MPs say compelling case for weekly testing of NHS staff to stop NHS becoming a Covid-only service in second wave
|
The Health and Social Care Committee is calling for urgent action
to assess and tackle a backlog of appointments and an unknown
patient demand for all health services, specifically across cancer
treatments, mental health services, dentistry services, GP services
and elective surgery. MPs say a compelling case has been made for
the nationwide routine testing of all NHS staff and they are yet to
understand why it cannot be introduced. The inquiry, launched in
April,...Request free trial
The Health and Social Care Committee is calling for urgent action to assess and tackle a backlog of appointments and an unknown patient demand for all health services, specifically across cancer treatments, mental health services, dentistry services, GP services and elective surgery. MPs say a compelling case has been made for the nationwide routine testing of all NHS staff and they are yet to understand why it cannot be introduced. The inquiry, launched in April, considered the provision of essential health and care services both during and after the pandemic and how the resulting pent-up demand for services would be managed and met. Representatives of the Royal Colleges, NHS Providers, the NHS Confederation, health think tanks, patients and patient groups, the Chief Executive of the NHS and other senior NHS leaders were among those who gave evidence. Members of the Committee pay tribute to frontline NHS and care staff who lost their lives to coronavirus and their bereaved families. Health and Social Care Committee Chair Rt Hon Jeremy Hunt MP said: “We are proud of the heroic contribution made by frontline NHS and care staff during this pandemic, which has saved many lives. Thanks to their efforts not a single coronavirus patient has been denied an intensive care bed or ventilator unlike in other countries. “However the pandemic has also massively impacted normal NHS services, something that could have been mitigated with earlier infection control measures in hospitals and clearer communication to patients whose care was disrupted. Weekly testing of NHS staff has been repeatedly promised in hotspot areas - but is still not being delivered. Failure to do so creates a real risk that the NHS will be forced to retreat into being a largely Covid-only service during a second spike. "We've heard of severe disruption to services, especially cancer, and here we could be looking at tens of thousands avoidable deaths within a year. If we’re to avoid this going forward it is time to give as much priority to avoiding harm and death caused by the interruption of normal NHS services and introduce mass testing for all NHS staff. Today we set out these and other steps the government and NHS leaders must take to manage services through a second wave." ENDS ‘Compelling’ case for routine testing for NHS staff The issue of routine testing for NHS staff was raised throughout the inquiry with the Health Secretary Matt Hancock, Chief Medical Officer Professor Chris Whitty and NHS England and Improvement Chief Executive Sir Simon Stevens questioned on its progress. MPs note that despite being informed that capacity constraints inhibited the routine testing of all NHS staff, they had also been told consistently that decisions about testing staff were medically led and based on scientific research. The CMO Professor Whitty is asked to clarify to what extent testing capacity has impacted the advice he and his colleagues have provided to the Government on routine testing of NHS staff. He is also asked to clarify whether he has advised the Government to introduce routine testing of all NHS staff in the current virus hotspots and if not, why. MPs conclude there is a compelling case for routine testing for all NHS staff in all parts of the country and are yet to understand why it cannot be introduced. They recommend it should be introduced as quickly as capacity allows, certainly before winter. Those who provide treatment to patients should not be put at any ‘further unnecessary risk’ of catching or spreading COVID-19, with steps taken to expand capacity rapidly to make this possible. Key recommendations on testing:
(please see attached Report for full list of all conclusions and recommendations) Reduction in core services While the delivery of all services had been significantly reduced, elective surgery, mental health services, cancer treatments and dental treatments are highlighted. Instruction to continue cancer services ‘not always adhered to’ The Report highlights the mismatch between assurances given in March by NHS England and Improvement Chief Executive Sir Simon Stevens that cancer operations and routine care would continue for cancer patients despite the pandemic and evidence given to the inquiry that cancer services had been severely disrupted. MPs conclude that despite his instruction that cancer services should not be stopped, it was clear that it was not always adhered to. Evidence to MPs included: referrals for diagnostic tests for suspected cancer tests were reported to have dropped by 75% in England; urgent cancer referrals fell by 62% on pre-pandemic levels in one week; 6,000 fewer people than expected were receiving chemotherapy since lockdown began; the suggestion that 36,000 cancer operations had been cancelled by mid-May; that 2.4 million people were waiting for screening, tests and treatments for cancer services. One study estimated continued delays to cancer services could result in 35,000 avoidable deaths within a year. The Report notes that Sir Simon Stevens has recognised the need to restore cancer services as quickly as possible and that it would be delivered in ‘new ways’ with instructions in July to trusts and primary care networks to restore the full operation of cancer services and manage the immediate growth in numbers requiring cancer diagnosis or treatment. Waiting times and managing the backlog of appointments The suspension or cancellation of services and treatments to focus on providing emergency care for Covid patients had led to "avoidable harm that is now very clearly happening" according to one charity, resulting from a backlog of appointments and pent-up demand for core health services. An accumulation of evidence to the inquiry shows the scale of the backlog:
