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British Society of Paediatric Gastroenterology, Hepatology and Nutrition

Dear members

I would like to draw your attention to 3 important items today 23/3/20.

  1. Letter from Simon Stevens

This  sets out important actions that the NHS should put in place to redirect staff and resources, building on multiple actions already in train.

To:  Free-up the maximum possible inpatient and critical care capacity.

  • Prepare for, and respond to, the anticipated large numbers of COVID-19 patients who will need respiratory support.
  • Support staff, and maximise their availability.  Play our part in the wider population measures newly announced by Government.
  • Stress-test operational readiness.
  • Remove routine burdens, so as to facilitate the above

2. Letter from CMO Stephen Powis (attached)

Advice concerning those who are or may be at increased risk of severe illness from COVID-19

Please see a letter suitable to be sent to families in annex 3. 

Patients on immunosuppression therapies sufficient to significantly increase risk of infection have been outlined in the BSG Guidance which has been updated today 23/3/20.

Our advice  today when we called families of children and young people with IBD in the high risk category, (see guidance –  while on steroids prednisolone equivalent to or greater than 20mg, or within 6 weeks of starting a biological therapy,  or with severe active disease),  was to reassure that Covid19 appears not to cause such severe disease in children and young people.

We reinforced that patients should  continue their usual treatment, including infusion therapy,  and to continue to contact their  IBD team by phone if they have symptoms eg fever, typical features of a relapse. The team will assess each patient case by case and advise accordingly.

3. HOMECARE (Home Parenteral nutrition)  advice from 23/3/20 issued by Susan Gibert, who is leading on COVID-19 for Homecare

This has been sent to all regional homecare leads who will disseminate to the trusts. 

NHSE contract – CCGs (12 week rule)

In TVW I have gained agreement that NHSE and CCGs will not be expecting the homecare activity to have been recorded within the usual time frames. It might be a good idea to do the same in your regions. 

Delivery windows – relaxation of expectation
I have agreed with NCHA members that the NHS will not be expecting homecare providers to ‘hit’ their 2 hour delivery windows. Deliveries may need to move to all day windows in the near future, and if this is necessary can we agree to be supportive please? Homecare providers and hospitals are asked to be extra vigilant with the delivery address details as patients may no longer be at their usual work or residential addresses.

Emergency deliveries

We may reach a time where same day, next day and emergency deliveries are no longer possible. We may need to consider adjusting buffer stock in patients’ homes. At the moment, we do not have the reassurance that there is stock to do this, but it is something that we need to bear in mind for the coming weeks.

Phone Lines
Homecare providers are experiencing high volumes of calls, this has led to longer wait times. Patients are also reporting that their hospital clinical teams are no longer manning some NHS helplines (as specialist nurses are being called to ward and other duties). Please can you ensure that you use the correct line of communication as per local agreements. If the route of contact is via your BDM, RBM etc, please can you refrain from ringing the homecare providers?

Equally if your CNS staff are being called to the front line, please can you ensure that the homecare providers have a contact number or email for an alternative contact? If in doubt, the pharmacy homecare team will be contacted for all enquiries that have not been dealt with in a timely manner. In TVW we will be ensuring that the pharmacy contacts are up to date, if you could do the same, that would be great.

Dr Sue Protheroe,
Consultant Paediatric Gastroenterologist,
Birmingham Women’s and Children’s Hospital.
Birmingham. B4 6NH. U.K.
Tel 0044 121 333 8705
Fax 0044 121 333 8701
Chair NHS England Clinical Reference Group, Paediatric Medicine.
President of British Society of Paediatric Gastroenterology, Hepatology & Nutrition.



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