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U-turn on mass expansion of covid care units as no funding available

Plans for a mass expansion of rehabilitation beds in new “Seacole centres” have been scrapped, with local leaders now told there is no capital funding to build them.

In late May, NHS England announced the “first” Seacole Centre in Surrey, for patients recovering from coronavirus, and asked other local systems to draw up proposals for similar units ahead of a possible second peak of the virus over winter.

The policy was designed to provide significant extra bed capacity to help get covid and other respiratory patients out of hospital more quickly, while offering effective rehab care.

But multiple well-placed sources have now told HSJ that capital bids for new Seacole units have been rejected.

In a statement, NHSE said: “Work with local NHS and social care providers suggests that these expanded rehab services can largely be provided in existing physical facilities as well as people’s own homes, so government has not allocated extra capital in year for this purpose.”

However, local leaders told HSJ that some of the plans to use “existing physical facilities” still required some capital funding to make them suitable for rehab care. One trust executive in the North West said: “If there’s no capital it means we can’t go ahead.”

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Source: HSJ, 5 August 2020

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NHS set to roll out £160m ‘Covid-friendly’ cancer initiative

As part of a £160m initiative, the NHS will look to roll out and expand ‘Covid-friendly’ cancer treatments which are safer for patients during the pandemic, the health service’s Chief Executive Sir Simon Stevens has announced.

The funding will help pay for drugs which treat patients without having as significant of an impact on their immune system, or which could offer other benefits such as a reduced number of hospital visits.

Almost 50 treatments have been approved for use as ‘swaps’ for existing drugs, with thousands of patients having already benefitted, and more are expected to be made available this week as part of deals struck between the NHS and pharmaceutical companies.

Within these treatments include options which allow patients to take tablets at home or receive medicines with fewer side effects rather than undergoing hospital-based treatment which can leave them more susceptible to coronavirus and other infections.

Sir Stevens said: “Since the first case of Covid in England six months ago, NHS staff have fast tracked new, innovative ways of working so that other services, including A&E, cancer and maternity could continue safely for patients and it is thanks to these incredible efforts that 65,000 people could start treatment for cancer during the pandemic.

“We are now adopting new, kinder treatment options which are not only effective but safer for use during the Covid-19 pandemic and more convenient for thousands of patients, who can take medication at home or be given medicines with less harmful effects on their immune system.”

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Source: National Health Executive, 3 August 2020

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Lockdown having 'pernicious impact' on LGBT community's mental health

The coronavirus lockdown has provoked a mental health crisis among the LGBTQ community, with younger people confined with bigoted relatives the most depressed, researchers found.

A study of LGBTQ people’s experience during the pandemic, by University College London (UCL) and Sussex University, found 69% of respondents suffered depressive symptoms, rising to about 90% of those who had experienced homophobia or transphobia.

Almost 10% of people reported they felt unsafe in their homes.

The study called for more government support for LGBTQ charities, which have experienced significant rises in demand since the start of the pandemic. It warned: “Poor LGBTQ+ mental health may remain unchecked without a substantial policy commitment and funding directed to ameliorating health inequalities exacerbated by the pandemic.”

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Source: The Guardian, 5 August 2020

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Coronavirus: ‘Stay at home’ message may have led to rise in heart attack deaths during lockdown, study finds

Patients suffering heart attacks during the coronavirus lockdown stayed away from hospitals with some dying as a result, a new study has found.

In an analysis of more than 50,000 patients who suffered heart attacks and were treated in 99 NHS hospitals in England both before and after lockdown, researchers found the proportion of deaths for patients with a milder form of heart attack jumped during the first month of lockdown.

Those suffering more severe heart attacks actually saw a lower death rate with hospitals keeping their emergency heart services running.

Dr Jianhua Wu, associate professor in biostatistics at the University of Leeds and lead author of the study, said: “It has revealed that although patients were able to get access to high levels of care, the study suggests a lot of very ill people were not seeking emergency treatment and that may have been an unintended consequence of the ‘stay at home’ messaging.”

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Source: The Independent, 5 August 2020

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NHS: MPs pilot system to measure delivery of key pledges

MPs are to launch a new system for evaluating whether key health targets are being met in England. 

A panel of experts reporting to the Commons health committee will assess progress made on policy commitments, starting with maternity services. They will rate performance from "outstanding" to "inadequate" and seek to drive improvements where needed.

Panel chair Dame Jane Dacre said it would be "fair and impartial" in its findings. She said she was keen to ask recent patients and users of NHS services to contribute to the panel's work as well as specialists in chosen fields, all of whom would have no political affiliation.

