The NHS in a post-COVID age

By Kate Weston

The NHS was founded in 1948 by the then Health Minister, Aneurin Bevan with the belief that good healthcare should be available to everyone. Seventy-two years on, and the founding principle still undergirds the NHS, which has certainly proved its worth during our country’s response to COVID-19.

As the UK emerges from lockdown, questions have been raised over what the future NHS might look like. COVID-19 has shown us the strengths of our health service, but it has also reminded us of its problems, and reforms are bound to come.

So, let have a look at the changes we think are likely to be implemented.

The use of technology is here to stay 

COVID-19 has been a catalyst for the rapid uptake of tech both in healthcare settings and in swathes of other industries throughout the country.

The slow and imperfect systems that once ruled the NHS have been forced to stop, allowing for sweeping changes from doctors’ surgeries to hospital wards. GPs have been very proactive – with a widespread uptake of digital platforms to carry out consultations. Many GP practices in England implemented a ‘total triage’ model using telephone and online consultation tools for every patient who contacted the practice.

Over the month of March, the proportion of appointments conducted face-to-face nearly halved and the proportion of telephone appointments increased by over 600% as GPs moved to keep patients out of surgeries except when absolutely necessary.

Elsewhere, the digital healthcare service ‘Attend Anywhere’ was introduced across the country. The programme collaborates with governments, hospitals and health systems to make video call access a normal part of day-to-day operations. There have been over 79,000 consultations through the programme to date. The number of consultations started at around 200 per day but rapidly increased to more than 6,000 per day. Acute trusts have taken up the main bulk of the appointments, carrying out 44,000 calls on the platform, while community and mental health trusts have carried out more than 20,000.

This hasn’t just been the case in England, in Northern Ireland the Department of Health has taken significant steps towards a digital future health system as a result of COVID-19. In June, the NI Health Minister Robin Swann announced a landmark digital contract award for the Encompass programme, which involves the creation of a single Digital Care Record for every citizen, bringing important benefits for both the public and staff.

Mental health services must step up to the plate

As we move on from the COVID-19 crisis, there are very real fears the country could quickly slide into a mental health crisis.

NHS trusts providing mental health services have quickly adapted to support the acute sector, providing intermediate care wards for those recovering from the virus, and setting up mental health A&Es and 24/7 emergency service access lines. They have also moved many home treatment models and clinical services online. Charities have set up mental health hotlines and special COVID-19 programmes. For instance, The Yellow House, an organisation dedicated to helping youths of Liverpool from disadvantaged backgrounds and with physical and mental disabilities, made a cover of The Beatles ‘Let It Be’ as part of their COVID programme.

However, as Ella Fuller from HSJ rightly notes, the “key to meeting the extra demand for mental health services created by the pandemic will be ensuring that the required expansion in service provision is properly funded, on a sustainable basis.” Current pressures have only reinforced widespread concerns that the mental health sector is not fit for purpose, following years of underinvestment.

Since England went into lockdown on 23rd March, the Government has invested more than £9 million in mental health charities to help them expand and reach those most in need. Furthermore, new online resources designed by health and education experts have been provided to schools and colleges to boost mental health support for staff and pupils.

NHS England’s Director of Mental Health Claire Murdoch has promised spending on mental health will not be cut to help other parts of the NHS, saying the commitment to investing £2.3 billion of extra spending by 2023-24 was “absolute.”

But, one question is – will this be enough? And will these measures cut to the roots cause of the crisis? Plus, what will the long-term mental health support look like?

The money that the Government has provided will no doubt help mental health services and organisations provide important support to those with existing mental health conditions and those who have developed them as a result of the pandemic. However, when you consider that Rishi Sunak provided £1.5 billion worth of funding for the arts yesterday (6th July 2020) or that over £10 million has been spent on the Governments COVID-19 app thus far, £9 million barely scratches the surface. This only leads to questions on whether the Government considers mental health a priority for the future.

It will be interesting to see how, or whether, the Government keeps its promise to help the mental health services in months to come.

The dawn of Integrated Care Systems

Before coronavirus threw our world into disarray, the health policy community was starting to get excited about the proposed legislation that would formalise the arrival of integrated care systems (ICSs) in the NHS.

ICSs are a key part of the NHS Long Term Plan; intended to bring about major changes in how health and care services are planned, paid for and delivered. They are partnerships that bring together providers and commissioners of NHS services across a geographical area with local authorities and other local partners, to collectively plan and integrate care to meet the needs of their population.

In May 2020, an additional four areas were designated as ICSs, bringing the total number to eighteen. This means approximately half of the country’s population is now covered by an ICS.

The NHS Long Term Plan set an ambition for all areas of England to be covered by an ICS by April 2021. Some have speculated whether this development will take a back seat in the coming months as local and national health and care leaders continue to focus their efforts on COVID-19.

However, others argue that all areas of national and local health systems have had to work together in order to effectively coordinate the best response. The new sense of teamwork, that has encapsulated much of the health sector’s response to COVID-19, has encouraged systems and teams to be more open to changing practice and cooperation.

Patricia Hewitt, former Secretary of State for Health who now chairs Norfolk and Waveney Sustainability and Transformation Partnership (STP), soon to become an ICS, sees no reason to abandon the April 2021 ambition. She does note however, that we cannot take these changes for granted and assume they will stay for the long-term.

What does this mean for Clinical Commissioning Groups? As Alastair McLellan from HSJ quite bluntly puts it: “it is over for clinical commissioning groups.”

Similarly, it seems Public Health England’s (PHE) days may also be numbered. Doubts over the agency’s future were raised in June when Boris Johnson publicly complained about the “sluggish” response of some parts of government to the coronavirus crisis — prompting widespread speculation he was referring to PHE in particular.

Whilst the PM remarks seems somewhat ambiguous, his comment gained significant national media attention and prompted a flurry of parliamentarians calling for PHE’s abolition. Former Tory leader Iain Duncan Smith called for PHE to be “abolished tomorrow” claiming the agency was guilty of “arrogance laced with incompetence”. A former Tory health minister also said PHE appeared “destined for the chop”.

Getting rid of PHE would certainly be a major structural upheaval, but when asked whether the agency could be abolished or reformed, Boris Johnson’s official spokesman made clear that the Government had already set up two new bodies, NHS Test and Trace and the Joint Biosecurity Centre, which are carrying out significant public health duties.

Now that the UK has passed the first peak of COVID-19, a lot has been learnt about the National Health Service and its ability to implement rapid change when it needs to. The NHS has discovered that it can move with astonishing speed to build new hospitals, decrease bureaucracy, redeploy staff into different roles and forge partnerships which must be maintained after the crisis.

Yet, we mustn’t go back after this. Instead, we must preserve and develop these changes to ensure that the principle of good healthcare for every person is as steadfast today, seventy-two years after the NHS was first established, as it was on day one.