Nigel Edwards: Expect long waits for anything that is not urgent
With the drop in Covid-19 cases and hospitals treating fewer critically ill patients, you’d think the worst is behind the NHS.
But living alongside Covid-19 for the foreseeable future will mean tough choices. Even if a second wave is prevented, resumption of routine hospital, primary care and dental services with such an infectious virus still in circulation will be virtually impossible without a vaccine.
A major problem will be the challenges of infection control: buffering, testing and isolating patients before surgery, creating time to change PPE between patients, allowing more time between operations or treatments to thoroughly clean or allow air changes in operating rooms or dental consultation rooms.
Even if a faster test can be developed, the impact on a system used to operating with very little spare capacity will be great. Even before the crisis, the number of acute and intensive care beds per 1,000 population was lower than that of most OECD countries. Providing and distributing primary PPE also poses challenges.
The NHS has a large number of older hospital buildings, with shared accommodation and narrow corridors. Many hospitals and medical offices do not have waiting areas for social distancing, and pre-pandemic A&E services were significantly overcrowded. Even if these difficulties can be overcome, the NHS will need to make sure it has enough beds and fans for a possible second wave.
The personnel problems will be profound. Workers in high-risk categories may need to be removed from front-line positions, which will exacerbate long-standing staff shortages. The remaining staff will have to make major changes to their daily work, change daily practices such as room tours and create time for tests and PPE.
The combined effect: a reduction in the ability of the NHS to provide care. Waiting lists will get longer, non-emergency procedures will be prioritized, and patients will find it more difficult to get routine appointments. The big question facing politicians is how far will the public be willing to accept such limitations from an NHS they have already sacrificed so much to protect.
• Nigel Edwards is the Managing Director of the Nuffield Trust
Sara Gorton: NHS and caregivers deserve a substantial salary increase
While the immediate priority is still to guarantee a guaranteed supply of PPE, regular testing of all NHS and social service staff and appropriate risk assessments for all vulnerable workers, ministers must ensure that NHS staff can depend on a substantial increase in wages. Any discussion of the return to austerity would cause widespread horror.
All NHS staff – regardless of their job, employer or private contractor – need secure employment and a living wage. The good practices and collective agreements established in the NHS should apply elsewhere. The unfair two-tier compensation system with its lower and zero hour rates cannot continue.
Prompt payments of Covid-19 by contractors cannot repair the wrongs of removing NHS direct job security personnel. When wages are reduced for sick or isolated people, staff can avoid testing and hide symptoms, which increases risks.
The low shameful status and job insecurity for most healthcare workers should prompt a proper rethinking of the organization of the sector. Social workers also deserve a decent and sustainable wage increase.
More homework is needed. It could be safe and viable for many jobs, not just in commissioning, project management and administration. Some thought – and better IT – could now help prevent the second wave from being interrupted.
Staffing levels also need to be improved. The numbers before the pandemic were just not clear. Record vacancies meant stress, high turnover and burnout. And immigration changes will soon prevent the NHS and the healthcare sector from filling the gaps with international recruits.
There should be no hasty dismissals of the 40,000 experienced employees who have returned from retirement. They could support a rest and recovery program for exhausted health workers and ensure safe staffing levels.
The fight against coronavirus has a price. But allowing economic pressures to stifle adequate future funding will do more harm.
• Sara Gorton is responsible for health at Unison
David Oliver: Support and empower health workers, and we will deliver
The pandemic has demonstrated the innate strength of front line NHS staff across the country. Acute hospital teams of clinicians, operational managers and support staff have reorganized their patient triage flows, service bases, rotations and redeployment.
They doubled and tripled the capacity of the intensive care unit and managed to avoid using the hospitals in Nightingale, or to be overtaken like some other countries. They worked closely with community partners to ensure that medically stable patients leave early. They launched innovative models for intensive care unit (ICU) rehabilitation, virtual services or home hospital.
Primary care used remote consultation services and introduced “hot spots” for suspected Covid-19 patients. We have to keep the best of innovations for the patients that it does not disadvantage.
