The phoney war is over...| Niall Dickson

Niall Dickson

When this crisis has passed, we will look back and say this was the greatest challenge the NHS has faced since its creation. The service is now the front line in the war against this silent and invisible killer. And that includes just about every part of the health and care system, from acute hospitals, community services, primary and social care. The contribution of each is vital to the performance of the whole.
 
The debate around the timing and extent of public health measures will doubtless rage on. We have taken the view that there is little alternative but to trust our public health experts, and to be fair that is what the governments across the UK are doing. Our modelling techniques are world leading, and it looks as if the spread here may be a little behind some other European nations.

But this strategy is like any war plan; it is filled with unknowns, not least the unknown of exactly how the enemy will react. The key going forward will be to adjust and adapt.
 

Constraints

 
For now, the priority is the right one – protect NHS services and do everything possible to prevent them from being overwhelmed. And that must include a massive scaling up of testing for NHS staff.
 
One other obvious constraint is equipment. Already it is clear the centre has struggled with supply chain issues affecting ventilators and personal protective equipment (PPE). In both cases, the messages are now more reassuring. On ventilators, the national figure now appears to be around 12,000, and there has been furious buying in markets around the world since the start of this month. UK manufacturers meanwhile are making some progress in switching their production lines from other products as the Prime Minister signalled, but it is not yet clear when this will start to deliver.
 
On protective equipment, there is apparently plenty of it around, just not in the right places. We have large stockpiles created for an influenza pandemic and more left over from no-deal Brexit planning. We just need an effective ordering and distribution system. We are told that this has now been fixed but we are still hearing reports of problems. Please do let us know if you are still having any difficulties. The somewhat quieter message is that not everyone has clocked that in terms of protecting clinical staff, coronavirus should be regarded as more like influenza than Ebola, and that the most advanced PPE is only required for more invasive procedures. More training and guidance may be needed.
 
The other constraints are financial resources and people. The government has made clear that money should not be an issue and we must hold ministers to that.  It would make sense to suspend aspects of financial oversight, including system control totals for the duration of the crisis. It is good that through the new Coronavirus Bill aspects of financial reporting in general practice have been suspended – for example for QOF payments, and we must see more of this. Any thoughts on other areas to lift the burden of reporting would be welcome.
 
The moves to bring back the recently retired and to bring the about-to-be qualified into clinical areas are welcome – but do let us know if regulators should be doing more. This is not a time for bureaucratic niceties.
 
In our role as NHS Employers, we have been working with government and the national bodies to collate the latest workforce advice into one central resource  – I hope this is useful.


How can we help?

So how can the Confederation support you during this extraordinary time? Here are four suggestions.
 
First, we can transmit your concerns, ideas and realities to those who are shaping national policy. Many of you can do this directly, but we hope to gather information and data from across the service and then ‘speak truth to power’.
 
For the most part we can do this behind the scenes, and we will always seek to be constructive. However, the system has moved rightly more into a command and control mode and it is vital that the voice of those who are organising and providing care are heard. We are keen to collect real-time issues, identify common themes and patterns and convey this to the centre.
 
There is certainly some frustration that the messages and guidance from the centre are not always as clear, coherent and consistent as they could be. The new Bill will help, though how the measures are implemented may well be more important than the measures themselves. I am sure there is a willingness to listen – as was shown by CQC’s response to our pleas about inspections, and we will keep up the pressure to remove any bureaucratic impediment that could hamper the fight against the virus.
 
Secondly, we will do what we can to interpret and clarify messages from the centre – the last thing we must do is bombard you with further information, but where we can we will try to simplify and target what matters. You can view a briefing on the new Bill. Together with NHS Clinical Commissioners, our PCN Network issued a briefing off the back of the latest advice for primary care covering how CCGs and Primary Care Networks can work effectively together during the pandemic.
 
Third, we are still keen to convene members on issues and topics because we believe now more than ever we need to be able to learn from each other. These will be virtual comings together but the purpose will be the same – to exchange views, experiences and insights to improve the organisation and delivery of care.
 
And last, we will continue to seek to represent you on national and through social media, reinforcing public health messages and explaining what the service is doing to protect the public and to save lives. 
 
But please let me know via niall.dickson@nhsconfed.org if there are other ways you feel we should be supporting you.
 
We are all feeling our way along this unchartered road, but with a sense of common purpose, this is a moment when the leadership of the service can come into its own.

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