Coronavirus was not a word that most people were familiar with just a few months ago, but now we can’t seem to escape it. The current pandemic has caused facts, figures, and opinions on the microscopic SARS-CoV-2 virus to multiply across the world.
Established after World War II with a work force of around 144,000, the NHS has grown over the past 70 years to become the single largest employer in the UK with around 1.7 million workers across the UK, making it the fifth-largest workforce in the world. The NHS is a fantastic beast – a 2016 survey by Ipsos MORI found that the NHS tops the list of “things that makes us most proud to be British”.
With the NHS arguably facing one of its biggest challenges ever, in the form of Covid-19, it continues to occupy a unique place in public consciousness. This was quite emphatically confirmed at the weekly “Clap for Carers” which has been taking place every Thursday since 26 March. Homes and households across the UK stood on their doorsteps and applauded care workers in their efforts in treating those affected by Covid-19.
With such a large workforce, and such a complicated web of different bodies piecing together to form the NHS, it is immensely difficult to create and sustain change. The NHS has set out a long term plan for its future through NHS Improvement. In this plan, they set out the ambitions for improvement over the next decade, with everything from improving clinical outcomes to digitisation of some of the archaic infrastructures in place.
It is often said that the NHS is now too big, and too complex, to be reformed. But as a junior doctor, working in the hospital during the current crisis has offered a unique insight into the change that is possible in the NHS. Watching events unfold over the past few weeks has really shown Covid-19 to be a stimulus for change.
One area to consider is digital medicine, which has already begun to change the way in which people interact with healthcare. With telemedicine services such as NHS 111 for telephone triage already running successfully across the country, this is a great first step, but there is more we can do across the board.
For our patients, there has been immense change over the past couple of weeks. Outpatient appointments have reduced dramatically due to service requirements. Those hospital appointments that are still happening are reserved for those cases which are clinically urgent, with new systems being put into place for those who are vulnerable or are not required to be seen in person. We have seen an upsurge in digital appointments through telephone or video-link.
These new digital appointments are still in the implementation stage, but are showing early signs of working remarkably well, with benefits for patients and clinicians. For our patients, there are obvious benefits such as a reduced burden of travel, as well as parking costs, and the need to navigate complicated hospital corridors and sitting in waiting rooms. In addition to this, some of our most vulnerable patients are not exposed to other potentially dangerous infections in the hospital setting.
For our clinicians and the NHS in general, there are also benefits. There is no need for a fully-equipped outpatient consultation room and more time can be focussed on clinical practice rather than on simple tasks such as helping patients find their seat. There are potential savings on administration.
There are reasons that a move to digitalisation has been slow. For one, both patients and staff are wary of change, but Covid-19 has been a catalyst in implementing changes in the way that we work to protect both patients and staff even more than ever. We are in a position now where the processes have been created and people are adapting to this change in a remarkably short period of time.
It is self-evident that not every patient, and not every clinical situation is appropriate for a video-consultation. But research from around the world has shown that patient satisfaction with video consultations is high and that when clinically appropriate (such as when there is no need for a physical examination), the quality and safety of care can be maintained.
Along with the digital revolution, the culture of the NHS workforce is also changing: millennials have new expectations from their workplace and most people seek a good work-life balance through flexible careers. The NHS Long Term Plan identifies the need for more healthcare workers to respond to this increasing demand. This is key not just for front-line staff, but also for the important administrative staff that keep the cogs of the NHS machine turning.
Opportunities to work from home should also be maintained after the crisis. Hospitals across the NHS have seen an upsurge in work-force self-isolating. And with social distancing measures, it has been important to provide the ability for colleagues who can, to work from home. In my own trust, a work-from-home policy didn’t even exist until the current pandemic presented itself. Now, in an unprecedented move, working from home has now been implemented successfully with 526 people opting to carry out their tasks from their own household (at the time of writing).
Once normality resumes, there will be an opportunity to reflect upon what has worked well with the implementation during this crisis and improve. Data governance, cyber security concerns and ethical frameworks will also need to be addressed in a more focussed effort. Of course, with all of this, staff development is vital to ensure a successful and long-term implementation of digital technologies in the workplace.
Covid-19 has provided a stimulus for change in the public attitude towards health and well-being. In terms of patient volume, our front-line staff in hospitals have seen a massive reduction in A&E attendances since the Covid-19 outbreak. This is important as it means that front line staff can focus their efforts on patients who need it most, and also reduces the daily demand on our NHS staff . Reduced attendances at A&E is due to a number of reasons; patients are avoiding hospital due to a fear of hospital acquired infections, and with current societal lockdown, patients are not as at risk of accidents through travel or work.
A contributing factor may also be that there has been a shift in public attitudes. What we hope is that patients who genuinely don’t need an emergency assessment are now avoiding A&E in these non-emergency situations and seeking alternative help. The optimists amongst us will hope that this change in attitude prevails once this pandemic subsides; we need to be careful however that we don’t discourage those with life-threatening conditions from seeking medical attention because they feel like a burden on our health system.
There is pride in our National Health Service and the shared social commitment that it represents. There is also concern over funding, staffing, increasing inequalities, and pressures from a growing and ageing population. However, there is optimism about the possibilities for continuing change, improvement, medical advance and better outcomes of care.
This is an exciting time for the NHS to benefit and capitalise on technological advances and this opportunity for change. Our Health Service is renowned for the professional, flexible and resilient way that it responds to adversity. We have seen that with the layers of bureaucracy and routine burdens removed and through the skilled, dedicated and adaptable staff of the NHS, along with the cooperation of the public, change can happen, and it’s been happening at breakneck speeds.
Let’s not let the resolution of this current crisis signal an end to the positive change that we have been seeing.
Dr Neil Cunningham is a junior medical doctor at Northampton General Hospital
