Best laid plans

Philip Hunt on Covid's wider impact on the NHS

The pandemic within which we now live our lives has seen Britain’s health service at its very best, with the public full of praise for the dedication and selflessness of staff.

Yet as the crisis looks set to continue through the coming winter, with Covid on the rise and the inevitable threat of a flu outbreak, the NHS faces considerable uncertainty about when and how it will resume anything like a normal service. The five-year ‘Long Term Plan’ (LTP) launched to much fanfare in 2019, now looks to be in considerable jeopardy.

When Covid first hit our country, the NHS was already suffering a shortage of doctors and nurses – as well as the worst four-hour wait performance in A&E since figures were first collected. And corresponding failures on key targets for cancer, GP appointments and hospital treatment merely emphasised the impact of pressures across the piece.

This vulnerability was behind the government’s first panicky response to Covid during the original lockdown in March. Huge efforts were put into preserving NHS capacity to deal with patients affected by the virus. Much else, however, had to go and the BMA have since warned that the shutdown of most non-Covid services has left a large backlog of related care.

Two million people are waiting more than 18 weeks for hospital treatment, with the NHS Confederation estimating that the waiting list for routine procedures could reach 10 million by the end of this year. The Royal College of Physicians, meanwhile, have warned that patients health will have deteriorated to the point where they will need far more extensive treatment than planned.

Alongside this, patients with cancers are at risk of surgery being postponed or undetected because they could not get tests; and many with mental health conditions have missed direct contact with health professionals. The NHS, therefore, has a major task to get normal services back on track let alone implement the LTP.

Ministers have set much store by the five-year programme, which aims to bring in a new service model that gives patients more options, better support, and joined up care. It also aims for GPs to extend the range of convenient local services; and envisages a further expansion of treatment centres to support those with learning disabilities and mental health conditions.

But for an NHS convulsed by the immediate pressures of a pandemic and a huge waiting list, the challenges are immense. So, there is an urgent need to deal with the immediate capacity issues, tackle the treatment backlog (with an emergency plan), and then recharge the LTP. 

On the positive side, the NHS will be able to build on some of the lessons learnt during the crisis.

For patients, remote appointments have worked well and suggest that unnecessary visits to hospital and GPs could largely be avoided in the future. Many organisational barriers to providing integrated care were swept away in a matter of days. Staff have been very flexible and quickly retrained to perform other roles. And local leaders are taking decisions that would normally get referred up the bureaucratic chain of command. A big lesson for our national bodies to take to heart.

While wartime analogies have been thrown about like confetti over the past six months, but at least one could prove useful. The origins of the NHS lay in the Beveridge report, which Nye Bevan and the post-1945 Labour government then built on. If ever we needed a second Beveridge it is now – with perhaps this time a view on sorting out social care. Sadly, Boris Johnson and his colleagues show no sign of having the will and wherewithal to think on that scale, or the leadership and competence to deliver.

Lord Philip Hunt of Kings Health is a Labour Peer and former Health Minister. He tweets @LordPhilofBrum

Published 13th September 2020

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