"It will be challenging, but I am committed to using available evidence to evaluate pledges, with the aim of improving patient care," she added.

The panel will scrutinise, on behalf of the health committee, major commitments made by the Department of Health, NHS England, NHS Improvement and other public bodies. It will base its approach on the Care Quality Commission, which evaluates care homes, hospitals, GP practices and other health services.

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Source: BBC News, 5 August 2020

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Health committee launches inquiry into NHS staff burnout

MPs have launched an inquiry examining workforce burnout across the NHS and social care, and the system’s ability to manage staff stress amid increased pressures during the COVID-19 pandemic. 

The House of Commons health and social care committee said it aims to produce a report showing the levels of staff needed in health and social care to tackle exhaustion and meet future challenges. 

The committee is calling for evidence on how workforce shortages impacted staff well-being and patient care during the pandemic and the areas that need to see recruitment most urgently. 

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Source: Pulse, 3 August 2020

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Chronic pain sufferers should not be given opioids, says medicines watchdog

People with chronic pain that can’t be explained by other conditions should not be prescribed opioids because they do more harm than good, the medicines watchdog has warned.

The National Institute for Health and Care Excellence (NICE) has said people should instead be offered group exercise, acupuncture and psychological therapy.

In new draft guidance, NICE said most of the common medications used for chronic primary pain has little or no evidence to support their use in patients aged over 16.

Its latest guidance comes amid concerns over the level of opioid use. In September last year a review by Public Health England found 1 in 4 adults have been prescribed addictive medications with half of them taking the drugs for longer than 12 months.

NICE’s new draft guidance said some antidepressants should be considered for people with chronic primary pain but it said paracetamol, non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen, as well as benzodiazepines or opioids should not be given because of concerns they might do more harm than good.

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Source: The Independent, 4 August 2020

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GPs asked to keep doors open after ‘significant incidents’ warning

New guidance requires GPs to offer at least some face-to-face appointments, amid reports that some had completely eliminated them, sparking ‘significant incidents’.

NHS England’s instructions for the third phase of the NHS response to COVID-19 were issued on Friday, including the call that “all GP practices must offer face to face appointments at their surgeries” along with remote triage and remote consultations.

Most appointments in primary care have been carried out remotely since the NHS instituted new operating procedures in response to covid, with practices offering a mix of remote consultations over the telephone or video, with a diminished number face-to-face. 

However, there have been reports of some GP practices not offering any face-to-face appointments at all, and continuing this approach following the peak of cases in the spring.

A letter to GPs last month told them they must offer appointments in person “where clinically appropriate”, now reiterated in the phase three guidance.

The letter added: “It should be clear to patients that all practice premises are open to provide care, with adjustments to the mode of delivery. No practice should be communicating to patients that their premises are closed.”

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Source: HSJ, 4 August 2020

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The shocking details of 'neglect' and fears for patients' lives at north Wales mental health unit

The mother of a former patient at a north Wales mental health unit has said she "couldn't let" her daughter "go back there" as new details about people being "neglected" there have emerged.

ITV News has seen a leaked copy of the Robin Holden report from 2014.

It was commissioned by Betsi Cadwaladr Health Board after staff on the Hergest mental health unit, which is situated within Ysbyty Gwynedd in Bangor, blew the whistle over management and patient safety concerns.

It reveals details never before made public, about how staff struggled to care for patients.

The document, which the health board has fought for six years to keep out of public view, gives an account of the death of a patient while no doctor was available because of rota gaps, another of a patient who tried to take their own life, again when no doctor was available, and inadequate staffing affecting patient care.

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Source: ITN News, 31 August 2020

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Patient Safety Movement Foundation, the American Society of Anesthesiologists, The Leapfrog Group, and ISQua join forces for #UniteForSafeCare World Patient Safety Day campaign

Today, four leading global organisations dedicated to fighting preventable deaths due to medical errors announced their partnership to co-convene the #uniteforsafecare programme on World Patient Safety Day (September 17, 2020).

In June, the Patient Safety Movement Foundation announced the wide-ranging campaign to bring attention to system-wide improvements that will ensure better health worker and patient safety outcomes, called #uniteforsafecare. Now, the organisation will be joined by the American Society of Anesthesiologists (ASA), The Leapfrog Group, and International Society for Quality in Health Care (ISQua) in co-convening the slate of programming, which includes a virtual physical challenge to raise awareness of the issue; collaboration with the National Association for Healthcare Quality’s annual conference, NEXT; an in-person demonstration in Washington, D.C. and a free virtual event for the public and those who have experienced errors, harms, or death to themselves or loved ones.

