NHS Wales Still Needs to Adapt to the Effect of the Pandemic

Not moving to virtual assessment panels to assess people’s healthcare needs mean patients and families in Wales face a damaging backlog, writes Dr Arun Midha.

The COVID-19 pandemic has put the NHS across the four nations of the UK under as much scrutiny as has ever been since devolution.

And whilst most of the discussion has centred on issues such as PPE, ventilator supply and other issues directly arising out of the current crisis, it is important to remember that the NHS is a body which has many responsibilities which have been affected differently during these last months.

NHS Continuing Healthcare is a package of care arranged by the NHS. It is available to individuals in care homes or at home who have on-going health needs. Care and Nursing home costs vary, Age UK have suggested that an average weekly cost could easily range from £600 – £800 per week for a Nursing home. 

An individual is assessed by a team of health and social care professionals who look at all care needs including risks to health if the right care isn’t provided. If the assessment identifies that an individual is not eligible for funding then they or their family can apply for a review of a decision by an NHS Independent Review Panel. 

The panel brings together a clinician and social worker to examine all the evidence to determine whether the original decision was justified. Of course no case or circumstance is the same but typically, individuals tend to be quite elderly with many in their 80s or 90s. 

One often sees cases where a family has been incredibly supportive to an elderly Mum or Dad but sadly an event, perhaps a stroke or fall has necessitated a hospital admission. 

The hospital stay has stabilised the situation sufficiently to enable them to be discharged but requiring more than a family in home environment, however committed is able to provide. A care home setting is felt to be in the best interests of Mum or Dad. 

The COVID-19 pandemic has required an urgent reassessment to the way these review panels are conducted given that until March 2020, reviews had been done using a ‘face to face’ model where a panel consisting a Clinician, Social Worker and Independent Chair had met physically with families and their advocates to determine eligibility decisions for Continuing Healthcare. 

In the late 1990s, a backlog of thousands of cases resulted in many families experiencing significant delays (measured in years).”

NHS Wales, perhaps for understandable reasons, made the decision to place a temporary halt on all panels, redeploying clinicians to other areas to address the pandemic crisis. NHS England took a different approach. 

Within days of the COVID-19 crisis and emergency measures requiring remote working, the decision was made to accelerate an approach that was under development to deliver reviews remotely through the use of Microsoft (MS) Teams, a video-conferencing software. 

The existing paper-based system was rapidly altered and a secure extranet system with documents now electronically scanned was introduced for panel members to access remotely from home. Panel members, families and their advocates were then able to participate in a ‘virtual’ panel though the MS Teams facility.

Clearly, as clinicians have been called to frontline work to deal with critical aspects resulting from the COVID-19 crisis, panels in England have inevitably lessened in frequency given clinician availability. 

However, critically, the MS Teams approach has allowed the Independent review process to continue in England and has meant also that clinicians can devote smaller chunks of time to a review panel given that there is no need for time-consuming travel time to venues. 

The virtual nature of the system has also enabled those clinicians who have been required to self-isolate at home because of potential contact with others who have had COVID-19 but were not ill to continue to participate on a panel as the MS Teams model lends itself to home-working. 

The approach has ensured continuity in England at minimal cost given the free access of use of MS Teams. It has also had a positive impact on individuals and families who have been waiting a significant amount of time to get to this Independent review panel stage. 

Early indications are that the approach adopted by NHS England is working and importantly the remote nature of engagement has not, it seems, had a negative impact on person-centredness. Crucially also, it is mitigating the risk of a significant build up in cases requiring panels.

There is an opportunity to change ways of working here in Wales at relatively minimal cost to ensure some continuity of provision as it is likely that, even with a lessening in COVID-19 infection rates, it is unlikely that the face to face panel model would be able to be reintroduced for many months. 

A move to virtual panels here in Wales would reduce costs in terms of travel, having also a positive impact on environmental goals and NHS Wales’ ambition of carbon neutral status.

Given that there would not be a necessity to travel to venues, clinicians could more easily participate in panel work given that they could fit panels around their daily work. 

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The danger of not finding a solution to provision of review panels in the short term is a build up of a backlog of significant numbers of cases where Wales (as did England) saw a significant number of discharges from hospitals of elderly people into care homes. 

This was understandable as at the height of the pandemic in March there was a genuine perception of a need to release beds for the potential influx of COVID-19 patients. 

However, in many cases there was not the time to undertake proper assessments to determine whether some could have qualified for Continuing Care Funding. 

NHS Wales will be faced with many claims for assessment and a proportion of these will no doubt be subject to an appeal. 

We have seen the result of such delays before. In the late 1990s, a backlog of many thousands of cases built up which resulted in many families experiencing significant delays (measured in years) before their independent review was heard. 

At that time, technology was not at a level where virtual panels could be used and a centralised system was established by NHS Wales to work through the backlog and, whilst successful, it took around 7 years to complete. 

Delivering panels virtually will enable far more to be held thus giving an earlier and timely resolution to families and perhaps preventing a similar situation to what happened in Wales many years ago. 


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Dr. Arun Midha is a former Welsh rugby union referee, former Trustee of the Wales rugby charitable trust and former Lay member of the UK Parliament's Select Committee on Standards

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