NHS struggles to return to new “normal”


Cleaning at Ipswich Hospital

There will be a new standard for the NHS – but it will be very different from the one that patients knew before the coronavirus crisis.

This is what health leaders predict as hospitals begin to reintroduce canceled services during Covid-19 pressure peak weeks.

Not only that – getting out of the current situation will be more difficult than getting in.

There is no doubt that the transformation of hospitals to cope with the expected influx of coronavirus patients has been a major achievement.

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Routine surgery was canceled and tens of thousands of additional intensive care beds were created within a few weeks. Despite warnings that the NHS could be overwhelmed, hospitals and other departments have coped.

But with the recent spike now past, where is the NHS going from here? How will social distance be observed? What capacity will be retained in the event of a new viral infection? How quickly can the backlog of operations and salaries be cleared?

Niall Dickson, executive director of the NHS Confederation, said tackling the backlog and the damage caused by the virus would be a “massive undertaking”.

He adds that there is a long list of problems to be resolved: “The mental health of the population, untreated illness, delayed operations, undiagnosed conditions, victims of closed screening programs and the depressed demand for so many of those who have not sought Help me. “

Return of non-emergency services

The Ipswich Hospital, like others, is beginning the process of reintroducing non-emergency services.

A service that was a complex unit of care for elderly patients before the pandemic was converted to “red service” for Covid-19 patients, including those receiving end-of-life care.

Now it is being thoroughly cleaned and is ready to return to a “green room” for non-Covid-19 patients.


Social distancing will reduce patient capacity

But due to social distance, the capacity of the room will be reduced and Perspex screens will separate the beds.

If there is a second peak in the virus, it may have to become a “red light district” again.

In A&E, the number of patients increases a little after a spectacular fall in April.

The department is being reconfigured to avoid overcrowding and keep people at a good distance from each other. This could imply a one-way system for patients arriving and departing.

Ipswich is part of the East Suffolk and North Essex NHS Trust, whose managing director is Nick Hulme.

He tries to prepare patients’ expectations while encouraging them not to stay away and put their health at risk: “We do it very carefully. I think it would be wrong to start many services and then realize that we had to close them. again because we didn’t have the capacity, the staff or the PPE.

“But I think there is also an important message that we are open to business, so make sure that people who are worried about their health always contact their GP or always come to A&E. “

Staffing could be problematic. Doctors, nurses and other front-line health professionals worked under stressful conditions to care for Covid-19 patients.

Their well-being must be prioritized while ensuring that hospital services can be extended and leaving open the possibility of a new outbreak of virus cases.

Unraveling takes time

Dr. Lauren Hoare is a hospital consultant and clinical director of her emergency assessment unit: “When we put in place the emergency arrangements and emergency rotations to start when the corona virus was at its peak , we lit many buttons and changed things very quickly.

“Sometimes sorting this out and going back to normal practice is much more difficult and certainly requires a lot of organization. “


Alternatives to face-to-face consultations will be necessary

Virtual video consultations, if any, during the Covid-19 crisis have proven popular with doctors and patients. They seem ready to take an increasing share of outpatient consultations.

General practitioners’ offices report that they have gone from about 20% of patient contact over the phone to about 75%.

Face-to-face appointments may resume, but few expect them to remain above half the overall workload of a general practitioner.

Chris Hopson, Managing Director of NHS Providers, representing trusts in England, said: “The trusts will do their utmost to restart the services as quickly as possible.

“They will try to solve all the problems they face, as they have always done so far. They will build on the innovations they have developed in the past two months, such as the 6,000 patient consultations per day currently delivered online, compared to 200 before the crisis. “

The new climate can therefore bring benefits to the NHS.

But returning to the usual volume of activity is far away. The virus will not go away quickly.

Nick Hulme says they have to assume it will be a threat for a while and infection control will need to be strictly observed: “Part of our planning for part of the service reconfiguration is not temporary.

“We are going to have to assume that some of our elective plans have been distancing themselves from society for some time. So it’s certainly not a year or two we think, it could be several years. “

NHS England has sent advice to hospitals to bring back routine operations and appointments.

The governments of Scotland, Wales and Northern Ireland are planning a gradual reintroduction of non-emergency services.

The Scottish government’s national clinical director, Professor Jason Leitch, said: “I don’t know what a new standard looks like, but I do know that health care and care in the UK will never be the same again.

“Virtual meetings, increased shared decision-making, integrated health and care leadership and public knowledge of public health will all remain and will help us.”


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