Behind the figures, patients experienced feelings of distress and abandonment. In evidence Rob Martinez spoke of his cancelled operation for joint replacement surgery being “absolutely devastating”. A surgeon said some patients were at risk of dying without a new heart valve, delayed as a result of the backlog. Mental health services Significant disruption was experienced in referral routes with the mental health charity Mind reporting vital mental health services were scaled back and people unable to get support. Extra demands on mental health provision were expected as a result of the pandemic, described by NHSE/I Chief Executive Sir Simon Stevens as an “unknown” additional burden. Among evidence received, 80% of people living with severe mental health problems reported their mental health support had been "severely cut" and did not feel supported at all by what was offered. Action required on managing core health services MPs conclude that despite the commitment of policy makers and the NHS leadership to restoring core NHS services and ongoing efforts to manage the backlog, it nevertheless remained unclear what practical steps the Government and NHSE/I were taking and planning to take to reduce waiting times, meet the backlog of appointments and prepare the NHS to deal with pent-up demand for key health services. Key recommendation to the Department of Health & Social Care and NHSE/I to provide updates by the end of October on:
‘Poor communication’ The message that the NHS was ‘open for business’ was found to be at odds with the reality for some patients. Communication about delays, cancellations, access to medical services and important medical advice could have been clearer. Some individuals received “less than helpful” communication from both the Department of Health & Social Care and NHSE/I, as well as individual hospitals, accentuating their worries. Some patients with life threating conditions, such as cancer, reported the emotional distress at not knowing when a medical appointment might take place, one describing feeling “in limbo” without information about when her chemotherapy would start. The Report notes some patients were left feeling confused by information on medical guidance, including shielding, supported by a body of written evidence on the difficulty patients had in understanding shielding guidance and what it meant for them. For some the patient experience had been unacceptably poor, leaving them feeling left "in the lurch". Unnecessary anxiety and stress had been caused to those patients due to poor communication not just from their local hospital but from national bodies.
Personal Protective Equipment for NHS and care staff The Report warns that without adequate access to PPE and a sensible testing regime, there is a risk that core NHS and care services could not be provided safely and effectively during the next phase of the pandemic. Evidence demonstrated persistent issues with procurement and supply of appropriate PPE to some NHS and care staff, particularly during the early stages. Difficulty in accessing sufficient levels of appropriately fitting PPE left a significant minority of NHS and care staff feeling unprepared and anxious as a result of being put at unnecessary risk of catching COVID-19. The lack of adequate PPE also had an impact in dentistry, limiting the number of patients treated.
Challenges facing BAME staff The delivery of core health and care services posed an unprecedented risk to Black, Asian and Minority Ethnic (BAME) NHS staff. Coronavirus continued to disproportionately harm those from BAME communities with data showing significant excess deaths. MPs welcome action being taken to protect BAME staff. However action must be taken to address discrimination and racism faced by some BAME NHS staff. The report calls for increased efforts to be made by the NHS to eradicate all forms of discrimination and racism experienced by BAME staff.
Diversity and race in the NHS will be examined in more detail in the Committee’s future work, including the workforce burnout and resilience in the NHS and social care inquiry. Staff stress and burnout Evidence provided showed that much of NHS and care staff workforce experienced fatigue, exhaustion and were otherwise “burnt out", with the wellbeing of staff, particularly their mental health, considered at significant risk. The NHS People Plan, published in August, demonstrated a desire to address workforce fatigue and provide mental health support to NHS staff however MPs express concern that it fails to set out future workforce recruitment objectives and address one of the biggest concerns of staff - whether there will be enough of them to give high quality care to patients. Among recommendations:
Dental services were “virtually non-existent” MPs flag concerns that there does not appear to be a plan for the restoration of dental services in England. Eight million courses of dental treatment were cancelled during the pandemic, leading to the Chair of the British Dental Association describing the availability of dental services as "virtually non-existent" at that time. Dental practices in England had been instructed to suspend all routine, non-urgent dental care while NHS regions set up local Urgent Dental Care systems for emergency dental treatment only. Despite the restoration of dental practices from 8 June 2020, concerns remain about the backlog of appointments for routine dental care.
Lessons learnt Positive innovations or changes that have happened in the NHS during the pandemic should be captured with NHS/I requested to provide an update on how it will seek to ensure positive changes could be implemented across the NHS. Future Fundamental changes required by the pandemic to the way NHS delivers patients services should be assessed.
|