Sebastian Rees is a researcher at Reform.
The pandemic has tested the NHS to the extreme, and while healthcare leaders and frontline workers continue their heroic efforts, the system has been found wanting. Last year’s announcement that Public Health England would be scrapped, and last week’s NHS White Paper reflect a desire to rectify perceived weaknesses. But it is vital that the right lessons are learnt.
While the response was initially slow, our healthcare system has withstood the onslaught of Covid – no small feat. But in doing so, we turned the National Health Service into a National Covid Service. As frontline workers and NHS leaders fought tirelessly to ensure those with serious cases were cared for, too many people with other debilitating and even life-threatening diseases had their treatment cancelled and delayed.
At the same time, many people who should have sought care did not – either because they didn’t want to burden the NHS during a pandemic, or because they were scared of catching Covid. In April, at the peak of the first wave, admissions to A&E dropped by a third, while GP referrals fell by 70 per cent.
The result of cancelled care, together with patients stopping presenting, is a ballooning backlog that, if not urgently addressed, will be devastating for the nation’s health.
New analysis out today by Reform and Edge Health reveals that, if all the ‘missing’ referrals were to return, the waiting list could reach 10 million. Perhaps most concerning, the research also found that by December last year, the number of people waiting for a year or more for care had increased by over 7000 per cent since March 2020, and could hit 375,000 by April 2021.
Delayed care means people living with deteriorating conditions, potentially developing permanent disabilities, and even having their lives cut short. This raises both short-term and long-term questions for the NHS: how can the service tackle the backlog – and how can it avoid finding itself in the same situation during future crises? Our new report makes proposals to address both.
We set out a road map for tackling the backlog in order to get patients the care they need as soon as possible. It involves making the use of all the capacity available, including in the private sector.
The Government’s decision to set aside £10 billion to extend contracts with private sector providers until November 2024 is central to ensuring patients can access timely care – particularly while so many NHS hospitals are still operating under pressure with Covid cases.
Yet, last month, NHS England had to ask local NHS leaders to share their plans for using the private sector capacity because of under-utilisation. Over the summer, when the NHS did make some headway on addressing the backlog, it was reported that two-thirds of the purchased private sector capacity was left unused.
In addition, the Government should increase investment in community diagnostic hubs to help ease the burden on hospitals, and make sure that life-threatening conditions like cancer are detected early.
In the longer term, and as the impressive vaccine rollout enables a greater focus on recovery, the NHS and government must take the opportunity to put in place mechanisms to boost the system’s resilience.
The NHS entered the pandemic facing chronic issues around funding, workforce numbers, and data quality and accessibility, as well as tensions between central control and local decision-making. All of this diminished its resilience, and contributed to the need to stop large swathes of business-as-usual care. These long-standing issues must be addressed.
In recent months, there have been calls for the Government to invest in building substantial spare capacity in the system – including drastically increasing acute bed numbers and stockpiling supplies of medical equipment.
However, resilience doesn’t require the full-time maintenance of crisis specific infrastructure. Stockpiling medication and PPE likely to go out of date before it is needed, or leaving thousands of beds empty in ‘normal’ times, comes at a price.
One of the biggest issues with our health and care system is the lack of community and social care beds – which acts as a significant blocker to discharging patients from acute care. Rather than focusing yet again on hospital capacity, an independent review should consider the types of beds needed for a sustainable and integrated system.
When it comes to clinical products, the NHS needs mechanisms to rapidly increase supply, including knowing which companies can repurpose their production lines to produce, for example, PPE. Had the Government known this pre-Covid, the delays to procurement would have been far less severe. We have seen how quickly British manufacturers can respond when asked.
And while the NHS must address its serious workforce shortages, in a time of crisis, additional flexibility is needed. Reform is calling for a formal reserve list to be drawn up so that ex-NHS staff can rapidly re-enter the system.
The NHS is a cherished institution, but that doesn’t mean it’s perfect. We can be grateful to those health and care workers who continue to battle this deadly virus, while also acknowledging the system is flawed. Government is right to want to reform it – but failing to get these basics right risks ministers once again finding themselves frustrated that the levers they pulls don’t seem to deliver at speed.