Being born into a medical family, my father a GP and mother a nurse, I couldn’t help but become aware of the National Health Service at a very young age. A childhood growing up with brothers who, like me, would go on to become doctors, and in my case to marry a GP, would cultivate a deep personal affection for the most treasured of all public services. And while I care deeply about the free at the point of care principles originating in The Beveridge Report, founded by Aneurin Bevan and protected by Conservative governments for the majority of time since, I am also acutely conscious that the NHS has its failings too.
Perhaps chief among those failings, and one that you will hear NHS staff talk about more than any other, is the overwhelming difficulties that you face in trying to effect change. The health service is a leviathan of an organisation, so much so that even when the need for change is obvious the practical implications of delivering it have historically been glacial.
In many ways coronavirus has, by necessity, changed that. Where in the past a technical development may have been discussed for many months the decision of the Prime Minister in March to lock the country down meant that innovation had to take place overnight. GPs who had been planning for the adoption of telemedicine for months and years, and who had not made the step because not all risks had been mitigated, were forced into telephone consultation within days. It is astonishing to contemplate that before lockdown only 3 per cent of GP surgeries were capable of offering video consultations. That percentage has now risen to the high 90s.
Secondary care has empowered clinicians to make swift decisions to cope with fast changing and complex problems. Of course, as with any new systems there were reports of teething troubles; but with the dedicated and wonderful professionals that we have working in the health service – and because there were no alternatives – these became molehills to be crushed rather than mountains to halt progress.
For the NHS coronavirus has meant innovation. In practices up and down the country GPs were printing and signing prescriptions as recently as six months ago; now e-prescribing has become the norm. And while the concept of digital interaction between doctor and patient has become the public facing reality of the pandemic, digital within the service has very much come to the forefront too.
In many ways Covid-19 has become the trigger to remove antiquated processes. In some cases, for the first time we are transmitting notes and letters electronically. Who knows? The NHS may even move away from holding that unenvied label of having been the world’s largest purchaser of fax machines.
We should never lose sight of the fact that the NHS is an employer too. As we have seen the benefits of home-working throughout the pandemic, with work-life balance for those working from home improving and the potential to realise office savings for employers, there is a real scope for NHS staff to do the same.
A GP working from home and adopting telemedicine principles has the capacity to provide every bit as good a service to patients as being desk based in a surgery, while at the same time reducing levels of burnout and potentially complementing the medic’s own family circumstances. Such an open-minded approach may well help to retain some of the doctors who had left their role but came back in response to the nation’s call.
All of this innovation has in-built potential for improved health outcomes too. Sitting on the Health and Social Care Select Committee we heard how cancer specialists working together have been able to build and model new clinical pathways. In a culture saying yes to innovation, in many ways for the first time, collaborative working has become fluid and doctors encouraged to be fleet of foot in addressing challenges.
Covid-19 has been responsible for a great loss of human life. We cannot let the price we have paid be forgotten. Politicians and policymakers must step up to help the NHS, we must be clear in our role so that the health service’s greatest resource – its staff – can do theirs.
We are in a moment when there is a real opportunity to create a positive legacy from coronavirus. The positives that have come out of this period of history must be retained, they give us great opportunity – opportunities to streamline management and opportunities to get rid of red tape. Since its inception the NHS has innovated in clinical excellence, while arguably it has lagged in its administrative processes. The pandemic has challenged that way of thinking.
I would very much hope that tangible outcomes would be better digital connections between primary and secondary care to allow easier sharing of notes and letters; flexible working for those on the front line and technical support to continue the trend; better integration between health professionals in multidisciplinary teams; and to strengthen the important relationships between the NHS and care homes.
All of the above exist, but the virus has shone a light on these areas to show they have huge potential to help the NHS move forward. Finally, with the drastic change in the interface between patients and healthcare workers, there is a danger that the professions retain this positivity, but the public is left behind.
Constituents have contacted me to tell me that they can’t see a GP, but when asking further it transpires they can, but the clinician is working in a different way and able to manage the workflow in a new manner. It is vitally important that together we educate our users into understanding that as delivery changes, our focus on the patient never does. As policymakers it is our duty to educate the public about the changes in interaction with health providers and what the benefits are in the service being provided. But we must highlight the opportunities this offers: to see more patients, to signpost care more clearly, and to give a better ability for clinicians to manage their workload.
I am mindful of the words of Henry Ford when he said: “If you always do what you’ve always done, you’ll always get what you’ve always got.” Covid-19 has meant that we don’t always have to do what we’ve always done, and where the outcomes of innovation are better it has made us realise that we can embrace them.