In a new briefing on the NHS response to Coronavirus, Chris Hopson, Chief Executive of NHS Providers looks to the long-term future of the service. The briefing draws on communications with Trust Chief Executives and Chairs over the last 10 weeks and whilst it looks back at how the NHS prepared for the pandemic, how it has coped and where the pinch points are, it ends by looking forwards.
The strong message from Trust leaders is that the NHS has achieved and is achieving extraordinary things and must keep going forward.
Whilst there will need to be a proper, considered debate on which temporary changes the NHS should adopt permanently, the briefing suggests “a starter for ten might include” the following:
• Digital transformation. The NHS has managed to move significant amounts of health care provision – GP appointments, outpatient appointments, basic consultations – online at record pace. This has shown what can be done when digital transformation is prioritised and appropriate funding is made available.
• Integration of health and care. The rapid discharge of tens of thousands of medically fit patients from hospital into social and community services shows how quickly care can be integrated when organisational and budgetary silos are ignored or bypassed.
• Tearing up red tape. The NHS has been able to adapt and shift shape at incredible speed by either rewriting or bypassing the myriad of regulations that have ossified existing structures and ways of doing things. Healthcare provision carries lots of risk so some level of regulation will always be necessary. But it’s amazing how much has been achieved how quickly with a significantly lighter, and more flexible, approach to regulation.
Underpinning the above are two more generic changes that Trust leaders want to preserve.
• Pace of change through local empowerment. The NHS has shown that, when galvanised behind a single, clear, vital imperative, it can change at a pace that would previously have been inconceivable. Trust leaders have been empowered to change what their Trust does at the drop of a hat – they’ve been given a clear objective and told to do whatever they thought was best. That’s then cascaded down throughout the rest of the Trust – frontline teams have been able to change how they work to best meet what they know needs to be done.
• Mobilising partnerships. The outpouring of support for the NHS has been extraordinary. By mobilising the support of a wide range of partners from specialist suppliers and the army to volunteers and colleagues in other public services, the NHS has been able to achieve things it could never have done by itself. We know that the NHS can often seem an inward looking, difficult to partner, behemoth. The service needs to maintain the highly productive set of relationships it has forged over the last two months.
The briefing also outlines that the experience of coronavirus will also bring us back to four important debates.
The NHS Long Term Plan
The delivery of commitments to improve care set out in the Long Term plan will, at best, be delayed as a result of dealing with coronavirus and at worst, it could be impossible to achieve them in the short/medium term. The NHS will need to re-assess what can be delivered when.
NHS structure
The government has already indicated that it intends to legislate on NHS structure, but NHS Providers believes it makes sense to learn the lessons of coronavirus before drafting legislation.
One example is the way problems around testing, ventilators and the PPE supply chain have been exacerbated by dispersed and unclear accountability between a number of different health arms-length bodies and different parts of government. We will need to think how the lessons learnt from this experience should be applied.
Workforce
Many in the health and care sector have been arguing for some time that the current workforce models in both the NHS and social care are unsustainable. Both sectors have been carrying significant long running vacancy rates, have become highly dependent on increasingly scarce overseas staff and have been trying to close an underlying demand/capacity gap by just working existing staff harder. The strains put on both sectors by coronavirus will highlight and exacerbate these problems.
Both sectors will need to consider how to move, as rapidly as possible, to more sustainable underlying models, including ensuring support and reward packages reflect the critical role of key workers and provide the right size of workforce required. This will involve significant and far-reaching change.
Capacity and funding
Coronavirus will also, inevitably, prompt a debate on what size and capacity of health and care service we want and need as a nation. The NHS is one of the most efficient and best health services in the world. However, both the NHS and social care have been running, “in the red zone”, some way over sustainable capacity, for some time.
Recent funding increases for the NHS are welcome, but the rate of increase is lower than the long run NHS average and barely keeps up with growing demand. It does not enable the NHS to recover the impact of the longest and deepest financial squeeze in its history or fund the transformation it needs.
The government’s clear statement that the NHS will have what it needs financially to deal with the current challenge was very welcome. But if better funded health services with greater underlying capacity, like Germany, are able to weather coronavirus much better than the UK, then there will be understandable debate about what level of health and social care funding and how much capacity our health and care system really need.
For the moment, though, we should all celebrate the incredible dedication and professionalism of frontline NHS staff who, once again, have risen to an unprecedented challenge when it was most needed.
Read the full briefing here.
