Nigel Edwards: Expect long waits for anything non-urgent
With Covid-19 cases falling and hospitals treating fewer critically ill patients, one could think the worst is behind the NHS.
But living alongside Covid-19 for the foreseeable future will mean stark choices. Even if a second wave is prevented, resuming routine hospital, primary care and dental services with such an infectious virus still circulating is going to be all but impossible without a vaccine.
A major problem will be the challenges of infection control: swabbing, testing and isolating patients before surgery, creating time for changing PPE between patients, allowing additional time between operations or treatments to deep clean or allow air changes in operating theatres or dentists’ consultation rooms.
Even if a more rapid test can be developed, the impact on a system used to running with very little spare capacity will be formidable. Even before the crisis, the number of acute and intensive care beds per 1,000 population was lower than most OECD countries. There are also challenges of supplying and distributing PPE to the frontline.
The NHS has large numbers of older hospital buildings, with shared accommodation and narrow corridors. Many hospitals and GP surgeries do not have waiting areas that allow for social distancing, and A&E departments before the pandemic were significantly overcrowded. Even if these difficulties can be overcome, the NHS will need to make sure it has enough beds and ventilators for a possible second wave.
The staffing problems will be profound. Workers in high-risk categories may need to be removed from frontline duties, worsening longstanding staffing shortages. Staff who remain will have to make big changes to their day-to-day work, changing daily practices like ward rounds and creating time for testing and PPE.
The combined effect: a reduction in the NHS’s ability to provide care. Waiting lists will lengthen, non-urgent procedures will be deprioritised, and patients will find it harder to get routine appointments. The big question facing politicians is how far the public will be prepared to accept such limitations on an NHS they have already sacrificed so much to protect.
• Nigel Edwards is the chief executive of the Nuffield Trust
Sara Gorton: NHS and care staff deserve a substantial pay rise
While the immediate priority is still ensuring guaranteed supplies of PPE, regular testing of all NHS and social care staff and proper risk assessments for all vulnerable workers, ministers must guarantee that NHS staff can depend on a substantial wage rise. Any talk of a return to pay austerity would cause widespread horror.
All NHS staff – regardless of job, NHS employer or private contractor – need secure employment and decent pay. The good practices and collective agreements established in the NHS must apply elsewhere. The unfair two-tier pay system with its inferior rates and zero hours can’t continue.
Quick-fix Covid-19 payments by contractors cannot right the wrongs of removing staff from the safety of direct NHS employment. Where wages are cut for those off sick or isolating, staff may avoid testing and mask symptoms – increasing the risks.
The shameful low status and job insecurity for most care employees must prompt a proper rethink about how the sector is organised. Care workers deserve a decent, lasting, pay rise too.
There needs to be more home working. It could be safe and viable for many jobs, not just in commissioning, project management and administration. Some thought – and better IT – now could help to prevent any second-wave disruption.
There must be improvements in staffing levels too. Pre-pandemic numbers simply weren’t safe. Record vacancies meant stress, high turnover and burnout. And immigration changes will soon prevent the NHS and care sector from filling gaps with international recruits.
There must be no hasty dismissal of the 40,000 experienced staff who have returned from retirement. They could support a rest and recuperate programme for worn-out health workers and ensure safe staffing levels.
Combating coronavirus has come at a price. But allowing economic pressures to stifle proper future funding will cause further harm.
• Sara Gorton is head of health at Unison
David Oliver: Support and empower health workers, and we’ll deliver
The pandemic has highlighted the innate strength of frontline NHS staff around the country. Acute hospital teams of clinicians, operational managers and support staff reorganised their patient triage streams, ward bases, rotas and redeployment.
They doubled and tripled intensive care unit capacity and managed to avoid using Nightingale hospitals, or be overwhelmed like some other countries. They worked closely with community partners to ensure medically stable patients left sooner. They started innovative models for post-intensive care unit (ICU) rehab, virtual wards or hospital at home.
Primary care has used more remote consulting and introduced “hot hubs” for suspected Covid-19 patients. We should retain the best of the innovations for those patients it doesn’t disadvantage.
