Health Policy
A reappraisal of what health and social care systems should and can deliver

By Professor Mike Bewick - Integrated Care Journal

In these unprecedented times, when the full effects of the Covid-19 pandemic are evolving around us, it is obvious that the capacity of the NHS and social care will be significantly challenged, and quite possibly overwhelmed.

We are learning, to our cost but not total surprise, that our ability to absorb large numbers of very ill patients in respiratory failure is inadequate. This is primarily due to the relatively low numbers of critical care beds available across the UK and a lack of trained staff ready to cope with such a surge in activity.

Recent announcements to bolster the health service, which include; rapid training in respiratory care for hospital staff; increasing the manufacture of respirators; pleas for 65,000 clinicians recently retired to return to the front line, are all helpful. Public health measures are even more important in attempting to reduce infection rates and to smooth down the peaks in demand through social behaviour adaptations.

The international evidence is variable on this as it seems to have been less effective in Italy than South Korea or China. This is a rapidly changing scenario and one where the normal rules of procurement and deployment are being either ditched or rapidly updated.

Rethinking the healthcare workforce 

Prior to the outbreak, there was already a recognition that the current workforce lacked the capacity to cope with the changing demographic both in the UK and internationally. The NHS People Plan which was to address this has been postponed until the end of the year. It seems a somewhat hopeful document at present.

Covid-19 has opened up opportunities for new ways of working. The focus on acute care being separate from elective and prevention services may make us think again about how services are delivered and commissioned.

At present, this means longer waiting times for routine surgery and, more worryingly, cancer cases. This can only be temporary but we may end up with networked hospitals on large population footprints delivering hot and cold sites for care. This doesn’t have to be on separate sites as providers can share diagnostics and support services. Perhaps the most significant change will be in how we deliver services locally and the increased use of digital health, such as remote consultations via video/telephone, self-care and accessing algorithm-based advice for self-limiting or chronic disease.

Lastly, the role of the private sector needs to be re-evaluated. The move to mobilise the bed base in large private providers for non-Covid-19 illness and procedures should act as a stimulus for further joint working in the future

What I think we are seeing, and probably long overdue, is a reappraisal of what a health and social care system should and can deliver. It will also entail a fundamental look at the skills and talents we need to lead and deliver care. Expect a major overhaul of education and training both pre and post-licensing of clinicians. However, none of this will be cost-neutral.

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