NELA & COVID-19 INFORMATION

NELA & COVID-19 INFORMATION
Info correct as 18-03-2020

Please see below an update in regards to NELA & COVID-19 situation:

We would like to update you with the implications for NELA during the COVID-19 pandemic.

As a follow up to the information below sent to all NELA Leads on 18/03/2020 please see document below, this specialty reorganisation guidance for anaesthesia released by NHSE on 17 March 2020.

 Specialty guide_Critical care and anaesthesia service reorganisation_V1_17 March.pdf (114 KB)

The 'Clinical guide for anaesthesia service reorganisation during the coronavirus pandemic' emphasises the importance of trying to maintain high standards for emergency surgery, especially Emergency Laparotomy and Hip fracture in order to reduce Length Of Stay for patients.

We would draw particular attention to this bit of text in the attached document:
'Maintain standards for emergency surgery, particularly high-risk such as emergency laparotomy (EL) and hip fracture: consultant care delivered within 24 hours of admission to hospital in all cases, sooner depending on clinical urgency for EL.'

Further Info:
Last week we requested guidance from HQIP, as our commissioners, about NELA data collection, and also NHS England regarding the Best Practice Tariff. We have been awaiting these replies so as to issue definitive guidance, rather than interim notices.

NELA data collection
Clinical and other hospital staff are involved in collection of NELA data, and we would expect staff to prioritise clinical activity for the benefit of patients. NELA has asked if data collection is being suspended. HQIP are awaiting further guidance from NHSE, as this affects all national audits. The reply received from HQIP on 17th March is as follows:
Impact of COVID-19 on NCAPOP
We are working with NHSE/I on guidance for NHSE Trusts regarding the impact of COVID-19 on national clinical audit. We will issue an update as soon as possible on our website, social media channels and via our subscriber bulletin.


Are Trusts still expected to adhere to the current standards of critical care admission (amongst other standards)?
NELA is funded to measure quality of care against standards set by other bodies such as the Royal Colleges and other professional bodies. As such, NELA is unable to suspend standards of care, or issue explicit guidance that certain standards do not apply during the COVID-19 pandemic. We would expect clinicians to continue to prioritise care according to need, recognising that emergency laparotomy cases will still continue during the COVID-19 pandemic, some of whom will also require critical care admission. It is clear that critical care capacity will be stretched during this time. The importance of robust risk assessment of emergency laparotomy patients, coupled with senior decision making in partnership with patients, is paramount. We would not expect patients to be denied potentially life-saving surgery purely because of a lack of critical care capacity.

How will NELA be reporting performance for this period?
NELA will ensure that the impact of COVID-19 is fully acknowledged and accounted for in future reports. NELA has robust time series reporting that is available to all providers on a real time basis, so tracking the impact of COVID-19 on the quality of care received by patients undergoing emergency laparotomy is easily investigated at local and national level, providing data is available. We also note that CQC have suspended hospital inspections.

Best Practice Tariff
The potential impact of COVID-19 on Trusts means that it is likely that data collection for NELA, and hence the BPT, will be reduced. It's possible that retrospective data collection will resume once the COVID-19 workload has reduced, but this means that many Trusts may miss the quarterly data collection windows for the BPT. We have been awaiting a decision from NHS England as to whether there will be any allowances such that Trusts are not financially disadvantaged due to COVID-19. The following guidance was released by NHSE on 17th March, stating:
...block contract payments 'on account' for all NHS trusts and foundation trusts for an initial period of 1 April to 31 July 2020, with suspension of the usual PBR national tariff payment architecture and associated administrative/ transactional processes.
The link to the full announcement is here:
https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/urgent-next-steps-on-nhs-response-to-covid-19-letter-simon-stevens.pdf

I am sure you will appreciate that many of the usual lines of communication that are ordinarily in place have been disrupted as many us of have been planning for COVID-19. This applies at many levels, including the NELA Clinical Leads who are also full time clinicians and hence involved in local COVID-19 planning, and staff within HQIP and NHSE working at higher levels. Decisions that may have been reached in different times are likely to take longer as staff are involved in both planning for COVID-19, and also the clinical workload that COVID-19 creates.

The NELA administrative team will continue to provide reporting to our sites and can still be contacted for assistance via info@nela.org.uk. and our Helpdesk number 0207 092 1676.

Please be aware that due to the closure of the RCoA building, the team is now working remotely. However, we will endeavour to deal with your queries and provide assistance to you as quickly as possible in the current extraordinary circumstances.

Dr Dave Murray
National Project Chair

Dr Sarah Hare
National Clinical Lead

Mr Jose Lourtie
Senior Project Manager