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- Over 1,100 experts have shared with us their concerns about COVID-19 and COVID-impacted areas in the immediate and longer term future.
- This report outlines concerns about health and social care.
- Experts have concerns about the NHS. These include its ability to cope with multiple waves of COVID-19 patients and patients with other conditions, lack of equipment, the future of funding and the structure of the NHS.
- They are also concerned about the demand on social care services and the safety of residents and staff of care homes.
- Concerns also focus on health and social care staff: their physical and mental health, their access to training, and the future of the workforce.
- Finally there are concerns about the ability of the UK to deal with excess mortality.
- You can find all our horizon scanning work on COVID-19 here.
Our survey of over 1,100 experts asked them what their most important concerns were in the short (next 3 months), medium (next 3 to 9 months) and long-term (beyond the next 9 months) relating to the COVID-19 outbreak. Their responses were analysed and synthesised. This synthesis comes from survey responses submitted between 3 and 30 April. Experts raised 556 concerns relating to the health and social care system. Below are the areas of concerns that experts have relating to this area.
National Health Service (NHS)
Over 400 concerns focus on effects of the COVID-19 outbreak on the NHS in the short, medium and long-term.
Nearly 100 concerns are about NHS capacity. Experts are concerned that in the short and medium-term the NHS may not have the capacity to deal with the increased number of patients from the COVID-19 outbreak. They suggest that the number of critical care beds and number of healthcare staff were lower than ideal before the outbreak. This means that any increases in the number of hospital patients could overwhelm the system. They note that the NHS is likely to have to deal with multiple waves of COVID-19 patients and it is not clear if the current wave will be the biggest. In the long-term some experts are concerned about how the NHS will cope if a wave coincides with seasonal influenza in winter, when resources are usually stretched.
Over 80 concerns focused on a lack of equipment in the NHS. In the short and medium-term experts want to know how the Government will ensure that all NHS hospitals receive the equipment and medication required to treat patients infected with the virus. Many experts express concern that NHS workers are not being provided with adequate personal protective equipment (PPE). They question how supply chains are being secured and what the role of UK manufacturers is in providing adequate PPE. They also express concern that, before the outbreak, there was not enough PPE set aside ready for distribution in case of a pandemic. In the long-term, experts suggest that there should be better preparedness to source, manufacture and deliver essential healthcare equipment in the event of a public health crisis.
Over 250 concerns are about the effect of the COVID-19 outbreak in the short and medium-term on non-COVID-19 healthcare. Experts are concerned that the closure or reduction of clinics may increase deaths from non-COVID-19 issues. Some experts note that people may also be reluctant to access emergency healthcare because of fears about the virus. This could result in worse health outcomes for people if issues are left untreated, which would add extra burden to the NHS. Experts express concern about specific services that may be most affected by reductions. These include services for mental health (59 concerns), addiction (59), palliative care (44), post-hospital rehabilitation (13), and sexual and reproductive health (11). Experts are concerned that in the long-term, services that have closed or reduced operation will have a backlog of patients to deal with. They express concern that some of these patients will deteriorate or die while waiting for services. They are also concerned that there will be an increase in demand for certain services following the COVID-19 outbreak (particularly mental health services, and sexual and reproductive health services). They want to know how the NHS will prepare for this increase.
In the medium and long-term, there are nearly 30 concerns about the future funding and structure of the NHS. Experts are concerned that the NHS may not have adequate funding in the long-term to deal with demand. Demand will come from ongoing COVID-19 cases, backlogs and increases in certain healthcare needs. They are also concerned about how effective the current structure of the NHS is at responding to public health crises. Some suggest that NHS England’s structure of clinical commissioning groups (CCGs) and acute trusts makes it difficult to coordinate a country-wide response. For example, CCGs or acute trusts managing equipment requirements can create duplication of effort and inadvertent competition for resources. Some experts also raise similar concerns about use of private providers by the NHS. In the long-term, some experts suggest that there may need to be a restructuring of the NHS to allow it to manage COVID-19 cases alongside everyday healthcare. For example, there may need to be specific wards or clinics dedicated to COVID-19 for a long time. Experts also want to know what changes will be made in the long-term to UK legislation and NHS policies to be better prepared for future public health crises.
