This briefing deliberately ends on a note of optimism. Trust leaders are clear that the NHS has already achieved, and is achieving, extraordinary things that they want to preserve going forward. There is a strong sense of "we should never go back".
The NHS will need a proper, considered, debate on which temporary changes it should adopt permanently but a starter for ten might include the following five:
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.
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.
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 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.
The experience of coronavirus will also bring us back to four important debates.
The NHS long term plan
The NHS has been working to a new strategic plan, launched in January 2019. That set out some important commitments to improve care in areas like mental health, cancer treatment, learning disability, cardiovascular disease and children and younger people’s health. These will make a significant contribution to improving the long-term health of the nation. However, dealing with coronavirus will, at best, delay the delivery of these improvements. At worst, it could make achievement of them impossible for the short- to medium-term. The NHS will need to re-assess what can be delivered when.
The government has already indicated that it intends to legislate on NHS structure. Timing will be important here, as it will make sense to learn the lessons of coronavirus before drafting legislation. It’s been very noticeable that, as the NHS has come under significant and sustained pressure, it has been the 217 trusts, alongside GPs and social care providers, who have needed to step forward to deliver what’s been required. The NHS will need to consider how that fits with the future role of clinical commissioning groups (CCGs) and the new emerging sustainability and transformation partnerships (STPs) and integrated care systems (ICSs). Many of the 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.
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.
The government has already indicated that it intends to legislate on NHS structure. Timing will be important here, as it will make sense to learn the lessons of coronavirus before drafting legislation.
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. But we have been running both the NHS and social care, ‘in the red zone’, some way over sustainable capacity, for some time. The long running social care funding crisis and failure to find a long term funding solution are rightly described as a national scandal. While the decision of the government led by Theresa May to increase funding for the NHS was welcome, 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.