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Review of children and young people
Hospital paediatricians and departments are being asked to review the risk status for those children and young people in their care who are currently flagged as 'high risk' through summer 2020.
You should review the RCPCH guidance and where you consider children in your care are no longer at 'high risk' of complications from Covid-19, you should submit a deduction to NHS Digital as per the guidance below.
We are asking hospitals to identify patients who are at the highest risk from coronavirus (COVID-19), and submit their details to us, so that they can be added to the shielded patients list (SPL).
We are also asking hospitals to:
- review the weekly data we send to them showing the change of shielding status for patients within their care
- ensure consultants and specialists providing care for those patients consider the current shielding status in reviewing the care of individual patients
Identifying patients as at high risk from coronavirus enables appropriate advice and guidance to be provided to those patients in the event of a local, regional or national coronavirus outbreak.
What you need to do
All NHS Medical Directors and all NHS Nursing Directors have received letters in April 2020 to inform them about the SPL, and to ask them to:
- review patient lists sent by NHS Digital
- add patients they deem clinically at highest risk, as appropriate, and write to those patients confirming this
Clinicians may have received additional communications from their Royal Colleges or Specialist Societies articulating the same process.
Since the initial review, we have provided hospital trusts with a weekly list of the patients under their care who appear on the shielded patient list. These lists are provided to hospital Covid-19 leads who have been nominated by each hospital. The list can change each week so it's important to review these files and consider the impact on individual patients in your care.
If you have not received a list for a given week, this is because we have not identified any patients on the SPL under your care for that period.
Hospital trusts should now review those patients within their care. You should consider:
- whether you believe any patients in your care who are currently on the weekly list no longer qualify as at high risk and should therefore be removed from the SPL
- implications for the ongoing care and/or shielding status arising from the current care episode for patients receiving treatment and who appear on the SPL
- whether any of those other patients in your care who do not currently appear on the SPL, but who now meet the CMO criteria, require a high risk flag
You should write to your patients if you identify them as being at high risk of complications from Covid-19. The letter provides advice and guidance on what it means to be at high risk, information relating to the support available, going to work, accessing NHS services and mental health support, as well as guidance on avoiding areas identified as being in a local lockdown.
An updated Word template of the letter was sent to Trusts in early September 2020. View a copy of the letter template.
You should notify your nominated Covid-19 trust lead who will follow the process below in 'How to submit data' to request relevant patients are added to the SPL with a high risk flag via a submission to NHS Digital.
If you decide a patient should no longer be included on the Shielded Patient List, you can request that they are deducted. This should only take place after a conversation with the patient and confirmation that there are no conditions that make them high risk. Once deducted, the patient will no longer be included on the NHS Shielded Patient List.
You should also write to patients who have previously been on the Shielded Patient List and now are assessed as being at moderate or low risk. We will calculate their risk as moderate or low nationally and update the GP record.
An updated Word template of the letter was sent to Trusts in early September. Download a letter template for patients assessed as not being at high risk.
Your nominated Covid-19 trust lead should follow the process below in “How to submit data” to request patients are removed from the SPL via a submission to NHS Digital. You will need to provide your Covid-19 lead with:
- The patient's NHS number, date of birth, postcode and consultant
- A request to remove the patient from the SPL
The submission window will be open daily between 8am and 5pm.
We can only accept one submission from each trust per day.
The data must be submitted by a named contact in the trust. Your trust data team should be able to provide details of Covid-19 lead(s) for your trust. Failing this, contact information can be provided to NHS trust staff by emailing: email@example.com
If you want to nominate another contact, it must be someone who is already registered to submit for one of the COVID-19 related data collections.
All error messages will be flagged in column N of the collection tool. You will not be able to submit the file until all errors are resolved.
This image shows the template in the SDCS. It includes the following fields:
- consultant code
- NHS number
- date of birth
- disease group:
- 1 - transplant
- 2a - cancer undergoing active chemo
- 2b - haematological cancers
- 3 - respiratory
- 4 - rare genetic, metabolic and autoimmune
- 5 - women who are pregnant with significant heart disease, congenital or acquired
- 6 - Academy of Medical Royal Colleges (AoMRC) categories – patients identified by Medical Royal College guidance that does not fit into 1 – 5
- supporting summary (max 255 char) including supporting ICD-10/OPCS codes
Mapping between the CMO criteria and the submission spreadsheet
The list of conditions that define patients as needing shielding was signed off by the Chief Medical Officers (CMO) of the four nations of the UK, and should be mapped to the disease group fields on the spreadsheet as follows:
Hospital spreadsheet disease group field
People who have had an organ transplant who remain on long term immune suppression therapy
People with specific cancers - people:
2a. Cancer undergoing active chemo
2b. Haematological cancers
People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD. Severe asthmatics are those who are frequently prescribed high dose steroid tablets.
People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)
|4. Rare, genetic, metabolic and autoimmune|
People on immunosuppression therapies sufficient to significantly increase risk of infection
|4. Rare, genetic, metabolic and autoimmune|
People who are pregnant with significant congenital heart disease
|5. Pregnant with congenital heart disease|
|Any other AoMRC grouping||State NO to all categories|
View full details of the methodology used to identify patients who should be shielded including a list of relevant ICD-10 codes.
How to retrieve data
In addition to Trust submissions, NHS Digital distribute a weekly list of shielding patients who are receiving care in your Trust. The lists are distributed via our Secure Electronic File Transfer (SEFT) system.
This weekly list includes patients where their risk of complications from Covid-19 has changed either as a result of being added to the list because they meet one or more of the CMO criteria, or because a GP has added or removed a patient from the list following an assessment of their health.
This list should be reviewed each week. It is the responsibility of Trusts to ensure this updated information is shared with those relevant consultants providing care to patients identified and their care is reviewed as and when their risk status changes. Each weekly list is the most current view of the risk status of those patients in your care, and therefore supersedes previous weekly lists.
The list will be available for download via SEFT to those individuals nominated to manage Covid-19 data within your Trust. They will be the same nominated contacts who are authorised to submit changes to the Covid-19 risk status for patients in your care as in the section above.
We would recommend that you use Internet Explorer 11 and Java version 8 when using the transfer tool. You'll have to add the link to the website in your 'Compatibility View Settings'.
If you have any questions about those people who can submit and retrieve data on your organisation’s behalf, please contact firstname.lastname@example.org.
Public Health England has published guidance on shielding and protecting people who are clinically extremely vulnerable from Covid-19 .
Updated guidance has also been provided by the Royal College of Paediatrics and Child Health on identifying children who are extremely clinically vulnerable.
Royal College of Paediatrics and Child Health (RCPCH)
If you have any other questions about the shielded patients list, identifying high risk patients or submitting data, contact us at email@example.com.