So, the NHS post C19 is better

Stephen Boyle, product specialist at TeleTracking UK, recently returned to frontline critical care nursing at East Cheshire NHS Trust in response to the COVID-19 pandemic. In this article he explains how, based on his experience, he does not believe the NHS has changed its operating model, despite a general consensus that it's recently undergone transformational change and he argues that most changes have been driven by pragmatic necessity and not deliberate innovation.

In my view the NHS has not fundamentally changed its operating model as a result of COVID-19.

Sure, it has adapted to cope for the surge. So, prognosticating that this is some great disruptive event may be a little premature.

Most of the changes we have seen have been driven by pragmatic necessity and not deliberate innovation.

In short, the NHS has, at some speed, reconfigured its estates and added private-sector hospital and Nightingale capacity. It has also retrained and redeployed staff and stalled thousands of lines of service.

There were rapid structural changes, too.

These included large payments to the underfunded social care system to enable it to take elderly patients languishing in hospitals and place them into nursing homes.

And, notably, the Department of Health and Social Care 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 clinical commissioning groups may come sooner than planned.

Meanwhile, financial changes included the writing off of historical deficits.

But, to be clear, this funding has nearly all been spent on additional ICU beds, increased payments for staff, and to cover the cost of PPE.

The NHS now finds itself working flat out to re-establish capacity to near-pre-C19 levels before winter, set against a backdrop of a vast amount of stored-up, unmet need in the population, and millions of patients now backed up on waiting lists.

Plus, the system is facing a restart in an environment of reduced capacity due to social distancing; all while the Novel Corona Virus C19 remains in circulation.

Unintended consequences

To think, as well, that patients staying away from A&E was due to some seismic shift in their attitudes to how they had previously accessed these services is wrong too.

Instead, the record reductions in attendances were brought about by many complex factors, such as fear mixed with good citizenship - fear of catching C19 and so staying at home, in droves, to deteriorate or even die, so as not to bother the doctors and nurses.

The Department of Health and Social Care 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 clinical commissioning groups may come sooner than planned

But, also, let’s not forget, too, that most of the population stayed at home and did not travel or commute on busy roads, with subsequent reductions in air pollution coupled with fine warm weather.

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.

Indeed, there has been a significant increase in Do Not Attempt Resuscitation/CPR and palliation of the frail in the nursing home population; a story that will no doubt be heard of more in the coming months.

But these changes are unravelling and we are seeing pressure returning to A&E departments as the fear of the virus dissipates and the UK goes back to work.

A digital tipping point

Yes, the NHS adapted quickly to a digital-first approach to access for non-urgent care via 111, GPs and outpatients.

But this shift is a massive non-scientific experiment. We have no evidence it works, or that you get the same outcomes from a digital consultation than you do from a face-to-face one.

That is before you even consider issues around equity of access from those people without access to broadband or access to a cellular device to have the consultation on in the first place.

And what of those citizens who do not have English as a first language? Or for women of lesser-emancipated cultures who historically access healthcare in very-low numbers? Then there are the poor, the homeless, and carers…..

Like A&E attendances, it is likely there will be some shift back from this to face-to-face services.