The NHS is Not Ready to Return to Normal

Doctors are seeing a rise in demand for NHS services as lockdown restrictions are eased but, as things stand, they won’t be able to manage patient demand, writes Dr David Bailey.

As Covid-19 hit and the Welsh NHS began preparations to deal with an influx in patients, non-essential services were paused to allow doctors and other healthcare professionals to focus on tackling the pandemic. 

But as Wales now begins to plan for the next stage, where more NHS services will resume, doctors are sharing their fears over their ability to continue to deliver excellent care. 

We must remember that the Welsh NHS was struggling before the pandemic hit, and we were continually seeing evidence that it simply didn’t have the resources, staff, or capacity to cope with rocketing demand.

Patients in emergency departments were facing long delays for admissions and there were cancellations of routine operations year-round due to a lack of beds. For the safety of our patients, we cannot go back to this situation; we must ensure measures are put in place now to ensure the system is safe to cope with this increase in demand for services.

Throughout the pandemic, the BMA has asked doctors in Wales to complete a survey to share their experiences of Covid-19; with questions focussing on Personal Protective Equipment (PPE), track and trace, and workload, to name a few.

Only 8% felt they had been fully engaged with plans.

Our latest tracker survey of doctors across Wales, found that more than half said they were either not very confident or not confident at all in their own department being able to manage patient demand as NHS services are resumed.

This rise in demand is already being felt on the ground with over 40% of doctors saying it had increased significantly in the past week. It’s a trend that’s likely to continue upwards as some of the tightest restrictions are loosened, and services resume. 

It is a huge undertaking to restart the full range of NHS services while managing the threat from Covid-19, and we need to ensure capacity in the system to be able to manage a second wave of infection as well as keep patients and staff safe whilst restoring normal service as far as we can. 

To address the backlog, we are urging the Welsh Government to bring together health leaders and staff groups to ensure frontline clinicians are leading discussions on how to prioritise the sickest patients left without treatment due to the redeployment of staff and resources to deal with the Covid-19 crisis. 

Worryingly, in our latest survey, almost a third of doctors said there had been no engagement with them over how to manage the increase in demand in their place of work or local area. Only 8% felt they had been fully engaged with plans.

 I cannot stress enough the importance of engaging staff with this task. Without successful engagement, actions to address urgent issues will be less effective and the quality of care offered to patients will be at risk.

In order to address the backlog, we believe the following must be priorities for the Welsh Government:

  • Transparency: Comprehensive data on healthcare demand, population health and workforce must be rapidly collated and published to inform planning in the months ahead. This will include up-to-date data around waiting lists as well as the prevalence of certain conditions and health inequalities.
  • Capacity: The NHS redistributed capacity to care for Covid-19 patients during the peak of the pandemic, but at the expense of other treatments and services. The Welsh Government must commit to giving the NHS whatever resources it needs to tackle the backlog as well as the extra capacity it needs to meet demand in the long-term.
  • Workforce: Additional physical capacity only works if there are staff to provide care – and the system has so far relied on doctors working above and beyond to meet Covid-19 demand. Efforts must be made to retain, support and protect the valuable staff who have given their all in fighting the pandemic, prioritising their wellbeing and mental health and protecting them from burnout.
  • Learning: Services have been overhauled in the response to the crisis, and the NHS must keep the positive changes for the long-term while ditching unnecessary, outdated systems in other areas. A key element of this will rely on IT functionality.

The last few months have been incredibly challenging and it’s important to learn from them. 

We have seen the potential of the Welsh NHS to move fast, implement video technology and new ways of remote working, and doctors have embraced the changes.

A reduction in paperwork, bureaucracy and unnecessary regulation has liberated doctors and allowed them to dedicate their time to seeing and treating patients.

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 We must retain these positive improvements, which of course require systematic changes like guaranteed access to up-to-date IT software and hardware – the lack of which has frustrated healthcare workers for too long. 

Over the last few months, we have witnessed the outstanding dedication of doctors, nurses and other healthcare workers. Of course, the dedication of these professionals has never been in doubt, but a light has been shone on their exceptional contribution in caring for our loved ones. 

Over the weeks and months to come, as services begin to resume, it’s essential that staff continue to be provided with appropriate PPE and access to mental health support. Their views must be listened to and respected as we navigate our way to the ‘new normal’. 

It is only when these priorities have been addressed can we return to a service that is safe for both doctors and patients in Wales.

All articles published on the welsh agenda are subject to IWA’s disclaimer.

Dr. David Bailey is Chair of BMA’s Welsh Council; the standing committee of the BMA, which focuses on all issues relevant to the medical profession and healthcare in Wales, formulating policy and ensuring it is implemented. He is also a practicing GP.

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