Oli Hudson and Paul Midgley, of Wilmington Healthcare, explain how coronavirus has expedited some parts of the plan but put others in jeopardy
Since the covid-19 pandemic began, some key Long-term Plan ambitions have been swiftly implemented, particularly around digital service delivery. However, a marked fall in emergency department attendance and growing mountain of elective cases has sparked concern over the effect on non-coronavirus patients.
In this article, we explore the impact of covid-19 on the NHS so far and assess which aspects of the Long-term Plan have been accelerated and which are being significantly derailed during these unprecedented times.
Digital service delivery
At the start of 2020, most GP work was still conducted face-to-face but since then there has been a seismic change with primary care adopting digital triaging as its main way of working in just three weeks.
There has also been a marked increase in the use of other digital tools. For example, hundreds of thousands of people across the country have been turning to services such as the NHS App or the NHS’s 111 online service for advice on their symptoms.
Also, nearly 700,000 people signed up in the first 24 hours of the launch of the Covid Symptom Tracker app which enables people to record their symptoms and feeds data through to a centralised collection point.
To make way for coronavirus cases, many older patients have been transferred from acute wards to care homes, or their own homes where they are being looked after by district nurses. Since moving more care out of hospitals into the community is another key ambition of the Long-term Plan, this trend is likely to continue.
It is also possible that covid-19 strategies could result in long-term conditions management being increasingly moved out of surgeries and more outpatients’ appointments conducted by specialists online in the future.
Elsewhere, synergy with Long-term Plan ambitions has been seen in the sharing of resources, which was necessitated after a national incident was declared over coronavirus. This enabled NHS England to command all NHS resources across England and NHS organisations were instructed not to stockpile medicines, devices or consumables. The move aligns with the Long-term Plan’s vision to move procurement away from individual hospitals to focus on the system as a whole.
The other side of the story
While it appears that covid-19 has been a catalyst for some positive change within the NHS, there has been concern that focusing too much attention on it will have unintended consequences and put some non-coronavirus patients at risk of significant harm or death because they are missing vital appointments or not attending emergency departments.
NHS England was tasked with identifying risk groups and building an intervention plan after it emerged that visits to A&E had dropped by almost 50 percent during a three-week period up to Sunday 29 March. This heightened fears that people with potentially serious symptoms were not seeking help for fear of contracting coronavirus in hospital.
The Long-term Plan makes it clear that early diagnosis and preventative strategies are key to improving outcomes in key disease areas. But if patients are not getting symptoms checked promptly, this could thwart efforts to drive improvements outlined in the plan.
The same principle applies in planned care, which has also been severely disrupted, prompting the Royal College of Surgeons to warn in April that the NHS would need a five-year strategy to deal with a “mountain” of an elective waiting list following the coronavirus outbreak.
To help manage care during the crisis, NHS England has issued a series of guides outlining how patients with conditions ranging from cardiovascular to diabetes and respiratory conditions should be treated and how services will be impacted during the coronavirus pandemic.
The raft of concerns that have emerged around non-coronavirus care have underlined a need to redress the balance and new NHS England guidance on resuming non-coronavirus services has been published. It is explicitly permissive in letting regions decide their own pace for reintroducing routine care, at least for the “transitional period” of the next six to eight weeks, but how this will unfold remains to be seen.
So far, the impact of coronavirus on the Long-term Plan has proven to be a double-edged sword. How long it will take to tackle covid-19 is, as yet, unknown and so too is the true toll that NHS service disruption will have taken on non-coronavirus patients.
When we finally emerge from the pandemic, it is possible that a new wave of NHS policy will be introduced that builds on key aspects of the Long-term Plan and cements some of the positive changes that have occurred. This provides a glimmer of hope that in the future, something positive will come from covid-19’s lasting legacy.
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