The coronavirus disease (covid-19) was first identified in China,1,2 and declared a pandemic by the World Health Organization on 11th March 2020.3 On that same evening, I was alongside 52,000 supporters in Anfield, watching Liverpool exit the UEFA Champions League after conceding three goals in extra time to a resolute Atlético Madrid.
There was controversy that the game went ahead. Madrid had seen a surge of covid-19 cases, yet hundreds of Atlético fans, the squad and entourage, made the journey to Liverpool. The same week 250,000 fans congregated at the Cheltenham Racing Festival. These were the last major sport events held. Liverpool FC’s legendary 1960s manager Bill Shankly once declared “Some people believe football is a matter of life and death… it is much more important than that.” When it came to covid-19, that was proven not to be true.
The UK Government, advised by experts, aimed to protect NHS capacity by initially promoting hand washing, social distancing, and strict self-isolation for those vulnerable to the disease, or suspected they had it. On the 23rd March 2020, the Prime Minster addressed the nation to extend the measures by closing schools and non-essential businesses, and banning gatherings of more than two people. The Chancellor introduced unprecedented financial support for workers and businesses. Society has not been as restricted in living memory, with Wimbledon’s tennis and the Open golf championships cancelled for the first time since World War Two. The drama of Brexit, primetime broadcasts of parliamentary wrangling, and the recent general election—all just a few months ago—are a fading memory. The pandemic has changed everything.
NHS services have been transformed. Many changes are for the better and will be beneficial post-pandemic. This begs the question: why has it taken a pandemic to instigate such needed change?
The NHS has seen a dramatic increase in resources, with more equipment, and field hospitals opening in London, Birmingham, Manchester, and beyond. Healthcare professionals have moved to an emergency footing, with massive internal upscale of intensive care beds, and the utilisation of all available resources to shield from/treat those with covid-19. Frustratingly, supply chain issues persist affecting provision of personal protective equipment and staff testing. It has been suggested that the pandemic convinced the chancellor to ease the pensions tax crisis that affected NHS consultants and services. However, the need for more resources and pension tax reform have been apparent for years. The NHS can’t be neglected ever again.
The media have eased their onslaught on hospitals and doctors which has dogged the NHS for years. The tone and appreciation for those especially on the front line has changed markedly. We have a weekly clap for carers, we are being showered with free food and coffee, and receive many an appreciative “thank you”. While the freebies should be directed to those who need it most, it is nice to be appreciated.
Healthcare professionals are happy to be scrutinised and regulated appropriately, but the previously unrelenting criticism, which erodes the NHS has to end. The vast majority of NHS workers, are decent individuals working together to achieve the best outcomes for their patients. No one should forget the service these heroes, front line and behind the scenes, provide before, during, and after the pandemic ever again.
Wellbeing had been high on the agenda for the BMA, The BMJ, and the Royal Colleges, including a desire for better work-life balance. Yet the biggest improvements have been made due to the pandemic. Self-isolation and risk reduction have made working from home and virtually held meetings the acceptable norm for many. Equipment and software has been provided at scale to facilitate this. Working from home and virtual meetings need to remain viable options for working post-pandemic as it improves wellbeing. We can never be so inflexible ever again.
To reduce covid-19 risk, clinic consultations are now done via telephone or video calls. This has worked well in our experience, particularly with patients one has met before. This isn’t problem free but has advantages over the traditional expectation of patients to take a half-day off work for a 15-minute follow-up appointment that is running an hour late. It is also startling that 5% of UK road transport emissions are attributable to NHS-related journeys,4 with consequential climate impact. Post-pandemic, patients should have the option of face to face, or telephone/video consultations, for the convenience of the patient, and to benefit the climate. We can never be so limited ever again.
Covid-19 is a game changer for the NHS and the wider society, and not just in healthcare. As Jurgen Klopp, Liverpool FC’s current manager declared when asked about covid-19 “If it’s a choice between football and the good of the wider society, it’s no contest. Really, it isn’t”. Post-pandemic, nothing will be (nor should be) the same ever again.
Ajay M Verma, consultant gastroenterologist, and chair of the New Consultants Committee RCP London.
Neeraj B Bhala, consultant gastroenterologist, University Hospitals Birmingham NHS Foundation Trust.
Competing interests: none declared.
- Hui DS, I Azhar E, Madani TA, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — The latest 2019 novel coronavirus outbreak in Wuhan, China. International Journal of Infectious Diseases 2020 Feb;91:264-266.
- World Health Organization. Pneumonia of unknown cause – China. 2020; Available at: https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en/.
- World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 – 11 March 2020. 2020; Available at: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020.
- The NHS Confederation. Taking the temperature: towards an NHS response to global warming. Available at: https://www.sustainabilitywestmidlands.org.uk/wp-content/uploads/Taking_the_Temperature_-_Towards_an_NHS_Response_to_Global_Warming_-_NHS_Confederation_2007.pdf