“As the first medical specialty to advocate for patient safety, and as physicians on the front lines treating COVID-19 patients, we know firsthand how critical ensuring health worker safety is,” said ASA President Mary Dale Peterson.  “The issue is especially timely.  From having the appropriate PPE to strategies for stress management and wellness – ensuring health worker safety is patient safety and improves outcomes.  We are happy to participate in this effort to advance safety in health care.”

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Coronavirus '90-minute tests to be provided in care homes and hospitals'

Two new tests for COVID-19 that are said to deliver results within 90 minutes are to be introduced across NHS hospitals and care homes, to speed up diagnosis ahead of winter and differentiate coronavirus infection from flu, the government says.

But some experts were surprised by the government’s decision, saying the particular tests were not well-known. No data had been published concerning their evaluation. The government had made mistakes in buying tests that turned out to be sub-standard in the past, they said.

“Repeatedly through the pandemic the government has raced ahead purchasing tests on the basis of manufacturer’s claims, and have found later when independent studies are done that the tests do not have adequate performance for use in the NHS,” said Professor Jon Deeks from Birmingham University, part of a team who have been evaluating tests of this sort.

“We would hope that the government would wait for proper evaluations, and consider the scientific evidence for all available tests before signing further contracts. The mistakes made in test purchasing have wasted millions of pounds as well as put lives at risk.”

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Source: The Guardian, 3 August 2020

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Trust with record covid deaths sees high rate of hospital acquired infection

The proportion of patients confirmed as infected with COVID-19 after admission to East Kent hospitals is running at twice the national rate, according to figures seen by HSJ.

The discovery comes as the Care Quality Commission confirmed to HSJ that it has sought and received further information from East Kent Hospitals University Foundation Trust on the high covid death rate at the trust. It is now deciding whether to take further action over the issue.

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Source: HSJ, 31 July 2020

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NHS told to return to "near-normal" performance before winter

Trusts have been set a series of “very stretching” targets to recover non-covid services to nearly normal levels in the next few months, in new guidance from NHS England.

NHS England and Improvement set out the system’s priorities for the remainder of 2020-21 in a “phase three letter” sent to local leaders.

It said the NHS must “return to near-normal levels of non-covid health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter”, when further emergency and covid pressures are anticipated.

In recent weeks providers have found it very difficult to resume many services, with many running at well below normal capacity, due to infection prevention measures, staffing gaps, and other covid-related barriers.

The targets in the new guidance for phase three of the NHS’s covid response include:

  • In September trusts must deliver “at least 80 per cent of their last year’s activity for both overnight electives and for outpatient/daycase procedures, rising to 90% in October (while aiming for 70% in August)”;
  • “This means that systems need to very swiftly return to at least 90 per cent of their last year’s levels of MRI/CT and endoscopy procedures, with an ambition to reach 100 per cent by October.”
  • “Trusts must hit 100 per cent of their last year’s activity for first outpatient attendances and follow-ups (face to face or virtually) from September through the balance of the year (and aiming for 90 per cent in August).”

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Source: HSJ, 31 July 2020

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Sponge-on-a-string test set to revolutionise oesophageal cancer diagnosis, researchers say

A sponge-on-a-string pill test could transform the way oesophageal cancer is diagnosed, researchers say. The method can identify 10 times more people with Barrett’s oesophagus than the usual GP route, scientists say.

The test, which can be carried out by a nurse in the GP surgery, is also better at picking up abnormal cells and potentially early-stage cancer.

Barrett’s oesophagus is a condition that can lead to oesophageal cancer, cancer of the food pipe, in a small number of people. Normally it is diagnosed in hospital by endoscopy, which involves passing a camera down into the stomach, following a GP referral for long-standing heartburn symptoms.

The cytosponge test, developed by researchers at the University of Cambridge, is a small pill with a thread attached that the patient swallows. It expands into a small sponge when it reaches the stomach, and is then quickly pulled back up the throat by a nurse, collecting cells from the oesophagus for analysis.

The pill is a quick, simple and well tolerated test that can be performed in a GP surgery and helps tell doctors who needs an endoscopy. In turn, this could prevent many people from having potentially unnecessary endoscopies.

Scientists say that as well as better detection, the test means cancer patients can benefit from kinder treatment options if their cancer is caught early enough.

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Source: The Independent, 1 August 2020

 

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From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists

The list of lingering maladies from COVID-19 is longer and more varied than most doctors could have imagined. Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys and brain.

