Covid recovery in the NHS...a thread

The pandemic has had a huge impact on the delivery of services to patients and it's our duty to maintain good outcomes for as many people as we can, not just those with Covid infection. This is a huge challenge

Capacity is reduced because of infection control measure and continues to be so, even as a backlog of planned care grows. Therefore we cannot approach this problem in our usual mode of delivery of we are to equitably meet need (as best we can with the resources we have)

The WHO had a helpful framework for maintaining essential services during a pandemic which prioritises life threatening, life changing and time sensitive issues above all others, given that choices will always have to be made when resources are scarce or safety an issue.

These categories focus on the essential prevention of adverse outcomes, responsive urgent care, essential management of chronic conditions, timely diagnosis of new problems and the proactive management of vulnerable groups

As we move out of the pandemic the range of people that can access planned treatment grows, but capacity may still be reduced and need to flex up and down depending on viral activity. Patients must be properly made aware of any additional risks and this factored into consent.

In medicine we tend to fight our own corner and we are advocates for the patient in front of us. Therefore a plethora of guidance documents from specialties emerge, many of which place equal demands on cross cutting services such as imaging, theatres and ICU.

There is insufficient capacity to catch up in our usual fashion so we need to figure out together how best to approach this, and broker clinical risk across all specialties. There is an argument for separating planned care out from acute care

And even to provide radical new regional solutions to tackle the surgical backlog

Open discussion and transparency in decision making will be key. If not we will be doing a huge disservice to patients and also to staff who will be managing as best they can and doing their utmost to look after their patients.

This also means really tackling anything which utilises capacity and is of lower value to patients. This can be supported in part by digital technology but will require a different approach to our clinical follow up behaviours, for example.

This is a challenge and an opportunity, and should be a stimulus for patient-facing technology that enables people far greater control over their own records and data.

Whatever happens, more of the same isn't going to help us .