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Having recently returned to front line Critical Care nursing part-time as a result of COVID-19, I don’t believe the NHS has transformed into a new innovative operating model. Sure, the spotlight has been shone on how the NHS has managed to quickly reconfigure its estates and add capacity through private hospitals and The Nightingale. And, yes it’s wonderful that humans have the ability to adapt when placed under immense pressure as we’ve seen the NHS redeploy and retrain staff to cope. But, is this really deliberate innovation or are these changes just coping mechanisms driven by pragmatic necessity?
We did see further changes too, but again, it’s hard to describe them as being disruptive. There were rapid structural changes. Large payments to the underfunded social care system to help place elderly patients into nursing homes. Notably, the Department of Health assumed a more direct role in operations for the first time in a decade and there is a view that some of this direct command may stick and the demise of CCGs may come sooner than planned(1).
Necessary spending for additional ICU beds, increased payments for staff (overtime & incentive premiums) and for PPE has whittled away any financial support such as writing off historical deficits.
There is now a backlog of unmet care and long patient wait lists along with the added challenge of restarting in an environment of reduced capacity due to social distancing(2). Furthermore, the NHS is having to work flat out to re-establish capacity to near pre-C19 levels before Winter(3). And, not forgetting that C19 hasn’t yet disappeared.
A&E attendances reached a record low during the peak of Coronavirus, but it wasn’t due to some seismic shift in their attitudes to how they had previously accessed these services. It was because of multiple complex factors. Not wanting to be a burden and fear of catching C19. The result; deterioration to a critical level of illness and in some cases death. And let’s not forget too that the UK ground to a halt with the majority of the population staying at home meaningless commuting and travelling on busy roads. The reality was that even throughout a major part of the crisis patients needing major care interventions still attended, and the vast reductions in attendance came from reduced low level and less urgent attendances, and a significantly reduced number of admissions from the care home sector.
A story that will no doubt be heard of more in the coming months is that of the significant increase in Do Not Attempt Resuscitation/ CPR and palliation of the frail in the nursing home population.
But these changes are not long term, the pressure is already returning to A&E departments as the fear of the virus dissipates and the UK goes back to work(4).
We’ve seen non-urgent care patients being granted access to digital-first consultations, namely for 111, GPs and outpatient(5) services. But the question arises as to whether you get the same outcomes from a digital consultation that you do from a face-to-face one? There is no scientific evidence to prove this.
And what about those people who can’t readily access the digital service? There’s a whole host of reasons for this including; no or limited use of broadband or cellular devices. Language barriers. Women of lesser emancipated cultures – who historically access healthcare in very low numbers. Capital wealth. Homelessness. The exclusion of some of our most vulnerable citizens means that there will need to be a shift back to face-to-face services for some.
Starting with some of the less tangible changes like improved health care literacy of the citizenry on what to do during the time of a pandemic. And the habit of frequent hand washing might also help us see some reductions in the spread of Norovirus and influenza this winter. Along with an increased up-take in the seasonal ‘flu-jab’.
The most visible NHS changes have been driven from necessity. Most have been pragmatic and yes, we have seen massive channel switches for how healthcare can be delivered. I do foresee a sustained disruption of the old-normal operating model in especially, the ambulatory care settings(6). Meaning permanent significant percentage shift from face-to-face to digital consultations.