COMMENTARY

NHS Recovery & Post-COVID Cancer Care

Prof Karol Sikora

Disclosures

February 22, 2021

This transcript has been edited for clarity.

Hello, my name is Professor Karol Sikora, and I've been an NHS consultant for over 40 years. I've seen it come and go; I've seen all the changes possible within a very difficult system.

Now we're in the post-COVID recovery phase, it's fascinating to see the plethora of reports coming out about what the NHS did well, what it did not so well, and how, most importantly, it could become more resilient.

The latest one came out on Wednesday last week, from Reform, which is a slightly right-leaning think tank, and it's entitled: 'What’s next for the NHS?: Building the resilience of the health and care system'. And it's not a bad time to actually have a look at what we could do to strengthen healthcare in Britain.

Now, I have to admit I was one of the advisors for the report. And it does look at the broad context, not so much of changing how we structure the funding of health care, but how we get out of the recovery from COVID.

Clearly, we've got serious problems now. The waiting lists for routine procedures, some of which are relatively trivial, but some of which are actually damaging to people's health - it's causing suffering. I mean, if you have bilateral cataracts that need doing, you can approach near blindness. It means you can't drive, you can't get out, you can't read, you can't even watch television. You can't go to the cinema because there are no cinemas, but you wouldn't be able to even if they were open.

So we have serious problems now. And if there were 10 million people, which is one of the potential predictions from April of this year, waiting for a procedure, then we have a lot of suffering out there.

So let's cut to the chase and go straight to the conclusions and see what level of support there would be from a wider public.

Recovery Strategies

So the first recommendation is that the NHS trusts should publish their recovery strategy, how are they going to deal with the waiting lists? And also, in that suggestion, should they involve the local independent sector, and if so, how? So each trust, I imagine, would draw up a list of what its waiting times are now, its waiting lists for different procedures, and then put the money in the pot and say, how can we best deal with this? Here's the money. Some of it we can do in-house, that's the obviously preferred option. Other things we have to contract out to the local independent sector.

And obviously, the doctors are in a bit of a cleft stick, because they work for both. When they work in the private sector they’re paid as private contractors; when they work in the NHS they get a salary. And here we have a system where you could produce conflict for the doctors, but I'm sure we can work a system out to clear the backlog. That's what's needed here. If we have a 10 million person waiting list, we just need to clear the backlog using some sort of imaginative process to do it.

And that's what the NHS is not great about: being imaginative. I think if you were a man from Mars, coming down to look at it, you could sort it out quite quickly.

Diagnostics Hubs

The second recommendation is that community diagnostic hubs should be set up. It's clear that for diagnostics in hospitals, people that are not in hospital are second class citizens. In other words, if you're waiting for a CT, and someone comes into the emergency room that needs a CT immediately, the emergency room patient gets the CT; yours gets cancelled, or at least postponed.

That's what we've got to stop. Diagnostic hubs, which can operate 24/7, nobody minds actually coming for a knee MRI at 3 in the morning if you're guaranteed to get it the next day. I think we'd all agree to do a diagnostic at an unusual hour just to get it done and out of the way.

NHS Reserve List

So the third recommendation: The GMC should create an NHS reserve list. This is old people like me, that are slightly rusty in their direct clinical medicine, although I still see patients albeit follow-up cancer patients and the occasional new patient. But can you keep a reserve list of people you can call on if there's a national emergency just as we've seen with COVID? And of course you can.

A lot of people volunteered. A lot of people were never called and they feel a little hurt, they filled in forms, they did some training online, and nothing really happened. They got no thanks for it.

The idea is that the NHS should actually, through Health Education England, set up a series of online courses that people can do on a regular interval to keep them in a state of alert, so they can go and join the register at some point.

Funding

Then the Government should provide funding to increase the number of beds. Now this is pretty contentious. The total number of beds in the NHS is about 140,000. When I say about, nobody actually knows the exact number of beds, it depends what you call a bed. Do you call chemotherapy couches in cancer care a bed? It's not really a bed, but it could be counted if you include patients that can be admitted to a hospital. Psychiatric beds, for example, are not really beds, they’re rooms with a bed in them, but the bed isn't part of the therapy, and they don't have to be in it for their treatment. So it's slightly different, and you couldn't admit someone that's got some other illness to a psychiatric hospital.

So if you take 140,000, do we have the right number? We have less than most countries in mainland Europe. But is that necessarily a bad thing?

It's not, if you've got the community backup to provide for it, and that may be the problem. We don't have the integrated care that everyone talks about, with social care at one end, outpatient diagnostics, slick, streamlined diagnostics at the other. And then the beds you use very efficiently for what they're there for. They allow people to have, and recover from operations, and then go home into step down accommodation.

Supply Chains

There should be end-to-end supply chain maps for critical diagnostic equipment, and they should be available, and the independent sector should be allowed to participate. The seventh recommendation is a register of firms able to switch their production to produce ventilators, to produce diagnostic PCRs, rapidly from equipment used for something else, but they could just move into respiratory viruses, if there was another pandemic, for example.

Recommendation 8: key assets including ventilators, and personal protective equipment. We should know that. Of course, this is a reflection of operation CIGNUS, the imaginary exercise in 2016 that showed the NHS would fail in a fictional pandemic, this was of the flu, and it failed miserably, and no one took any action. And then we came to the real scenario in 2020. And action had to be taken, but it wasn't that great.

Technology

And then the final recommendation, recommendation 9, is that NHS England and the digital arm of the NHS, NHSX, should adopt a 'scan for safety' programme. In other words, everything we do in the NHS should be coded onto a computer. And the simplest way is to have some sort of barcode on everything you have: a piece of equipment; every blood taken has a barcode, blood taken date, time and everything, logged onto the computer. So using big data, you can see the total activity of what's going on in a hospital, in a region, in the country as a whole.

More Reports

So will this make a difference? Probably not. There'll be lots of reports like this. I'm sure NHS England will be looking at them. The real problem, as far as I can see it, is the intense politicisation of health care in the UK. Not so in other countries. But here, we really love the NHS. We love the concept of fairness, of universality.

But of course, there are other ways to universal care, other than a publicly-driven service. It can be partly private, partly public, and the funding can come from a mix of tax, of insurance and paid co-payment by patients.

So what does the future really hold for us? Well, I suspect we've got to get out of COVID without any juggling with the structure of the NHS.

That will take at least a year. Once that's over, then I think it's time to think again about how we structure things, and to deal with the thorny problem of people like me, people of my age, they're going to be quite demanding customers from whatever health system emerges in the future.

So a nice report, but it asks a lot of questions without necessarily providing the solutions.

The solutions are in our hands, and we've got to get there somehow for the benefit of all future patients.

Thank you very much, delighted to hear your views.

You can follow Prof Karol Sikora on Twitter

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