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19 February 2021
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Retaining urgency in pandemic recovery

By Dr Nathanael Macdonald

Orthopaedic Registrar, Frimley Park Hospital NHS Foundation Trust

As we emerge from another wave of Covid-19, it becomes clear that the difficulty facing healthcare currently is how we return to normal practice.

Our DGH (district general hospital) was one of the ‘harder hit’ by Covid, but responded admirably. Clinical leaders and managers worked quickly and efficiently to enact changes within the hospital. There was a real sense of urgency in response: rotas were changed, staff redeployed and ITU beds recreated in theatres, wards and recovery. The urgency and passion for delivery of service was palpable because the Covid response had visible immediate outcomes. Patients needing ITU support would live or die based on capacity. Patient outcomes improved with redeployment of staff to free up medical consultants and experienced physicians to care for the complex patients.

However, as we now come out of the third wave, and as patient numbers fall once again, we seem to lack the urgency we had initially to respond to the virus. It has been highlighted that the pandemic has resulted in huge delays to waiting lists, and in some cases to cancer services. As previously when coming out of emergency rotas and Covid precautions, there is a cautious reintroduction of services and movement of staff. This is partly due to no tangible immediate benefit to the system in restarting elective services - the waiting list of patients is not a visible stressful presence in the hospital, yet. But, if we do not muster the energy and urgency, not only will patients find real impacts on their health as a result, but also the health service may find itself in difficulty in the years to come. 

So what are the solutions? On a local level we must have cogent arguments for restarting services; these must be represented as soon as the inpatient load falls - local private capacity must be fully utilised and planned for maximum capacity use. Where possible, cold sites must become Covid green sites and elective services resume. This may need local investment in locum services, but these should be supported nationally. Finally, the need for national leadership is clear - hospitals must be encouraged to return to normal as soon as possible, supporting busy elective services (such as cataract and joint surgery) with the maximum impact on patients’ lives. This will become more important as time progresses, especially as it appears Covid may be here for longer with a winter pressure type picture. 


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