The likelihood of a patient developing persistent symptoms is hard to pin down because different studies track different outcomes and follow survivors for different lengths of time. One group in Italy found that 87% of a patient cohort hospitalized for acute COVID-19 was still struggling 2 months later. Data from the COVID Symptom Study, which uses an app into which millions of people in the United States, United Kingdom, and Sweden have tapped their symptoms, suggest 10% to 15% of people—including some “mild” cases—don’t quickly recover. But with the crisis just months old, no one knows how far into the future symptoms will endure, and whether COVID-19 will prompt the onset of chronic diseases.

One such patient is Athena Akrami. Her early symptoms were textbook for COVID-19: a fever and cough, followed by shortness of breath, chest pain, and extreme fatigue. For weeks, she struggled to heal at home. But rather than ebb with time, Akrami’s symptoms waxed and waned without ever going away. She’s had just 3 weeks since March when her body temperature was normal.

“Everybody talks about a binary situation, you either get it mild and recover quickly, or you get really sick and wind up in the ICU,” says Akrami, who falls into neither category. Thousands echo her story in online COVID-19 support groups. Outpatient clinics for survivors are springing up, and some are already overburdened. Akrami has been waiting more than 4 weeks to be seen at one of them, despite a referral from her general practitioner.

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Source: Science, 31 July 2020

 

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Learning the lessons of the past to restore the nation’s health and prevent widening health inequalities post-COVID-19

A healthy population is one of any nation’s most important assets. We have known for a long time that not everyone has the same opportunity to access the things they need to lead a healthy life, such as good quality work and safe secure stable housing. Now we can see that the COVID-19 pandemic is replicating and exacerbating deep-rooted health inequalities. Without concerted action, this health crisis will also become a health inequalities crisis.

The COVID-19 pandemic has brought health inequalities into sharp focus. While every part of the population has been affected by the current crisis, some communities have been hit much harder both by the virus itself and by the measures taken to control its spread.

Evidence is starting to emerge, for example, of the unequal impact of the shutdown of the economy. For example a recent survey of UK households found that the lowest earners have been worst hit by loss of earnings, with the most severe losses for single parents.

The uneven impact of COVID-19 has also highlighted the inequalities faced by Black, Asian and minority ethnic communities. Recent data shows that some ethnic groups are at much higher risk of dying from COVID-19 than the rest of the population (e.g. Black men are four times more likely to have died of COVID-19 than their White peers).

Read full article here.

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New analysis lays bare government’s failure to protect social care from COVID-19

New analysis by the Health Foundation reveals the devastating impact the pandemic has had on social care in England. The independent charity says the findings provide further evidence that the government acted too slowly and did not do enough to support social care users and staff, and that protecting social care has been given far lower priority than the NHS.

The Health Foundation finds that policy action on social care has focused primarily on care homes and that this has risked leaving out other vulnerable groups of users and services, including those receiving care in their own homes (domiciliary care). It also notes that the shortcomings of the government’s response have been made worse by longstanding political neglect and chronic underfunding of the social care system.

Since March there have been more than 30,500 excess deaths* among care home residents in England and 4,500 excess deaths among people receiving domiciliary care. While high numbers of excess deaths of people living in care homes have been well reported, the analysis shows there has been a greater proportional increase in deaths among domiciliary care users than in care homes (225% compared to 208%). And while deaths in care homes have now returned to average levels for this time of year, the latest data (up until 19 June) shows that there have continued to be excess deaths reported among domiciliary care users.

The Health Foundation says that decades of inaction by successive governments have meant that the social care system entered the pandemic underfunded, understaffed, and at risk of collapse.

Read full article here.

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Children's Society latest research: Lives on hold and what it means for young people's well-being

Over the past few months, we have been living in unprecedented and uncertain times as a result of the Covid-19 pandemic. Lockdown measures, school closures and social distancing have all had a substantial impact on the way we live our lives.

But, what have been the experiences of children, young people and their families during this time? And how has children’s well-being been affected?

Our well-being research

Every year we (The Children's Society) measure the well-being of children in the UK through a regular survey, with the findings presented in our Good Childhood Report. This research has shown how, since 2009, children’s well-being in this country has been in decline.

In our 2020 survey, we included a number of questions to gauge the impact of Covid-19 and the resulting social distancing/lockdown measures on children’s lives. The survey was completed between April and June, when the UK was in lockdown.

Our latest briefing, Life on Hold, brings together the findings of these survey questions about Covid-19, together with children’s own accounts. 

Read the full article and findings here.

