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HEALTHCAR E DE LIVE RY
effectiveness of the test and trace programme and adequate supplies of protective equipment as services restart. In a letter to the Prime Minister, the NHS Confederation warned that it will not be possible to simply ‘switch on’ NHS services immediately. It calls on the Government to manage expectations about how quickly key patient services can be restored and to communicate this clearly if public confidence in the service is to be maintained. Based on engagement with its members, which span services that commission and provide healthcare, including primary care, the report sets out some of the ways in which local NHS organisations will need support to get the NHS back on track – many of which require local health and care partnerships to be empowered to oversee transformative change. It also calls for a commitment to support local government and social care services, without which the NHS cannot function effectively. The report identifies the following areas that need to be addressed:
Funding The report states that local NHS organisations are facing an uphill battle. They are already having to manage ongoing demands from COVID-19, support exhausted frontline staff, cope with renewed demand in just about every area, and restart routine care, against a backdrop of increased unmet demand.
All this is compounded by the need to create separate COVID-19 and non- COVID-19 areas and enforce social distancing for patients and staff. Temporary arrangements, including the use of block contracts, are in place to ensure any ‘reasonable’ excess costs faced by providers are funded centrally. This arrangement needs to be continued for the rest of the financial year to take into account the profound impact on the NHS and its people dealing with the pandemic.
Capacity
The NHS Confederation points out that NHS organisations across the service face capacity constraints with hospitals, for example, having to run at much lower rates of occupancy than normal. It advises that ongoing arrangements with the private sector should be put in place until the end of the financial year to support the NHS to manage the backlog of treatment.
The NHS Confederation highlights the fact that the waiting list stood at 4.2 million before COVID-19 and it will rise much further without extra capacity from the private sector. In addition, the NHS Confederation adds that the Nightingale Hospitals should be maintained in case of any further spikes in infections.
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For the NHS to respond effectively to COVID-19, while restarting other services, the report emphasises that the test and trace system needs to be fully operational. Similarly, there needs to be appropriate supplies of personal protective equipment (PPE). Other recommendations include a review of ‘burnout’ and wider wellbeing across the NHS and social care workforce. In addressing capacity, the NHS Confederation is calling for the recommencement of the Evidence-Based
Interventions programme (EBI), which reduces interventions considered by consensus to be of low clinical value. This, it argues, would capitalise on the significant reduction in such interventions during COVID-19. It states that patients on previous waiting lists for any EBI procedures should be removed. The report also calls for an ongoing focus on digital technology that maximises use of capacity – for example, to enable remote working for socially isolating staff who could still provide remote consultations to support patients waiting for follow up or information on elective procedures. The NHS Confederation further suggests that the NHS should allow backlogs to be pooled and addressed across a system of providers – ensuring that burdens are shared to support those facing the most severe pressures.
Rehabilitation The report goes on to look at how resources should shift to support a system based on ongoing care and rehabilitation for patients who require social care, respiratory and psychological treatment. For many, rehabilitation will last long after their discharge from secondary care. The social care sector will be key to
supporting the most vulnerable in society over the coming months, but there are concerns over the stability of the social care market for providers due to financial
AUGUST 2020
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