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A ‘re-imagining’ of the NHS necessary to emerge stronger

Calls have been made for a dramatic reassessment of what the health service is able to deliver as it prepares to grapple with a triple challenge from rising Covid-19 infection rates, major backlogs faced in treatment and reduced capacity due to infection control measures.

Informed by a new survey of more than 250 senior leaders across the NHS in England, the report warns of the need for extra investment and support for frontline services if the NHS is to emerge from the pandemic on a stronger footing.

As part of a new NHS Reset report - NHS Reset: a new direction for health and care – the NHS Confederation outlines the need to ensure that a raft of positive changes which have bene introduced in recent months of the pandemic are ‘locked-in’ for the benefit of patients, local communities and NHS staff.

These include stripping back time-consuming bureaucratic process, handing more control to local NHS leaders, accelerating steps to integrate health and social care, as well as sustained and funded action to tackle the health inequalities that have been exacerbated by coronavirus.

Above all, the report has called for political leaders to be honest and realistic with the public about waiting times and other treatment areas as the NHS continues to resume services, while managing the ongoing threat of coronavirus.

Input was gathered from clinical leaders across many different services, including chief executives, chairs and leaders working in hospitals, mental health and community services, ambulance trusts, commissioning groups, primary care networks and integrated care systems.

It revealed widespread concerns as we head into the traditionally busy winter months, alongside a positive vision for how services can be ‘re-imagined’ to help produce a stronger and more resilient health service moving forward.

Key findings included in the report include:

  • Despite the NHS being a universal service, NHS leaders recognise the profound impact that coronavirus has had on people from black and minority ethnic (BME) backgrounds and other disadvantaged communities. More than eight in ten leaders (84%) say they believe the NHS must deliver a step change in how it cares for diverse and marginalised communities.
  • Nine out of ten leaders (88%) say a lack of funding will be a significant barrier to delivering waiting time standards for patients. Three out of four leaders (74%) say they are not confident their services will be able to meet the national targets to bring back routine operations to ‘near-normal’ levels by the end of October.
  • Fewer than one in ten NHS leaders (8%) say their current funding allows them to deliver safe and effective services.
  • Fewer than one in ten (8%) were confident they would achieve the goals of the NHS Long Term Plan within their existing funding settlement for day-to-day ‘revenue’ spending, with almost three-quarters (73%) saying they did not have enough capital funding to upgrade their buildings, IT and other infrastructure to deliver services in new ways.
  • Following a gruelling six months, nine out of ten leaders (90%) said they are concerned about the long-term impact that the pandemic will have on doctors, nurses and other frontline staff.

There was also an overwhelming view which came out of the survey and report showing NHS leaders keen to see the Government reassess the health service’s settlement in its November spending review, with significant shift and increase in demand seen and predicted compared with the needs outlined back in 2018 when the last five-year £20bn funding settlement was agreed.

In particular, there was a highlighting of the need for additional revenue and capital funding needed to cover the extra costs of meeting rising demand, particularly in mental health services. The additional costs of the NHS working to overcome the backlog of treatment and deliver patient services in new and improved ways as part of the transformative programme outlined in the NHS Long Term Plan.

Danny Mortimer, Chief Executive of the NHS Confederation, said: “No one can be in any doubt that the road to recovery for the NHS and social care services will be long. Despite dire predictions that it would not be able to cope, the NHS has not only managed a huge wave of Covid-19 patients but also continued to treat millions not infected with the virus.

“We have learned much and are in a better position to manage the virus than first time round, despite still not having an effective test and trace system. The strain will continue to be felt across the country, but we must take this opportunity to re-cast services for the long-term benefit of patients and local communities.  Our members continue to do everything they can to maintain access to vital mental health, cancer and other services for their non-Covid patients.

“This is a moment of truth for the Government and its stewardship of the NHS. Either it embraces what we have learned in recent months and provides the support and investment the NHS and social care need to get back on track and reform for the long term.

“Or they continue with short-term fixes, bail-outs and ever-increasing targets and regulation that continue to stifle NHS staff from ‘locking-in’ the changes that are essential if the health service is to manage the threat of the pandemic and emerge in a stronger position. In return, taxpayers and the Government will rightly expect the NHS to embrace new technology, eliminate waste and deliver services in new and improved ways for patients.”

Lord Victor Adebowale, Chair of the NHS Confederation, added: “COVID-19 has been the biggest disruptor in the NHS’s history. Out of necessity, it has transformed patient services in ways previously unimagined and changes that would usually take years have been delivered in weeks.

“This is the moment for Government to grasp the nettle, be bold and invest in a health and care system not just for this winter but for the long term. It must be reimagined in a way that lets local leaders deliver services that work for everyone in their communities.

“Above all, we need to see a radical and conscious shift in every part of the country towards tackling health inequalities. If there is one lesson from the pandemic, it is that our universal health service does not care for everyone equally.”

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