The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.
Update 7th June 2020
A group of 27 leading medics and scientists have called on the Government to hold an urgent public inquiry on the UK response to COVID-19 to help prepare for a possible second wave in winter (https://www.theguardian.com/politics/2020/jun/05/uk-experts-call-for-coronavirus-inquiry-to-prevent-deadly-second-wave). The calls come following the UKs high death rate, which is currently the second highest in the world and which has disproportionately affected poor and ethnic minority communities. In an open letter, the experts stated that a number of problems needed to be addressed, including ‘the fragmentation of the NHS, public health and social care in England; the failure of those in Westminster to engage with local government and devolved nations; the channels by which scientific evidence feeds into policy; and an inability to plan for the necessary goods and services and procure them’. While the Government has stated that lessons will need to be learnt from the crisis, they have not yet committed to an inquiry.
A pandemic response plan was in place before the outbreak of COVID-19, but it was specific to pandemic influenza. The National Pandemic Influenza Plan outlines advice including:
• Guidance for local planners
• A health and social care response, including
o Detection and assessment and the relative roles of primary, secondary and social care and the provision of stockpiled PPE
o Treatment and escalation, including the roles of public health, primary and secondary care, ambulance services and others and the potential for legislative change
o The recovery phase
• Workplace/business guidance
• Ethical framework
• Pandemic flu: communication and public engagement
Emergency legislation (Coronavirus Act 2020) in response to COVID-19 received Royal Assent and was passed into law on 25th March 2020 (http://www.legislation.gov.uk/ukpga/2020/7/contents/enacted/data.htm). The new legislation grants the government powers to restrict the movement of infected persons, to restrict or prohibit gatherings and events, to increase capacity in the health workforce by increasing registration of health and social care professionals and to reduce barriers to working overtime as well as fundamental changes to the Mental Capacity Act and death certification processes.
The national response to COVID-19 is led by Public Health England. The response has been coordinated at the national level, but the home nations (England, Northern Ireland, Scotland and Wales) have considerable leeway in their individual responses and they have been exercising their rights. Responses have differed at the subnational level as health system capacity and demography varies across the country. Some London hospitals are better equipped, for example, with larger intensive care units and more ECMO, and have younger populations. Others are less well-resourced and have older populations, and are therefore more likely to discharge patients to community providers or care homes than treat them. As testing is now being rolled out locally, some areas have been faster to commission quick, efficient testing than others.
Although there was some guidance published in March for the residential and supported living/home care sectors (https://www.gov.uk/government/publications/covid-19-residential-care-supported-living-and-home-care-guidance), the government’s overall action plan for social care in England was not published until 15 April, amid growing concerns about lack of PPE, testing and handling people being discharged from hospital. Prior to publication of that strategy, social care organisations raised concerns about confused messaging and lack of support.