Within the UK, the Covid-19 epidemic has had a profound impact on the National Health Service, precipitating faster and more wide-ranging changes to the health care system than at any other time in the service’s history. Set against a backdrop of health systems in other countries becoming overwhelmed with critically sick Covid-19 patients, the NHS set about reconfiguring its services to free up and create additional capacity and staff.
Searching questions will need to be asked about the UK’s overall Covid-19 response, in particular around testing, supply of protective equipment, care home policies and the large numbers of excess deaths. But there can be no doubt that the rapid changes made by the NHS to increase the supply of intensive care beds and capacity were impressive. Now policy attention is turning to how the NHS can restart some more routine activities, with hospitals beginning to resume elective surgery and cancer treatments.
But doing this while living alongside Covid-19 will involve major practical challenges that will need to be overcome. It will inevitably have a large negative impact on the ability of the NHS to deliver what it was able to offer previously. This could mean the public having to accept reduced services, health and care staff facing continued and long-term changes to their ways of working, and difficult choices ahead for policymakers in accepting a degree of rationing of health care that would previously have been seen as unacceptable.
We have been discussing the implications of this with representatives from different parts of the NHS.
Our work found that leaders expect that:
- For patients requiring help in an emergency, staff will need to assume they are Covid-19 positive, requiring enhanced PPE and significant extra time for cleaning beds, imaging equipment and operating theatres between patients.
- Without a quick and reliable test, patients needing planned surgery will have to be swabbed and required to self-isolate before planned investigation or treatment with a further test immediately before. This will have a large impact on the system, slowing down basic processes and treatments.
- Staff in high-risk categories may need to be removed from front-line duties, further exacerbating the shortages that predated Covid-19. Daily work for those remaining will be onerous – from changing in and out of PPE, to administering tests and changing daily practices – all reducing the amount of work they can do.
- These changes do not just apply to hospital staff. In many services like dentistry and general practice, direct physical contact between the patient and the professional is needed. Dental practices could face financial ruin as they have to don full PPE and clean rooms between patients.
- GP surgeries have made great strides in rolling out more virtual treatment and consultations, but these are not a panacea: there are limits to what can be done virtually.
- The building and design of many English hospitals makes them unprepared for the kind of infection prevention and control needed in the coming months. The NHS has large numbers of older hospital buildings, which include shared accommodation and narrow corridors. That will make segregating Covid and non-Covid patients very difficult.
Edwards N (2020) Here to stay? How the NHS will have to learn to live with coronavirus. Discussion paper, Nuffield Trust.