How will Covid-19 change the NHS?

The Covid-19 pandemic has been the biggest challenge the health and care system has faced in living memory. It is essential that lessons are learned from this experience – whether from the extraordinary contributions of millions of staff and volunteers, the rapid progress achieved in digitising and transforming service delivery, or from the shortcomings and inequalities brought sharply into focus.

How did Covid-19 impact the NHS?

The Covid-19 outbreak has shown many aspects of the health and care system at its best. Health and care workers responded with outstanding dedication and skill. Doctors and managers went above and beyond to quickly develop new ways of delivering services safely. Hospitals joined forces to offer each other mutual aid and ensure continued delivery of essential services. In some areas the NHS, local government and other local services worked together like never before to co-ordinate their responses and support communities. The crisis also underlined public support for the NHS and for care staff.

However, the pandemic has also exposed clear issues and made some existing issues worse:

• People who have been worst affected by Covid-19 are generally those who had poorer health before the pandemic, such as people from ethnic minority communities or those living in more deprived areas.
• NHS staff were already under enormous pressure before the pandemic and they have now had to work through the demands of the pandemic. The pandemic has taken a bigger toll on staff from ethnic minority backgrounds, who already faced higher levels of discrimination and poorer workplace experiences than their white counterparts.
• Following the longest funding squeeze in its history before the pandemic, NHS services were already under pressure. This meant that the NHS entered the Covid-19 crisis already stretched to its limits. To prevent hospitals being overwhelmed, non-urgent care was suspended, leaving many people without the level of care and support that they would usually expect to receive.

Beyond the immediate impact of Covid-19 on the NHS, the lockdowns caused deep damage to public finances and the wider economy. The social and economic consequences of the crisis will undoubtedly have had an impact on the population’s health and mental wellbeing, and risk deepening inequalities further.

What will it take to restore NHS services?

The NHS faces major challenges to restoring services, not only in hospitals, but also in primary care, mental health and community-based services.

First, depending on the take-up and success of vaccination, the NHS will need to be fully prepared at local, regional and national levels for any future waves of Covid-19 and for the potential need for further mass vaccination against new variants. This will require the NHS to quickly learn from what has and hasn’t worked so far to avoid a repeat of previous mistakes.

Second, there are big practical challenges to delivering routine care while Covid-19 remains a risk. Changes have already been made to reduce the spread of the virus (including the creation of Covid-free areas) and personal protective equipment (PPE) may continue to be required for the foreseeable future. It’s important to say that these considerations apply across the NHS and not only hospitals. No matter how well they are designed, these measures are likely to slow the pace at which patients can be treated, having an impact on waiting times and people’s outcomes and experiences of care.

Third, a major sustained effort is required to address the backlog of demand for care and bring down waiting times. Importantly, this relies on having the staff available to deliver care; it is not realistic to expect exhausted staff to move straight from responding to the pressures of Covid to catching up with the backlog without sufficient time to rest and recover. It isn’t just staff wellbeing that poses a risk to tackling the backlog, the latest NHS staff survey has found that the moral of the workforce has declined for a second year, with pay dissatisfaction being a key issue alongside the difficulty that the NHS is experiencing in recruiting staff to cover existing vacancies.

This article is adapted from The road to renewal: five priorities for health and care