Written Statement: Coronavirus (COVID-19): NHS Wales Operating Framework for Quarter 1 (2020/21)

We are moving 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.

In March I made a number of decisions to ensure early and decisive action to continue to provide care and support to the most vulnerable people in our communities, whilst also making sure organisations and professionals were supported to prepare local responses to the public health emergency. The NHS in Wales has already delivered a remarkable response to the COVID-19 health emergency since receiving the first coronavirus patients and now we must take the next steps.

To maintain momentum and to ensure the system continues to focus its attention on the provision of a wider range of services, I have issued an NHS Wales COVID-19 operating framework for quarter 1 (2020/21).

The document highlights four types of harm that could emanate from COVID-19 which we must remain focused on and guard against. These are;

• 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

This framework will drive, even further, our systems focus on the two components of ensuring both a continued effective response to COVID-19 whilst providing other essential services in a careful and balanced manner.

I have taken advice from professional colleagues, including NHS Chief Executives and Medical Directors. This advice demonstrates consensus across the health and care system that we must ensure delivery of essential services for our population and where possible recommence more routine care. The advice I have received also says that this must be done progressively, with caution and in a flexible and agile manner to ensure confidence for the public and staff. 

This framework is set under a number of themes;

New ways of working and workforce wellbeing - Staff have created and quickly embraced new ways of working to respond to the COVID-19 challenge, offering benefits in terms of safety and quality to both staff and patients whilst also contributing to reduced congestion in primary care and hospital settings. We must continue to build on this work and harness the opportunities it has provided.

Examples of the scale of transformation include the rollout of video consultations safely to primary care. Locally and nationally these new ways of working must be sustainably embedded.

This framework recognises the importance of the wellbeing of our workforce, and in particular those staff who have been under significant pressure in responding to COVID-19 and they must be at the forefront of our minds.  Pressures may increase again in the next few months. I am clear that appropriate testing systems must be in place and be informed by the impending Testing Strategy being developed to support and help sustain staff.

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. The key criterion I will looking to organisations to be assured on include:

• Ongoing and consistent application of Infection Prevention and Control guidance.
• Identification of COVID “zones” and dedicated isolation facilities. I will be anticipating that regional solutions are explored along with the targeted use of independent sector hospitals and field hospitals to support the separation of COVID and non-COVID activity in the immediate term.
• New service or specialty based triage and streaming processes in both unscheduled and planned care to support the separation of patient services.
• Continued implementation of Acute Pathways for COVID-19 and the related rehabilitation
• Assurance on the availability of sufficient physical and workforce capacity that reflect the need to maintain social distancing and infection prevention and control measures.

The framework reflects my determination that we retain our ability to quickly activate additional critical care capacity, if we enter into another peak.

“Essential” services - I am clear that Essential Services should be maintained at all times throughout the pandemic. An Essential Services technical document has been developed in line with The World Health Organization (WHO) guidance. If, in any areas of essential services, the response to COVID-19 has led to backlogs they must be urgently addressed. Ultimately I recognise that some decisions on treatment will rest between patients and their clinicians, taking account of their specific risks during the COVID outbreak.

“Routine” services - We know that capacity exists in some parts of our system to support the re-introduction of routine services. The reintroduction of these services is a local operational decision for Health Boards and Trusts in conjunction with relevant partners. These decisions must be taken with care, and organisations need to assure themselves that it is safe and appropriate to do so. I outline how they need to assure themselves in the framework.

Primary care - For General Medical Services we have seen a shift to telephone first triage; this must remain in place during Quarter 1 and I encourage it longer term. Equally our community pharmacy services have been under significant pressure and have introduced new ways of working to manage patient care safely and efficiently, these too must continue where the benefits are clear.

All routine primary care dental treatments and check-ups continue to be cancelled. Dental practices with NHS contracts remain ‘open’ for remote triage, the provision of advice and the issuing of prescription. Further guidance will be issued separately to this framework about the future status and restoration of dental services.  In optometry services, a number of practices remain open for emergency and essential eye care services. Health boards must continue to ensure urgent patients are seen.

Social Care Interface - Finally the framework makes clear that NHS organisations must continue to work with partners to ensure an effective interface with social care. This is in line with the approach set out in “A Healthier Wales” and the framework makes clear how this must happen.

There has been clear and consistent messages for the public that the NHS is still available at times of need despite COVID-19. We must continue to ensure that key services are available and patients can access them, now and in the future.

To help patients access these services over the last eight to ten weeks there has been a seismic level of transformation across our system. We must reflect on these changes but not dwell on them. They must be adopted, adapted and applied. This framework supports the health and care system in moving to the next phase of providing services.  

Essential health services during COVID-19