Will the NHS recover from COVID-19?

I take a deep look at the longer-term challenges COVID-19 presents the NHS, days after the Mayor of London has declared a major incident in the capital.

Sadiq Khan has declared a health emergency in London as data suggests 1 in 30 Londoners have COVID-19. The worst infection rates the UK has seen since the start of this pandemic.

The personal health effects of COVID-19 are well documented. However, it seems that this virus can be merciful to some and ruthlessly unmerciful to others, with no certain explanation why.

The unknown makes it all the scarier. Another scary unknown is how the NHS system will recover from these inhuman efforts to preserve life.

Is this an acute period of crisis for the system, or should we be worried about what this means for the NHS longer term?

Let’s start with the single most important thing to any successful organisation, its workforce. The NHS is the fifth largest employer in the world today and is well regarded for its highly skilled and highly compassionate workers.

There have been concerns, however, that the NHS faces a workforce crisis. The Health Foundation projections from February 2020 show that there is a shortfall of over 115,000 full-time equivalent staff in England.

On current trends, this gap will double over the next 5 years. These projections did not even account for any COVID-19 impacts.

Surely, you’re thinking along the same lines as me here… ‘those figures are bound to get (a lot) worse after this gruelling period’. I mean who could blame our nurses, doctors and midwives for needing some time to recover after what they have been through?

There is certainly evidence to suggest it is needed… The guardian found a third of doctors were suffering from burnout and compassion fatigue in 2020. Another survey in the Nursing Times found of 3,500 nurses 33% rated their overall mental health and wellbeing as “bad” or “very bad” and 50% described themselves as “a lot” more anxious or stressed since the pandemic.

NHSE data shows that staff sickness and absence rates are up year on year, the most reported reason for sickness and absence last year was anxiety/stress/depression/other psychiatric illnesses at 21.3%.

The workforce crisis does seem likely to get even worse then post COVID, but does this present the system with a real threat longer term? We are now at a ‘critical juncture’, according to The King’s Fund.

In response, government are making it easier for foreign trained doctors and nurses to work in the UK, they aim to recruit 5,000 healthcare staff from overseas each year. However, with COVID and Brexit movement of labour is changing. There is also not much point funnelling new staff in if more staff are falling out the exit door.

Overseas staff present part of a solution, they should not be seen as a replacement for experienced UK trained healthcare professionals who are of course finite. On our current trajectory we stand to have a poorer quality labour force.

We must invest more to protect and care for the staff we have, savouring their invaluable experience whilst also expanding our programmes for domestically trained healthcare professionals.

The health emergency recently declared by the Mayor of London indicates that healthcare supply is currently not able to match the incessant demand. Infection rates are higher than April which are fuelling ever increasing hospital admissions.

Intensive Care Units’s are at capacity across the UK, but there is no doubt London (purple line above) faces the sternest test.

In response millions of pounds has been funnelled into The Nightingale Hospital. A surge hospital housed in the ExCeL centre equipped to care for the overflow of patients.

The project demonstrates the very best qualities of our public service, rapid, selfless collaborative working. But. It is an expensive solution for the short term, a sticking plaster on what is definitely not a paper cut.

A big reason for the second spike in cases and resulting pressures on hospital services has been a mutation in COVID-19. The virus has proven in its relatively short life that it can become more contagious and more dangerous.

It would be foolish to think even with a vaccine that this is the last we will see of COVID-19 fuelled healthcare emergencies. We are in a longer battle, that will bring pressures winter after winter similar to influenza.

We need longer term capacity planning rather than short term fixes.

However, according to its most recent quarterly published data, NHS general and acute bed base numbers actually fell to 92,596 in the first quarter of 2020–21, down from just over 100,000 for the same quarter in the two years before.

Our baseline service capacity is going in the wrong direction. We need to urgently focus on updating hospital facilities and delivering — on the promises of government — 10 new hospitals across the UK, so we don’t have to rely on short term fixes.

We have seen how busy hospitals are right now. What we are yet to look at is how much time doctors and nurses are spending on ‘normal’ healthcare vs COVID-19 healthcare. Looking at the below “COVID load” tells us that the balance is heavily tipped for many regions in the UK.

The higher COVID load areas have already been forced to cancel elective procedures, including cancer surgeries and therapies. This will have a huge impact on patient outcomes, with many sadly set to experience deteriorations in their health.

Perhaps those patients that require a simple procedure now will need much more complex treatment by the time they finally see their doctor. So, whilst these delays are undoubtedly bad for us personally, when aggregated across a population it presents a fresh longer-term challenge and resource burden for the system as a whole.

The longer we see higher COVID loads the longer ‘normal’ care is paused. This has swelled appointment waiting lists so much, we find ourselves returning to the wait lists waiting times of a decade ago.

The total number of patients reportedly now waiting for a healthcare appointment is 10 million. I will let that sink in for a moment.

How is a system with a widening workforce gap and less facilities equipped to handle that recovery challenge?

Well, the NHSE recovery plan recommends a number of good action steps and new ways of working, a big feature is leveraging digital tools. There is no doubt digital health is at a maturity to significantly help the NHS become more efficient.

One NHSE recommendation I particularly like is for hospitals adopt a Patient Initiated Follow Up (PIFU) model of care. Here, qualifying patients should be equipped with the technology / tools and knowledge to assess their own condition and self-refer when they spot something isn’t quite right. Turning healthcare from a time based to a need based follow up model. This is certainly a positive step but it feels like we are using a pick axe to dismantle an ice burg.

Fewer beds in hospitals, fewer doctors and nurses looking after us and the challenge of backlogged more complex care demands for arguably the next decade. COVID-19 has bludgeoned our NHS in recent months, but its effects are likely to be felt for much much longer.

The task is unforgivable. Yet as someone who works close to the NHS and knows the type people who keep it ticking, I for one am confident it will persevere. Like it always does.