Some experts suggest that in the long-term the NHS should make greater use of digital technologies. They note that many services have had to use new technologies during the COVID-19 outbreak. They want these innovations to continue and expand. They suggest greater investment in digital technology and digital infrastructure in the healthcare service would make it more resilient to future public health crises.
Example of a typical short-term concern in this area: Availability of hospital beds, ventilators and ICU [Intensive Care Unit] equipment for infected.
Social care system
Nearly 30 concerns focus on the social care system. Experts note that funding for social care was not sufficient to meet demand before the COVID-19 outbreak. They are concerned in the long-term that there will be an increase in the demand for social care. For example, there may be more children who are identified as being at-risk or more people identified as needing long-term care. In addition, if there are ongoing population health effects from the COVID-19 outbreak, community care requirements may increase. Experts also suggest that local authorities will face a backlog of care assessments because they cannot carry them out currently. As with the NHS, many experts are concerned that the social care system may not have adequate funding in the long-term to deal with ongoing COVID-19 cases alongside backlogs and increasing demand.
Experts also express concern in the short and medium-term about residents and staff in care homes. They note that deaths in care homes have been far higher than in the general population. They want to know why and what changes will be made in the long-term to protect those living in care homes from contagious diseases.
Example of a typical short-term concern in this area: There is a focus on the NHS without consideration of the wider health and social system and how these other areas require further support/funding to tackle COVID-19 and reduce hospital burden
Health and social care workers
Nearly 100 concerns focus on health and social care workers. Over 40 concerns are about the physical and mental health of health and social care workers. Experts note that in the short-term, workers’ health could be being put at risk through inadequate PPE. In the medium-term, they are concerned about the effects of staff having to work for months at such high intensity. They suggest this could lead to stress and burnout. Experts are also concerned about the long-term health effects of working during the COVID-19 outbreak. They suggest that there could be an increase in depression, anxiety and post-traumatic stress disorder (PTSD) among health and social care workers. They want to know what current policies are in place to protect and support workers.
Experts raise nearly 20 concerns about training of health and social care staff. They are concerned that training to use vital equipment has been inadequate in the short-term and that this could lead to long-term health consequences for staff and patients. In the medium and long-term, some experts suggest that more staff should be trained to be able to work in various settings to allow greater flexibility in the workforce. For example, some experts suggest that all health and social care workers should be trained in drug dosage calculations and use of emergency medical equipment.
There are nearly 30 concerns about the future workforce for health and social care. Experts note that even before the COVID-19 outbreak there were issues with staff recruitment and retention. They suggest that the outbreak will worsen this situation. They note that in the long-term more staff may be signed off work or leave because of the health effects of working during the outbreak. However, they also suggest that some workers from outside the UK may prefer to return to their home countries, especially with the UK out of the EU. Experts are concerned that staffing levels in health and social care will drop without increased support, training and funding.
Example of a typical long-term concern in this area: How we support our healthcare workforce, many of whom may experience negative mental health and post-traumatic stress as a result of frontline care.
Dealing with excess mortality
There are around 30 concerns focussing on how the UK will deal with excess mortality (the people who would not have died if there had not been a COVID-19 outbreak). Experts suggest that services will be stretched in the short and medium-term while the UK deals will a greater number of deaths than usual. They want to know how systems will cope with increases in transporting human remains, registering deaths and arranging burials/cremations. Experts are also concerned about demands in the medium and long-term on bereavement services. They note that restrictions on hospital visitation and funerals may make people more susceptible to bereavement-related mental health issues. They suggest there could be economic impacts if an increased percentage of the population is dealing with complex grief and, therefore, is unable to return to work.
Example of a typical short-term concern in this area: Ensure funding for bereavement support charities/agencies who will be helping many more people- with mental trauma from COVID deaths, restricted funerals etc.
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