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instability. Local government, private and voluntary, community and social enterprise (VCSE) sector organisations delivering care will need to be supported as equal partners during this next, longer-term phase of the recovery.
Health inequalities
The pandemic has revealed and further exposed the level of health inequalities throughout England. Of particular concern during the pandemic has been the impact on black and minority ethnic (BME) populations, who have been disproportionately affected by infection and mortality. In addition, the shielded population and vulnerable children who have not benefited from health visiting services remain a concern. The report calls for further guidance to tackle this with specific goals to reduce health inequalities using population health data and strategies.
Regulation and inspections According to the NHS Confederation, ‘lighter-touch’ regulation and performance management have allowed clinicians to redesign services at pace. The report argues that we must not return to the pre-COVID-19 models of Care Quality Commission (CQC) inspections and other forms of regulation.
System working The NHS Confederation points out that
COVID-19 has accelerated transformational change, much of it enabled by effective partnership working. It states that this is a key area that future legislative reform will need to look closely at in the months to come. NHS systems will need to be able to design and implement a recovery that is right for their populations at that moment in time, allowing for local variations in infection rates, facilities and capacity and any future outbreaks. The report calls for performance data to be shared across NHS regions to help providers benchmark recovering services. There is also an opportunity to regard the NHS, local government, private and voluntary, community and social enterprise organisations as equal partners during the next phase of the recovery.
Managing public expectations The report concludes that there is a real danger that expectations will run ahead of what the NHS can deliver. The NHS Confederation points out that there is a need for realism about what can and cannot be achieved, with clear and consistent communication from political leaders that it will take many months, possibly longer, to return to pre-COVID-19 levels of activity. Commenting on the report, Niall Dickson, chief executive of the NHS Confederation, said: “NHS leaders understand the need to ease lockdown and get the country ‘back to work’. Part of this will involve restarting
diagnostic screening, routine operations, outpatient appointments and other care, but we need to do this safely. Our members are aware that the virus is still with us and of the real risks of outbreaks in care settings. That is why we need a robust plan, communicated clearly. Political leaders have a vital role to play in reassuring the public that every step possible is being taken to manage the virus, while safely bringing back services that had to be paused. Retaining, public confidence and trust in the NHS will be vital over the next few months.”
CSJ
The report is the second from the NHS Confederation’s NHS Reset campaign, which aims to contribute to the public debate on what the health and care system should look like in the aftermath of COVID-19.
References 1 Figures cited by Anita Charlesworth, Health Foundation, accessed at:
https://www.health.org.uk/ news-and-comment/blogs/shock-to-the-system- covid-19s-long-term-impact-on-the-nhs
2 Press release, ‘Performance figures reveal ‘unseen impact’ of coronavirus, says NHS Confederation’, 11 June 2020. Accessed at: https://www.nhsconfed. org/news/2020/06/performance-figures-reveal- unseen-impact-of-coronavirus
3 NHS Confederation, Getting the NHS back on track planning for the next phase of Covid-19, 10 June 2020. Accessed at:
https://www.nhsconfed.org/ resources/2020/06/getting-the-nhs-back-on-track
Services will take over a year to return to full capacity
Almost half of physician specialities, including cardiology, gastroenterology and rheumatology, expect to be working at less than previous pre-COVID activity levels for at least 12 months or more. The Royal College of Physicians asked nineteen medical specialties in England to estimate what capacity they expect to be working at over the next 12 months compared with pre-COVID-19 activity levels. Eight of them expect to be working under capacity for the foreseeable future. This is in part due to the time it takes for the extra infection prevention and control measures to be carried out, all of which have been put in place to reduce the spread of COVID-19 and reduce nosocomial infection. For example, doctors are conducting fewer procedures due to the time it takes to don and doff PPE before and after each procedure, the need to implement social distancing to protect patients and staff, and the need for more regular cleaning of spaces between patient visits. COVID-19 has also meant that patients recovering from infection will also need
the on-going support of NHS services, especially in respiratory medicine, rehabilitation medicine, renal medicine and clinical psychology. This is additional activity compared to pre-COVID times. Speciality leaders in respiratory medicine and gastroenterology expect it to take two years to recover from the backlog created by COVID-19, while those in cardiology are expecting it to take 18–21 months. These figures bring to light the sheer scale of the challenge facing the NHS after the first wave of COVID-19 in England. Many doctors are still working in areas of medicine they were redeployed to at the start of the pandemic, meaning that patients in other areas are waiting longer for care and the resumption of services is still far from pre-pandemic levels. In the middle of May, 32% of RCP’s 25,500 members in the UK reported working in a clinical area that was different from their normal practice. By the start of June this had reduced by 10% to 22%, meaning one-fifth of the workforce were still working outside their usual area. When asked how long it will take for the
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NHS to get back on an ‘even keel’ (defined as ‘backlogs managed and services stabilised to a “new normal”’), 98% of RCP members thought it will take at least 6 months, 70% believe it will take over a year and 39% more than 18 months. Professor Andrew Goddard, president
of the Royal College of Physicians said: “We cannot underestimate the extent of the work that still lies ahead for the NHS workforce, and the very real possibility of further COVID-19 outbreaks and additional waves, which would of course increase the challenge ahead.
“Medical specialities are doing their utmost to keep up with demand, and will need the ongoing support of NHS England the Department of Health and Social Care to get services back on an even keel. In the short to medium term it is likely that doctors will need to further prioritise care, as they have always done, to respond to the reduced capacity levels across the NHS. We also need to be honest with patients that things will take longer and that we are working as hard as possible to restore services to pre-pandemic levels.”
AUGUST 2020
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