Thread by @nedwards_1

I’ve been speaking to leaders in hospitals, community & primary care about the return to full NHS operations while living with the virus
nuffieldtrust.org.uk/resource/here-…
1/13

The logistical issues of returning the NHS to normal are daunting & the impact on its ability to operate at anything like pre-outbreak levels are profound & worrying 2/13

Many A&Es were operating well above their design capacity before the outbreak and were certainly not designed for separating Covid and non-Covid patients or distancing. As patients start coming back they’ll need to be expanded to create space 3/13

Perhaps we should consider the system in some other countries where you can’t go to A&E without a referral from the GP, a (more clinically delivered) version of 111 or by ambulance, unless in exceptional circumstances 4/13

Critical care capacity that has been created will need to be maintained in case of future surges in the virus – often using up other clinical space & sometimes anaesthetist time that is needed for surgery 5/13

The need to keep Covid/ non-Covid patients apart will reduce hospital capacity and create bottlenecks. Just the extra work of enhanced PPE use, testing patients before treatment and other operational details will slow things down. 6/13

Services seeng patients who might be infectious but where there is no time to wait for a test will need to be segregated from others. All of this adds up to a significant drop in the capacity of the hospital sector, which means longer waits and increased rationing. 7/13

Normally around 1.6m people per month start treatment pathways in hospitals. But most of this did not happen in April and May and it will take time to restart – waiting lists are going to balloon (when GP referrals return to normal) 8/13

There will be similar issues in community services – group rehab sessions, visits to people’s homes, one stop clinics – all need rethinking 9/13

General practice faces big challenges too and, while web and phone have helped, they’re not a panacea. People will still need face-to-face contact and GPs need to be able to examine patients. Dentists face an existential threat to their current business model 10/13

A quick, cheap & very reliable point of care test would help with much of this - but not all. 11/13

The overall result is likely to be levels of service well below what we are used to. I told the Health Select Committee it would be like having the capacity of a middle income country but with the demand, expectations and regulatory standards of a high income one. 12/13

All this is going to create some major challenges and tensions. I hope my paper today will help provoke conversations about those tensions 13/13
nuffieldtrust.org.uk/resource/here-… Also in the Times thetimes.co.uk/edition/news/n…