in our recent work for World Patient Safety Day made the case for staff safety being intrinsically linked with patient safety.[7] In terms of physical safety during the pandemic, the case for this is clear – ensuring sufficient suitable PPE is available and that staff have access to testing is essential in both limiting the risk of passing on infection to patients as well as protecting staff themselves. We also note that in discussing PPE requirements the report refers to a specific issue around problems with fitting PPE, particularly for staff from some ethnic groups. We note the Royal College of Nursing has called for equality impact assessments on PPE and fit testing and we think that this should form part of the Department of Health and Social Care response to this report. Burnout and staff wellbeing The report notes the significant impact that the pandemic has had on both the mental and physical wellbeing of staff, advising that the Committee also has launched a separate inquiry on this, 'Workforce burnout and resilience in the NHS and social care'. This is also an area we highlighted in our submission to the inquiry and we have been sharing and highlighting staff perspectives on this during the pandemic on the hub.[8] We are also using the hub to share and publicise tools to help support staff through this period, such as a set of wellbeing resources from the Scottish Patient Safety Programme. We welcome the report’s call on NHS to set out in more detail the steps it will take “to support the mental and physical wellbeing of all staff and a plan to deal with the specific issue of sustained workplace pressure due to the current pandemic and backlog associated with the coronavirus”. Learning lessons from the pandemic The final section of the report considers the fundamental changes that have been ushered into health and social care services by the pandemic, looking in more detail at the 111 dial service, technology and digital innovations, and the independent sector. It calls on the Department of Health and Social Care and the NHS to assess the effectiveness of such changes while also noting the need to “ensure patients’ wellbeing is not jeopardised by the risk of being digitally excluded from accessing medical treatment and advice”. Patient Safety Learning welcomes these recommendations. As we noted in our response to the inquiry, the pandemic has created the opportunity for innovations in health and social care that we should seize upon to improve future services. We also believe that this presents an opportunity to design new models of care and delivery with patient safety and staff safety at their core. References Health and Social Care Select Committee, Delivering core NHS and care services during the pandemic and beyond, 1 October 2020. UK Parliament, Delivering Core NHS and Care Services during the Pandemic and Beyond, Last Accessed 30 September 2020. Patient Safety Learning and CECOPS, Hospital Discharge Arrangements, 7 May 2020. Patient Safety Learning, Response to the Health and Social Care Select Committee Inquiry: Delivering Core NHS and Care Services during the Pandemic and Beyond, 8 May 2020. Patient Safety Learning, Your voice matters: how it is shaping out work in non Covid-19 care and patient and staff safety, 14 May 2020. Patient Safety Learning, The return of elective surgery and implications for patient safety, 15 June 2020. Patient Safety Learning, Why is staff safety a patient safety issue?, 3 September 2020. Claire Cox, “I know this is burnout. I didn’t want it to be. But it is.”, Patient Safety Learning’s the hub, 11 June 2020.