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Open PDF 124KB Written evidence submitted by the Department of Health and Social Care (DEL00294) Introduction 1. The COVID-19 outbreak is the biggest challenge this country and our public sector has faced in a lifetime. DHSC has established four strategic objectives: to keep people safe, to protect our NHS, to protect the adult social care system and to minimise deaths. We welcome the Committee’s inquiry and are pleased to submit this evidence. Roles and strategic approach 2. The Government’s response to COVID-19 is guided by the science, advice from organisations such as WHO, surveillance, data modelling based on the best available evidence, and the recommendations of our expert bodies1. Expert medical advice is provided by the Scientific Advisory Group for Emergencies (SAGE) and the four UK Government Chief Medical Officers (CMOs). 3. In its response to the COVID-19 outbreak, DHSC has and continues to work with Public Health England (PHE), NHS England, other government departments and partners in local government and the health sector. DHSC’s COVID-19 response comprises six workstreams: Social Distancing, Shielding, Resilience, Supply, Testing and Technology. Social Distancing 4. Social distancing is vital in controlling the outbreak. On 16 March, the Secretary of State for Health and Social Care announced a Stay at Home policy, advising people to avoid pubs, clubs, cinemas and restaurants; avoid all unnecessary social contact with others and all unnecessary travel; and to work from home where possible. On 20 March entertainment, hospitality and indoor leisure premises were closed and firmer social distancing measures were introduced. 5. Social distancing guidance2 published on GOV.UK outlines three measures to reduce the impact on the NHS and save lives: i. Requiring people to stay at home, except for limited purposes; ii. Closing certain businesses and venues; iii. Stopping gatherings of two or more people in public. Key parts of these measures are underpinned by law. 1 https://www.gov.uk/government/publications/coronavirus-action-plan/coronavirus-action-plan-a-guide-to- what-you-can-expect-across-the-uk#expert-advice-and-guidance 2 https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others/full- guidance-on-staying-at-home-and-away-from-others Young-people friendly social distancing guidance will be published shortly. 6. On 10 May, the Government announced a three-step plan to ease lockdown restrictions in the UK. The plan is supported by a new five-level alert system relating to the level of COVID-19 threat in the UK and the R rate; level 1 means the virus is no longer present in the UK, and level 5 means the virus has overwhelmed the health service. As of 10 May the UK is at level 4 and beginning to move to level 3. 7. Step 1 of the plan was brought into place on 10 May: i. Where work cannot be done at home, offices and contact centres can be open. As soon as it is practical, workplaces should follow the new ‘COVID-19 secure’ guidelines. This will be published shortly. ii. For those working in other people’s homes, where the services do not involve extended contact with people, they can go to work if the ‘COVID-19 secure’ guidelines are followed, including the two-metre distance, and nobody in the home has symptoms of coronavirus. iii. Those people returning to work should avoid using public transport wherever possible and choose to cycle, walk or drive instead. iv. Garden centres and outdoor sports courts can open from 13 May with appropriate social distancing guidelines in place. v. As of Wednesday 13 May, people may spend time outdoors, including exercise, with one person who is not in their household as long as they stay two metres apart. vi. Further activities that are permitted as of 13 May include fishing, working on allotments, picnics and relaxing outside, and driving to outdoor spaces regardless of distance. vii. Guidance stating that exercise should be limited to once a day will be removed. Sports courts, including outdoor tennis, basketball courts and golf courses, that had been forced to close, can open. 8. Steps 2 and 3 of the plan were announced on 10 May, but are conditional on the decrease of the R rate: i. Step 2 will involve gradually replacing the current social distancing restrictions with measures that have the largest effect on controlling the epidemic but at the lowest health, economic and social cost. This could include the phased reopening of shops and steps to get primary pupils back into schools, in stages, beginning with reception, Year 1 and Year 6. ii. Over time, we will introduce more localised measures, supported by widespread, accurate monitoring of the disease. iii. Step 3 will involve rolling out effective treatments or a vaccine to reduce the virus to manageable levels. If and only if the numbers support it, it is in this step that we may be able to re-open at least some of the hospitality industry and other public places, provided they are safe and enforce social distancing. 9. The Government is keeping these measures under close review. The Government must be satisfied with five tests before the measures are adjusted further: i. The NHS can provide sufficient critical care and specialist care across the UK; ii. A sustained fall in the death rate; iii. Rate of infection has decreased across all settings; iv. Confidence that operational challenges, such as increasing our testing capacity and having enough PPE, are in hand v. Confidence that any changes will not lead to a significant second peak of infections. Shielding 10. Whereas other social distancing measures are designed to reduce transmission in the general population, shielding is designed to protect the extremely clinically vulnerable (with a mortality rate of c. 30%) from contracting COVID-19 by minimising all interaction with others. Guidance3 on shielding and protecting people who are particularly vulnerable from COVID-19 has been published on GOV.UK 11. NHS Digital developed the Shielded Patients List (SPL), enabling organisations across government to support and protect those who need to shield. Additionally, NHSX has developed an SMS service for people identified as needing to shield. By the end of March, c.900,000 people identified as needing to shield had been contacted by letter or SMS. GPs and specialists have been asked to consider if any of their patients who have not yet been contacted should also be required to shield. 12. Those shielding are eligible for food delivery and additional care in the home, which they register for via a webpage and phoneline. Additionally, community pharmacies continue to provide support for self-care alongside dispensing of medicines. The COVID-19 standard operating procedure for community pharmacies was updated to allow all pharmacies to close to the public for two and half hours a day, allowing staff to focus on dispensing prescriptions and providing advice over the phone to those unable to attend. 13. The COVID-19 operating procedure for GPs has been updated for shielding patients. It advises that if a patient needs a face-to-face assessment, they should be seen on a home visit, and not brought into general practice premises unless a designated site has been set up. ‘NHS Volunteer Responders’ has been set up to support people who are at most risk from the virus, and an NHS Medicine Delivery Service will ensure delivery of medicines to shielding patients. 33 https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable- persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19 14. Given the vulnerability of those shielding, they have been advised to follow shielding measures for at least 12 weeks from the beginning of the pandemic. The removal of certain restrictions as announced on 10 May does not apply to those shielding. Mental Health 15. The Government recognises that the impacts of the COVID-19 outbreak – particularly social distancing and self-isolation – are likely to increase the risk of mental health issues, particularly for the clinically vulnerable. Guidance on Mental Health and Wellbeing will soon be published. 16. NHS mental health services have remained open, and we continue to support them to provide services in innovative ways, such as through digital channels. For those with severe needs or in crisis, NHS England has asked all mental health trusts to ensure there are 24/7 open access telephone lines for urgent NHS mental health support, advice and triage for people of all ages through a single point of access. 17. We have launched a digital tool on GOV.UK to help identify and respond to the needs of vulnerable people. It includes a section on mental health and wellbeing that signposts individuals to a range of guidance and support. More than 15,000 people have used this so far. We have also provided a £5 million grant to Mind and the Mental Health Consortia to administer a COVID-19 Mental Health Response Fund. We have pledged a further £750 million to ensure that charities, including mental health charities, can continue their vital work. NHSX has set up a mental health support cell to increase the usage of digital tools and platforms to support people who are known to mental health services during the response to COVID-19. 18. NHSX and MHCLG announced 18 digital solutions that have been awarded up to £25,000 to test their solution under the TechForce19 challenge. This initiative identifies new technologies that could support the vulnerable, elderly and self-isolating in response to COVID-19. Innovators awarded funding include Chanua, whose platform neurolove.org supports young people to manage anxiety and low mood, and Peppy, proving mental health support for parents-to-be and new parents.
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