If you support and empower and free local NHS and care staff, we will deliver. We are more than capable of agility and purpose. What is needed is less management and less control from central government agencies.
The number of deaths in nursing homes has shown the need for much more joint work with social care as an equal partner, not an afterthought. The Prime Minister’s commitment to find a sustainable interparty solution to social care must be respected. It should end the divisions between needs-based services and eligibility criteria, while supporting providers through higher local authority fees.
Nursing homes need adequate PPE, testing, and full access to improved health support from the local community and primary health services for residents who often have health needs complex, acute or palliative and to ensure equity of access to the acute care hospital when it is really needed.
“Protecting the NHS” naturally focused on protecting the few hospital and intensive care beds. But for any second wave, health care and social services must collaborate more closely in planning, infection control policies, and health care for residents of nursing homes.
• David Oliver is a consultant geriatrician and general practitioner at the Royal Berkshire NHS Foundation Trust
Rehana Azam: Failure to protect BAME staff is institutional racism
GMB represents many thousands of auxiliary personnel, from porters and cleaners from hospitals to paramedics and administrative staff without whom our hospitals could not function.
NHS employers were too late to undertake individual risk assessments to minimize the exposure of these frontline workers to the coronavirus. When risk assessments have taken place, they have focused on staff with long-term health concerns who are concerned about the lack of PPE and social distancing issues.
We now know that if you are of black, Asian and minority ethnicity, you are more likely to be killed by a coronavirus. However, the experience of NHS BAME staff at work has not been fully taken into account.
Part of it is a matter of deprivation. BAME people are more likely to have poor housing, lower incomes, higher risk jobs and a higher risk of underlying health problems. Official figures from last week showed that those living in the poorest areas are twice as likely to die from Covid-19 as those in the wealthiest areas.
Historical structural racism also plays a role, according to a draft report from Public Health England. He says it could make people in the BAME groups less likely to seek care or insist on PPE.
The government’s failure to put in place additional protection for BAME’s front line workers will have cost their lives. It’s nothing less than institutional racism.
What needs to change in the NHS? BAME workers’ health risk assessments need to be forensic and supported by law, and there needs to be more work on tackling structural racism in health services, including greater diversity leadership roles. As one of the most senior BAME unionists in the country, I understand the importance of having more BAME people in leadership positions.
Tests and PPE are still not provided consistently for all staff and we need solid guarantees of full pay during Covid-19 sick leave – for each NHS employee.
When the last calls of the dead are read and we see all the faces that represent the underinvestment, the undervaluation, the glaring inequalities accumulated on the shoulders of the NHS, then know it. We will not look away.
• Rehana Azam is national secretary of GMB union
Sam Allen: Mental health services will face a triple blow
The psychological fallout from Covid-19 will be profound for many people. In the UK, mental health deteriorated considerably during the first two months of closure. And the NHS mental health services will potentially face a triple blow. Existing patients whose mental health needs have been exacerbated by the circumstances surrounding Covid-19, people who developed mental health problems during this period and who traumatized health and care staff.
So, are we ready with the mental health support that will be needed?
It will be difficult. People will need support, encouragement and empathy, especially health and care workers who may feel like they have just done their job. The caregiver clap was a wonderful weekly moment of shared gratitude. But our NHS and our caregivers are not heroes. They are human. Some will naturally be traumatized by their experiences.
We are already seeing an increase in referrals to specialized mental health services after a temporary decline in recent weeks. But we also need to prepare for the mental health needs of people whose psychological trauma may not become apparent for several months.
We must ensure that the needs of those suffering from a serious and lasting mental illness are not overlooked. It is a quick and early intervention, prevention and guaranteeing accessibility of services. Huge planning is already underway.
The transformation of health and care goes far beyond strategy, working groups or policy announcements. It’s about working with people and communities, harnessing their energy, creativity and expertise to transform services.
• Sam Allen is Executive Director of the Sussex Partnership NHS Foundation and President of the Health and Care Women Leaders Network