Written Statement: NHS Wales operating Framework Quarter 3/Quarter 4 2020-21

Winter for our health and social services colleagues is always difficult, however, the occurrence of COVID-19 has added a further dimension, so we are preparing for a winter like no other. 

Last week I published the ‘Winter Protection Plan’ for Health and Social Care in Wales. This is a plan which builds on the four harms approach which we have used to underpin our existing planning arrangements with health and social care to date:

• Harm from COVID-19 itself
• Harm from overwhelmed NHS and social care system
• Harm from reduction in non COVID-19 activity
• Harm from wider societal actions/ lockdown

The Winter Protection Plan is the Welsh Government’s overarching plan which describes the priorities until March 2021. It is underpinned by a range of actions which stakeholders across public services, together with partners in the independent and third sectors, as well as service users, carers and the wider public, will need to take to ensure we all play our part to keep Wales safe.

English: Winter protection plan for health and social care 2020 to 2021

Welsh: Cynllun diogelu’r gaeaf ar gyfer iechyd a gofal cymdeithasol 2020 i 2021

Following the publication of the Winter Protection Plan last week, I have asked the Chief Executive of NHS Wales to issue technical guidance to NHS organisations. The specific requirements for the next six months are set in the NHS Wales Operating Framework Quarter 3/Quarter 4 2020-21. We need to ensure the balance is right between COVID-19 and non COVID-19 activity and the framework sets the context within which NHS organisations need to plan for the winter ahead.

The NHS has been asked to prepare these plans by 19 October and these will be published by organisations following their usual governance mechanisms. These plans are for the NHS organisations themselves to use to inform Board decisions around actions needed to minimise and address risks and deliver services effectively over the winter period. They will also be helpful to inform regional and national planning and decision making.

I have been clear that Quarter 3/4 plans should not be a set of ‘new’ plans; they must build on the quarterly planning discipline which NHS Wales has so far adopted, but inform the longer period of planning until March 2021. As we move cautiously into this next six months it will be challenging to ensure our contingency planning, including winter and EU transition, will provide the foundation needed to take us through to spring 2021.  

The Quarter 3/Quarter 4 Operating Framework contains more technical and activity requirements than previous frameworks and it is supported by a minimum data set. The Quarter 3/ Quarter 4 Framework covers range of areas including:

• Local prevention and response plans, including Test, Trace and Protect.
• Essential Services
• Primary and Community Care
• Urgent and emergency care
• Working with partners
• Capacity plans
• Operational workforce plans
• Finance plans

There is no requirement for the Quarter 3/Quarter 4 plans to duplicate what has already been planned for, but they should be aligned to local prevention and response plans. The expectation is for the Quarter 3/Quarter 4 plans to contain a summary of the main implications, milestones and risks.

Essential services are important. There is a need to ensure that people across Wales can access services if they are urgent and life threatening or life impacting as well as services that without timely intervention could result in harm over the longer term such as maintaining vaccination programmes. To do so safely will require planning and ensuring sufficient stocks of PPE, medicines, blood, consumables and other supplies, necessary to treat people and mitigate the risks of COVID-19.

As we progress the recovery of the health system, there are valuable lessons from the rapid transformation that has occurred since the start of the pandemic that should shape the re-set and recovery of primary and community care over coming weeks and months. We must continue to embed the principle of ‘care closer to home’ across the whole health system. Without this there is a risk that we re-instate pre-COVID ways of working.

We also recognise that urgent and emergency care is in great demand during the winter months, both with accidents due to colder weather and respiratory and other conditions which are exacerbated at this time of year. The new Welsh Access Model for emergency care, including ’contact first’, will be introduced and this is supported by the six goals for urgent and emergency care which have been developed with, and supported by, strong clinical advice.

Working with partners is key. The health and social care community is not run by one organisation alone but rather a range of services to provide integrated care. A Healthier Wales intention is still evident and we have retained this core feature. So these NHS plans, while focusing on the detail of what needs to be done, also need to reflect the support they give to, and receive from, other organisations, including local authorities and the third and independent sectors.

COVID-19 is still present and the threat is growing as we approach the autumn. Modelling and advice suggest we need to plan for an extra 5000 acute beds and 350 critical care beds across Wales this winter. Some of these beds will be provided in field hospitals, others in extending hospital sites. I am looking for organisations to demonstrate their ‘surge’ capacity locally and regionally, supported by robust workforce capacity.

In May this year, the Welsh Government announced funding of £495m for the Health and Social Services budget to manage the COVID-19 response. In August Ministers for Health & Social Services and Finance & Trefnydd announced a further £800m stabilisation funding package for the NHS to provide funding certainty on the NHS resource envelope for the rest of this financial year.

Of this total funding of c£1.3bn, £451m has been allocated in relation to costs incurred to date this financial year on staffing, field hospital set-up, testing, personal protection equipment (PPE) and use of the independent sector. The balance of available funding will now be deployed in support of national priorities and local plans.