Covid-19 will have profound consequences for the NHS for many years to come, and we need to be ready to manage that, says Chris Hopson
In recent weeks, the NHS has come under a degree of pressure it has never experienced before in its 72 year history. Frontline staff have risen to an extraordinary challenge and given their all. At times it was touch and go. There was a brief period when NHS leaders seriously feared the service was about to be overwhelmed. But thanks to the NHS’s flexibility, rapidly doubling its national level critical care capacity and its nature as a national service, quickly increasing mutual aid and collaboration in local health and care systems, the NHS continued to provide care to those who needed it.
Much current commentary concentrates on how the NHS will come out of this phase of the pandemic. There’s an understandable focus on staff support and recovery, tackling care backlogs, and meeting the increases in mental health demand that we are now seeing.
There has been remarkably little commentary on what the NHS needs to do to live with covid-19 long term. However, that’s what’s required. As HIV has shown, we can inoculate ourselves against the effects of viruses and manage their impact through ever more effective treatments. But viruses have a nasty habit of persisting in the community for a long time. This will have profound consequences for the NHS for many years to come.
Take five areas—vaccination, test and trace, infection control, NHS estates, and NHS buffer capacity.
As covid-19 mutates we are likely to need an annual rolling covid vaccination campaign, with an annually tweaked vaccination that takes account of the latest mutations. NHS staff are doing a brilliant job with the current vaccination programme. But this is using an unsustainable workforce model. We are taking huge amounts of time from GPs, diverting them from normal primary care work. NHS trust staff, particularly in community trusts, are being redeployed from existing roles. We are using an army of volunteers who may not be available in future. The NHS needs to quickly develop a sustainable workforce model to deliver a national covid vaccination campaign, year in year out, for some time yet. That is a huge undertaking.
The biggest risk from covid-19 that we probably now face is from a mutation that has a high vaccine evasion rate. That risk would be magnified enormously if the mutation had a higher mortality rate—for example 5%, rather than the “less than 1%” rate we currently see. The only way to manage this risk is through a highly effective test, trace and isolate system capable of genomically sequencing large numbers of tests in a few days’ turnaround time. Test and trace’s capacity has grown significantly, but there’s still some way to go for it to reach the level of capacity and capability required, and that we see in the most successful South East Asian countries and countries like Canada.
If covid-19 continues to circulate, it’s likely there will be significant numbers of covid-positive patients needing hospital treatment, meaning we will need to maintain strengthened infection control measures. As we’ve discovered over the last year, these have a major impact on NHS bed capacity. The NHS was already short of capacity before the pandemic, as we saw in the traditional winter pressures that the service struggles with at this time of year. Living with covid-19 will require us to invest in further capacity to cope with all the demands the service will face, including the increase in mental health demand we are now seeing.
Another lesson of the last year has been how the virus tends to surge in regionalised waves, creating peaks of demand that can potentially overwhelm healthcare services in particular areas. The key, as we’ve seen over the last few weeks, is to have sufficient surge, and super surge, capacity to cope with peaks of demand and ensure that the provision of mutual aid across trusts and regions works effectively. That has profound implications for NHS estates—how do we create community, hospital, general/acute, and ICU capacity that can be easily flexed up and down? How do we create reserve ambulance capacity that can be called on? The same argument applies to funding and support for the NHS workforce—do we need to create a standing reserve, as in the armed forces?
Simon Stevens, CEO of the NHS, has also argued eloquently that the NHS now needs a buffer to function sustainably. NHS Providers has argued consistently that we have been trying to run the NHS permanently in the red zone for several years now. Whichever per head of population number you look at—beds, nurses, doctors, diagnostic equipment—the resources available to the NHS compare poorly with key European comparators like France and Germany. But how big this should this buffer be and what should it look like?
These are just five examples of how we will need to rethink our NHS to enable it to cope with covid-19 long term. There are many more. Reconfiguring the NHS to meet these challenges will require investment and leadership time. These will need to be factored in alongside the bulging bag of other priorities the NHS has now got to deliver. But this has become a vital task we need to turn to quickly.
Chris Hopson is the chief executive of NHS Providers, the membership organisation for all of England’s 215 ambulance, community, hospital and mental health trusts.
Competing interests: none declared.