Wednesday, February 24

The NHS accepted the Covid challenge, but its next test may be even more difficult | NHS


THEIn the past year, our NHS has faced the challenges of the pandemic. But it has been something very closed. There have been well-publicized difficulties, such as the shortage of ventilators, ICU beds and PPE, and the physical and personnel capacity of the health service has been stretched to the limit. GPs have managed the risks of patients who have not been able to receive specialized care. We now face a growing backlog of postponed treatments and emerging mental health problems. So if we were to imagine a post-Covid NHS, hardened by the challenges of the pandemic but better prepared for the future, what would it look like?

The NHS was created in a completely different era, so it is not surprising that some aspects need to be modernized and reformed. Life expectancy has increased by an average of 13 years since the health service was founded in 1948 and has faced many new challenges, including caring for the increasingly frail and chronically ill elderly.

For too long, our elderly population has suffered the consequences of a disjointed and bureaucratic health and social care system. By 2050, there will be an estimated 19 million people over the age of 65 in the UK. This will put great pressure on both the NHS and families to provide care. In short, we urgently need better ways of caring for the elderly in our society.

Elderly patients with chronic diseases such as arthritis, diabetes and heart disease already account for the largest proportion of the NHS budget. Before Covid-19, at least one third of patients in our acute care hospitals he did not need to be there. Many had ended up in the hospital for conditions that could be better managed in nursing homes or at home with the right support. As our health and social care system is forced to adapt to Britain’s changing demographics, it will have to find new ways to keep the elderly out of expensive hospital beds. This is a win-win: it keeps costs from skyrocketing, keeps beds free for those who need them most, and vastly improves the quality of life for older people.

Covid-19 has exposed the need to address the capacity and resilience of the NHS. In normal times, the flu puts great pressure on the health service during the winter months. Routine care suffers, operations are canceled, and NHS staff grapple with the backlog over the summer. This delay will be much worse after Covid. Any doubt that we need more capacity in the NHS and social care has evaporated. The question is what kind of capacity and where.

Increasing capacity is not just about providing more beds. It requires better organizing ourselves to meet the changing needs of patients by distributing the workforce more effectively, reusing unused buildings, and relying on out-of-hospital services, such as pharmacies, to offer a broader range of services. Not everything has to cost money. For example, before the pandemic, there were meaningless obstacles to sharing staff between hospitals. Now this practice is commonplace.

We already manage our financial and social life online, but the NHS has lagged behind in this field. The pandemic has shown us what is possible. Within a fortnight of the first confinement, more than 50% of all GP visits they were being carried out virtually, and hospital consultations soon followed. Tools that allow people to monitor their symptoms remotely have been shown to reduce the need for unnecessary hospital visits and admissions. After Covid, we are likely to see the continuation of digital consultations, although of course not everything has to be done online, and many people will still want the personal touch of face-to-face dating.

Where technology will really excel is when it frees up physicians to provide specialized care. In the near future, you may be able to take a picture of a skin lesion and an AI app will have the diagnostic ability to advise you on how to treat it and whether to seek medical help. In hospitals, AI could help with faster and more accurate diagnoses of some scans and biopsies, giving doctors more time to administer specialized treatments.

But such tools will require careful regulation. Digital information does not respect the regional boundaries of the NHS. If someone in Sheffield uploads an image of a rash to an app where they get advice from a doctor in Belgium, for example, who is then responsible if the advice turns out wrong?

New technologies will also help the NHS to provide care outside of hospitals. We have seen an explosion of digital therapies that relieve anxiety, depression, and insomnia. Some are excellent. Most are not. But with proper scientific regulation, such tools could be enormously beneficial, particularly for those who may be struggling with isolation and loneliness.

AI is not the only field that is changing what the NHS will be able to do. Over the past century, vaccines, antibiotics, and monoclonal antibodies have transformed the way we prevent and treat disease. We are now on the cusp of another medical breakthrough. British scientists are at the forefront in understanding how the human genome and cells work. This area of ​​research could yield cures for previously incurable conditions like hemophilia and some forms of leukemia. The challenge with these treatments is that they will be very expensive, which raises difficult questions about how to divide a finite budget: should we choose to spend resources on smaller and cheaper health improvements for many people, or costly and life-changing health improvements? of a lot of people? a few?

Covid-19 has shown how the NHS could be a world-class research laboratory. The UK is home to some of the best universities in the world and we are well above our weight in medical research. During the pandemic, NHS hospitals participated in large and rapid clinical trials which led to improvements in treatments like dexamethasone. The relationship between academic research and the NHS has already proven its worth and must be integrated into the future of the health service.

To ensure that the health service is capable of meeting the challenges it will face in the next decade and beyond, structural and local reforms will be required. The word ‘reform’ causes discontent among many NHS professionals, who have undergone numerous reorganizations over the years and have seen efforts diverted towards reform at the expense of improving patient care. While some of the changes in the recent NHS technical report seem sensible, their effectiveness will depend on the last detail.

To ensure that the focus remains on patients, all policy reforms and local changes must convincingly pass at least one of these six tests: will they reduce demand on the NHS by preventing disease or improving well-being? Will you speed up the time between a patient seeking help and receiving treatment? Will they improve patient safety before, during or after treatment? Will they allow better clinical results? Will they provide better value for the taxpayer? And will they reduce the inequality of access that has caused some groups to receive less attention than others?

The pandemic has shown us all how dependent we are on the NHS. In this dark year, it is worth remembering that the health service was founded during an equally intense period of hardship after World War II. It was the most ambitious social security project in history and became an icon of British social consciousness. Our task now is to ensure its resilience for the future.

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