If you support and empower and liberate local NHS and care staff, we will deliver. We are more than capable of agility and purpose. What’s needed is less managerialism and central control-freakery from central government agencies.
The number of deaths in care homes has shown the need for far more joined-up work with social care as an equal partner and not an afterthought. The prime minister’s pledge to find a lasting cross-party solution to social care must be honoured. It should end divisions between needs-based and eligibility-based means tested services, while supporting providers through higher local authority maximum fees.
Care homes need adequate PPE, testing and full access to enhanced healthcare support from local community and primary health services for residents whose health needs are often complex, acute or palliative and to ensure equity of access to acute hospital when it really is required.
“Protect the NHS” was understandably focused on protecting scarce acute hospital and ICU beds. But for any second wave, health and social care need to work more closely together in planning, infection control policies and healthcare for care home residents.
• David Oliver is a consultant geriatrician and general physician at Royal Berkshire NHS foundation trust
Rehana Azam: Failure to protect BAME staff is institutional racism
The GMB represents many of the thousands of ancillary staff from hospital porters and cleaners to ambulance workers and admin staff without whom our hospitals couldn’t function.
NHS employers were too late to undertake individual risk assessments to minimise these frontline workers’ exposure to the coronavirus. When risk assessments did happen, they were focused on staff with long-term health conditions and concerns over the lack of PPE and social distancing challenges.
Now we know that if you are from a Black, Asian, and minority ethnic background, you are more likely to be killed by coronavirus. Yet the experiences of NHS BAME staff at work weren’t fully taken into consideration.
It’s partly a question of deprivation. BAME people are more likely to have poor housing, lower incomes, higher risk jobs and greater risk of underlying health conditions. Last week’s official figures showed that those living in the most deprived areas are twice as likely to die from Covid-19 than those in the wealthiest areas.
Historic structural racism also plays a role, according to a draft of a report by Public Health England. It says this could make people from BAME groups less likely to ask for care, or to insist on having PPE.
The government’s failure to put in place additional protection for BAME frontline workers will have cost lives. It is no less than institutional racism.
What has to change in the NHS? Health risk assessments for BAME workers should be forensic and backed by law and there needs to be more work on tackling structural racism within the health service, including greater diversity in leadership roles. As one of the most senior BAME trade unionists in the country, I understand the importance of having more BAME people in senior management roles.
Testing and PPE still isn’t being provided consistently for all staff and we need rock-solid guarantees of full pay during Covid-19-related sickness absence – for every NHS worker.
When the last roll calls of the dead are read out and we see all of the faces that represent the underinvestment, the undervaluing, the stark inequalities heaped upon the shoulders of the NHS, then know this. We will not look away.
• Rehana Azam is national secretary of the GMB union
Sam Allen: Mental health services will face a triple whammy
The psychological fallout of Covid-19 will be profound for many people. Mental health in the UK worsened substantially in the first two months of lockdown. And NHS mental health services will potentially be faced with a triple whammy. Existing patients whose mental health needs have been exacerbated by the circumstances surrounding Covid-19, people who have developed mental health problems during this time, and traumatised health and care staff.
So, are we ready with the mental health support that will be needed?
It will be tough. People will need support, encouragement and empathy, particularly health and care staff who may feel they have simply been doing their job. The clap for carers has been a wonderful weekly moment of shared gratitude. But our NHS and care staff are not heroes. They are human. Some will be understandably traumatised by their experiences.
We are already seeing referrals to specialist mental health services increase after a temporary dip in recent weeks. But we also need to prepare for the mental health needs of people whose psychological trauma may not become apparent for many months.
We need to make sure the needs of those with severe, enduring mental illness are not overlooked. This is about timely and early intervention, prevention and ensuring services are accessible. A huge amount of planning is already happening.
Health and care transformation is so much more than strategy, taskforces or policy announcements. It’s about working with people and communities, harnessing their energy, creativity and expertise to transform services.
• Sam Allen is chief executive of the Sussex Partnership NHS foundation trust and chair of the Health and Care Women Leaders Network