Saturday, October 16

Team applauded, long delays, too few beds and staff: the NHS enters 2021 in a sorry state | NHS


Do you think 2020 has been terrible for the NHS? Next year is shaping up to be much worse, and most of the gaping hole it is in was dug long before Covid. The virus has simply finished the job.

The health service does not have the beds, staff or equipment to make up the ground it lost during the first two waves of the coronavirus pandemic, but the government is blocking desperately needed improvements and another round of organizational disruption looms. .

About one in 11 clinical positions is vacant, and it would not be a surprise to see many employees rush to retirement after the worst of the pandemic has passed. The NHS cannot solve the problem without long-term certainty about staff funding.

Around 140,000 patients in England have been waiting more than a year for surgeries such as a hip replacement, a hundred times more than a year ago. With the entire system beset by delays long before we had even heard of the coronavirus, the lack of reserve capacity means it will take years to help many patients.

The unprecedented interruptions and delays in cancer testing and treatment have been exacerbated by the dismal state of diagnostic equipment. Access to CT and MRI scans is far behind countries with a fraction of our wealth, like Slovenia and Slovakia. However, the best Chancellor Rishi Sunak could accomplish in his spending review to reverse this was a commitment to Replace the most applauded kit pieces.

Amid all this turmoil, the NHS in England faces another round of legislative and organizational turmoil next year, the likely arrival of a new chief executive and a possible fight with Downing Street over the extent of political control.

The government seems willing to support NHS England proposals for legislation to undo the worst damages of the Andrew Lansley reforms which came into effect in 2013. The plan is to abolish the circular firing squad of hospitals that compete for business and instead establish some 40 integrated care systems to monitor services.

Many of these integrated systems have already started to function and the rest will be launched next April, but they have no legal basis, which has made it necessary to wink and wink agreements between the existing organizations to allow their operation. This is not a sustainable way to manage a health system.

It is likely to mean a round of disruptions next April and another a year later. Continuing disconnected attention wouldn’t be a great plan, but the moment we emerge from the pandemic is horrible.

And with the long-awaited departure of NHS England CEO Sir Simon Stevens after seven years, a new face is expected to be responsible for navigating all of this mess by next summer.

But, as is often the case with the NHS, a political battle over patient care may be the first item on the new boss’s to-do list. Boris Johnson and Health and Social Care Secretary Matt Hancock have been frustrated by the operational independence that the NHS England enjoyed under Lansley’s reforms, a freedom Stevens used to extraordinary effect before the pandemic to force additional funds. A government task force has been investigating how to use the new legislation to reduce the power of the CEO and bring them closer to the orbit of Downing Street.

As always, the NHS will overcome difficulties thanks to the frenzied efforts of its staff, whose success often comes despite, rather than thanks to, the systems they work on. But getting by and getting ahead will never provide the quality of health care the country needs. Like many other public services, the NHS faces the specter of a perpetual crisis.


www.theguardian.com

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