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NHS futures: continuing Covid challenge and Coffey's new plan


NHS futures: continuing Covid challenge and Coffey's new plan

The pandemic has had a significant impact on the current health of the UK and has evolved in a way that poses risks to future health as well, according to the Health Foundation. A year on from its Covid-19 impact inquiry, the charity says that while it will be a long time before the full effects are understood, some impacts are already clear.

While the pandemic response has shown the power of policy action to address social ills and the broad success of large-scale programmes of vaccination and financial support, the disproportionate effects of the pandemic on some groups reflect existing societal fault lines. “The failure to address historical inequalities exacerbate the impact for many,” the Foundation says. “We also know that Covid-19 deaths continue to be more likely in the most deprived areas and that there are clear gaps in vaccination coverage.”

The Foundation says there is still a significant risk that unequal effects will continue as the country learns to live with the virus, while further disruption could have a significant impact on recovery, particularly in tackling the NHS backlog. 

“One major risk to longer term health is education. Evidence to date suggests gaps between children from richer and poorer backgrounds that widened during the pandemic are likely to persist. There has been limited action to bring education levels back in line with pre-pandemic expectations. The inadequacy of the catch-up funding combined with the long-term implications for individuals and society make education an area of significant policy failure.”

It argues that changing political leadership presents an opportunity to refresh and refocus efforts, while the delayed health disparities White Paper remains an important vehicle to make progress and commit to a long-term strategy and action to tackle poor health and health inequalities. 

The Health Foundation says that inequalities in Covid-19 mortality persist, with rates three to four times higher in the most deprived areas, although the overall number of deaths is now significantly lower than it was during the first year of the pandemic. At the same time, while the vaccination programme has been key to reducing mortality rates, uptake is still low in some groups, especially among people living in poorer areas and some minority ethnic backgrounds.

We will look to go further on enabling pharmacists with more prescribing powers and making more simple diagnostic tests available in community pharmacy

On mental health, the significant deterioration during the first year of the pandemic has been reversing, but has not entirely returned to pre-pandemic levels. Data suggests that anxiety remains heightened, especially among women. As a result, people are likely to be less resilient to cope with the stress associated with the growing cost-of-living crisis.

In addition, there has been a failure to act on education gaps due to lost learning time in the pandemic and a cohort of ‘left-behind’ children face significant risks to their long-term health and living standards.

Inequalities have also remained among people from different ethnic backgrounds. In the Omicron wave, Bangladeshi and Pakistani men and women have had mortality rates between two and three times higher than White British men and women; mortality rates for Black Caribbean men and women of mixed ethnicity are also higher.

The vaccination programme appears to have reduced the risk of a given infection leading to long Covid; by June 2022, according to the Office for National Statistics survey, some 1.6 million people in England had long Covid. The Health Foundation says that comparing data across the pandemic suggests that the first 13 million infections led to 930,000 cases (around one in 14) of long Covid, while the next 49 million led to around 700,000 instances (around one in 70). 

“This is not to downplay the severity of long Covid when it arises, with a large proportion reporting severe limitations on day-to-day activities. Nearly three-quarters (72 per cent) of people on the ONS measure of long Covid report limitation in their day-to-day activities, posing a large health burden.

The incidence of long Covid on this measure is also unequal. The self-reported incidence is higher for those in more deprived areas, people of white ethnicity, those aged 35-69 years, and in particular, those whose pre-existing health was limited by conditions. 

Coffey's new plan gets mixed reviews

Elsewhere, the new secretary of state for health and social care has laid out her priorities. At only 3,500 words, Our Plan for Patients is, as commentator Roy Lilley has pointed out, “pretty thin”, but it does contain an indication of where Thérèse Coffey might see the pharmacy sector. 

“I am determined to be the champion of the patient and focus the NHS and social care on how best to deliver for them,” Dr Coffey says in the ministerial foreword. “My approach is to trust and empower to deliver. I will be proactive, not prescriptive, with a relentless focus on measures that affect most people’s experiences of the NHS and social care.

“This could be putting more information at the fingertips of patients or freeing up the time of clinicians. We have listened and we are responding by removing various reasons that healthcare professionals say are holding them back from what they do best: caring for patients.”

So far so good. But after a hint that gaps in the workforce might be filled by a ‘national endeavour’ – for which read volunteers – Our Plan does promise again that there’s a workforce plan in the works, makes clear the NHS Long Term Plan is still in play and that reforming adult social care is still on the agenda. It promises to help people be better informed about how to prevent the need for healthcare, how to access it when you do need it and what you should expect when you get there. 

As well as the focus on ABCD – ambulances, backlogs, care, doctors and dentists – the paper recognises that “good primary care is the foundation of an effective health system for patients.  When working well, it supports the early identification of serious illnesses and the management of chronic conditions, while also helping people to live healthier lives. Getting patients in to see their GP, dentist or practice nurse is therefore front and centre of our plan.”

Unfortunately, it fails to join up primary care by reaffirming that an appointment with general practice is the main mechanism by which care is delivered and by setting expectations for being able to get an appointment “with the practice”, rather than the practice or other service working closely with it.  

This is partly remedied later, in a section entitled ‘Launching a new community pharmacy offer, reducing reliance on GPs’, which states: “We will expand the range of services available from community pharmacies, increasing convenience for patients and freeing up GP time for more complex needs of patients. Pharmacists will be able to manage and supply more medicines, without a prescription from a GP. We will look to go further on enabling pharmacists with more prescribing powers and making more simple diagnostic tests available in community pharmacy.”

Nothing new in there – and no mention of a Pharmacy First scheme – but the sector’s leaders may see it as at least a useful opener to be mentioned in such a rapid tour of the health system. 

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