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NHS People Plan 2020/21 response by The Health Foundation

NHS People Plan provides a stop-gap but leaves glaring omissions

'Two years after it was first promised, the NHS is still waiting for a long-term workforce plan. Some of the measures announced in today’s People Plan are positive. As the plan acknowledges, it is important to learn from the impressive changes made by NHS staff during the pandemic. And improving support for people from black and minority ethnic communities – who make up one fifth of the NHS workforce – is rightly a top priority. 

'But there are glaring omissions. The NHS went into the pandemic with a workforce gap of around 100,000 staff, yet the plan does not say how this will be addressed in the medium term. This is particularly concerning at a time when our recruitment of nurses from abroad has dropped dramatically. These details are missing because the NHS is still waiting on government to set out what funding will be available to expand the NHS workforce – without which the NHS cannot recruit and retain the doctors, nurses and other staff it needs. 

'While this plan at least provides a stop-gap to help get the NHS through the winter, there is no equivalent plan for social care – a sector suffering from decades of political neglect and the devastating impact of COVID-19 on care users and staff. A comprehensive workforce plan for both the NHS and social care is needed now more than ever'.

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Scandal-hit NHS trust admits negligence over death of six-week-old baby

Hospital trust ‘truly sorry that mistakes were made in care’ of Luchii Gavrilescu, who died after being sent home from hospital with undiagnosed tuberculosis.

An NHS trust investigated over maternity care failings has apologised after a six-week-old child was found to have died due to mistakes at one of its hospitals.

East Kent Hospitals University Trust was embroiled in a major scandal after The Independent revealed the trust had seen more than 130 babies over a four-year period suffer brain damage as a result of being starved of oxygen during birth. A report into the trust concluded in April that there had been “recurrent safety risks” at its maternity units.

Read full article here.

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Matt Hancock - the future of healthcare

Health and social care secretary Matt Hancock delivered a ‘future of healthcare’ speech to the Royal College of Physicians on Thursday and laid out seven lessons from the health and care response to Covid-19 that he wants to see retained. If followed through, some of his points would mark significant shifts in policy and Conservative thinking. However, Hancock said it was important to “build better” in the way that London was built better after the Great Fire in 1666.

Hancock’s seven points were: the NHS must value people and ‘bust bureaucracy’ that gets in their way; the future is “collaboration not competition”; “better technology means better healthcare”; the NHS must be open to other sectors; planning and funding will be “system first”; and social care and public health need more attention. On tech, Hancock said consultations will be digital first, and there will be a new focus on interoperability and data sharing.

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All GP consultations should be remote by default, says Matt Hancock

All GP appointments should be done remotely by default unless a patient needs to be seen in person, Matt Hancock has said, prompting doctors to warn of the risk of abandoning face-to-face consultations.

In a speech setting out lessons for the NHS and care sector from the coronavirus pandemic, the health secretary claimed that while some errors were made, “so many things went right” in the response to Covid-19, and new ways of working should continue. He said it was patronising to claim that older patients were not able to handle technology.

The plan for web-based GP appointments is set to become formal policy, and follows guidance already sent to GPs on having more online consultations. But the Royal College of GPs (RCGP) hit back, saying it would oppose a predominantly online system on the grounds that both doctors and patients benefited from proper contact.

Read full article here

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Duncan Selbie's (PHE) Friday Message - 31 July 2020

This week, Public Health England (PHE) Chief Executive's message covers the social care sector's management of COVID-19 outbreaks and the exemplary work in Hammersmith and Fulham Council, PHE's Better Health campaign, new reports on greenspaces and global disaster risk reduction, and our studies to support musicians and artists during the pandemic.

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Launch of NHS People Plan (2020-21)

"We are the NHS: People Plan 2020/21 – action for us all, along with Our People Promise, sets out what our NHS people can expect from their leaders and from each other.  It builds on the creativity and drive shown by our NHS people in their response, to date, to the COVID-19 pandemic and the interim NHS People Plan. It focuses on how we must all continue to look after each other and foster a culture of inclusion and belonging, as well as take action to grow our workforce, train our people, and work together differently to deliver patient care.

This plan sets out practical actions for employers and systems, as well as the actions that NHS England and NHS Improvement and Health Education England will take, over the remainder of 2020/21. It includes specific commitments around:

  • Looking after our people – with quality health and wellbeing support for everyone
  • Belonging in the NHS – with a particular focus on tackling the discrimination that some staff face
  • New ways of working and delivering care – making effective use of the full range of our people’s skills and experience
  • Growing for the future – how we recruit and keep our people, and welcome back colleagues who want to return

The arrival of COVID-19 acted as a springboard, bringing about an incredible scale and pace of transformation, and highlighting the enormous contribution of all our NHS people. The NHS must build on this momentum and continue to transform – keeping people at the heart of all we do."

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