It is normal for most organisations to have a business continuity plan that is regularly reviewed, updated and stress-tested to ensure that it is sufficiently robust to deal with pretty much every conceivable disaster scenario.
Most organisations also fervently hope that their plan will never have to be implemented for real. In March, this hope turned to dust as every organisation, private and public, had to put their business continuity plans into action and in double-quick time. Of course, the organisation most immediately affected was the NHS that had to ensure that it had sufficient capacity not only to cope with rapidly rising numbers of patients infected with Covid-19 but also to ensure that it had enough medical equipment and protective gear for its staff.
NHS immediate response impressive
Now that we seem to be past the immediate crisis in the UK, it is possible to reflect momentarily on how the NHS response fared in the face of an unknown disease that blindsided everyone. On the plus side, we now know that we can erect temporary ‘field’ hospitals, capable of dealing with thousands of infected patients, in a matter of days / weeks. We can prepare hospitals by facilitating the quick discharge of patients, cancelling all non-urgent surgery and appointments and encouraging retired medical professionals to return to bolster resources. On the minus side, it seems that our PPE procurement and distribution plan was, to put it mildly, chaotic but, more seriously, insufficient consideration was given to the health needs of patients who, although not infected by Covid-19, had surgery and treatment either cancelled or deferred indefinitely. So, are there any immediate lessons that we can learn?
Side lining other medical needs an overreaction?
The consequences of redirecting the nation’s medical resources to deal with the coronavirus pandemic on those suffering with non-Covid health-related problems has been widely reported. Indeed, the ONS has released figures indicating that almost 13,000 more deaths than usual, not attributed to Covid-19, have been recorded in the past three months. Indeed, MD in a recent issue of Private Eye observed that the NHS overreacted in response to the Government’s underreaction in not imposing lockdown sooner – notwithstanding that the Government gave the NHS specific instructions to clear the decks in preparation for an influx of patients ill with Covid-19. It now transpires that there are many hospitals that, having done what was asked of them, are running significantly below capacity and have not seen the expected surge of Covid patients. The tone and content of the messaging, telling people not to go to hospital unless it was an emergency or otherwise essential left many people scared and confused. Doctors’ surgeries almost all went online making diagnoses via video conference or telephone call.
NHS facing major backlog of cases
The upshot is that, in addition to the extra deaths, we are now hearing numerous reports of people with serious symptoms of heart disease, cancer or other life-threatening conditions who have either not gone to hospital or who have had a late diagnosis. Indeed, the Health Foundation carried out a survey in May that found that the largest fall in the use of the health service was among two groups: those suffering from cancer and those struggling with mental health problems. Even before the pandemic struck, the 18-week waiting time standard was already looking shaky in many areas of the country; post-Covid, any chances of hospitals meeting the standard is looking very slim indeed. According the Health Foundation again, 4.4 million people were waiting for elective treatment before Covid. Once lockdown has been lifted, that number will have increased exponentially.
Future pandemics must not de-rail all medical care
Thousands of people will have missed having essential treatment while the pandemic raged and this will be the most important lesson for clinicians and politicians: how to keep medical care going in future for those people not infected by the next disease to hit our shores for which we have no immunity. One answer might be to allocate specific hospitals to carry on with non-pandemic medical matters and concentrate those with the disease in the ‘field’ hospitals and other specialist centres.
But for now, there will be heart breaking stories of people who have died unnecessarily, or find themselves at serious risk of dying prematurely, because they chose not to seek, or couldn’t access, the help they needed and only time will tell whether or not this will amount to medical negligence. However, what is for sure is that next time there will not be an excuse – our politicians and Public Health England must start forward planning for the next crisis: they know what to expect and what needs to be done. The population will be less forgiving of mistakes the next time round if lessons are not learnt now.