The COVID-19 pandemic has been a major shock to the world, creating a great struggle for the NHS and social care systems in the UK. In order to control hospital bed capacity and maintain care services, NHS providers had to drastically change their approach to medical services.
Investing in technology and creating a discharge to assess are just two examples of the strategies the NHS put in place to tackle demands. Using the latest NHS reports, we’re taking a closer look at the impact the COVID-19 pandemic has had on the NHS and what’s to come in 2021.
- Discharge to Assess
- Impact on Care for People with Long-Term Conditions
- Waiting Times to Increase
- Supporting COVID-19 Patients Throughout their Recovery
- Use of Digital Technology
Discharge to Assess
According to a reasonable worst-case scenario national modelling, the NHS was at risk of being overwhelmed by COVID-19 patients in April during the initial peak. This is why NHSEI instructed trusts to initiate COVID-19 preparations, like discharging all medically fit patients out of acute and community hospitality beds. Before this initiative was activated, many acute Trusts were running at over 90% capacity, but this was then reduced to 50 or 60%.
On 19th March 2020, the hospital discharge requirements removed bureaucratic and financial negotiations around NHS Continuing Healthcare assessments, as these contribute to bed blocking and delay discharges.
According to the August 2020 report, the national guidance provided four pathways to discharge patients, with ‘pathway 0’ created to ensure that 50% of people could be discharged from hospital with minimal support as soon as they were medically fit. In the best performing areas, reports from community service providers show that 80-90% of patients are now discharged on pathway 0.
This has created the ‘home first’ model, which has been a goal for local systems for years. A home first model has many benefits for patients, including lowering the risk of contracting a hospital-acquired infection - such as COVID-19. For the health and care system, bed capacity can be used more efficiently and non-elective admissions are reduced.
The latest NHS report, published September 2020, shows the same discharge model is being applied:
- Pathway 0. 50% of people – simple discharge, no formal input from health or social care needed once home.
- Pathway 1. 45% of people – support to recover at home; able to return home with support from health and/or social care.
- Pathway 2. 4% of people – rehabilitation or short-term care in a 24-hour bed-based setting.
- Pathway 3. 1% of people – require ongoing 24-hour nursing care, often in a bedded setting. Long-term care is likely to be required for these individuals.
As a result, patients should expect regular and open sharing of information on the next steps for their care after being discharged. Due to discharge being organised as soon as clinically appropriate, 95% of people leaving hospital will have an assessment at home, where needed.
Impact on Care for People with Long-Term Conditions
Prior to the pandemic, around 85% of the ‘burden of disease’ in the UK was due to long-term conditions. Despite the government putting measures in place to support vulnerable individuals, concerns are growing about the impact of the pandemic on the healthcare needs of people with long-term health conditions.
A survey conducted by the Health Foundation and YouGov found a 20% decrease in access to health services for people with pre-existing conditions during the peak of the COVID-19 pandemic. Some of the largest falls in the use of health services are for mental health and cancer.
47% of the patients surveyed who had pre-existing conditions and reported that they hadn’t accessed care also said they didn’t need access while 10% said they couldn’t get an appointment and 22% said they were afraid of contracting or transmitting the virus or breaking lockdown rules.
Data from NHS Digital reflects this survey which shows a significant fall in GP appointments towards the end of March and during April. There has also been a drop in face-to-face appointments which have only partially been replaced by telephone and other methods.
Waiting Times to Increase
Even before January 2020 and the large number of COVID-19 cases and hospitalisations, 4.4 million patients were on the waiting list for routine hospital treatment. Not only that, but of the 4.4 million patients waiting, around 730,000 had waited more than 18 weeks.
Before the pandemic, to clear the backlog of patients who will have already waited more than 18 weeks, the NHS would have needed to treat an additional 500,000 patients a year for the next 4 years. As a result, a radical intervention to increase capacity would be needed to ensure the 18-week standard is achieved by 2024.
Supporting COVID-19 Patients Throughout Their Recovery
Because of the nature of COVID-19, some patients will require complex aftercare following treatment in hospital. Therefore, there will need to be a focus on supportive discharge, rehabilitative care and integrated care planning. Some providers are adapting their existing services to meet COVID-19 patients’ recovery needs, including but not limited to:
- Community tracheostomy teams.
- Respiratory clinics.
- Therapy services.
- Psychology and counselling.
- Community reablement.
- Specialist allied health professional outpatient services.
- Exercise referral schemes.
- Cardio-pulmonary rehabilitation.
Use of Digital Technology
In order to reduce the risk of COVID-19 transmission, NHS providers quickly moved to use telephone and video consultations, where appropriate. A recent survey found that 83% of community Trusts reported that they have managed to increase capacity by utilising remote appointments, like telephone and video.
Alongside virtual consultations, many NHS providers also set up virtual wards for patients at home or in care settings. In these virtual wards, caregivers could identify signs of deterioration in care home residents and as these virtual wards kept patients under the care of secondary care consultants, it avoided burdening GPs.
Although we can’t be certain of the true consequences COVID-19 will have across the healthcare sector, it’s paramount that patients are prioritised at all times. That’s why we’ve delved deeper into the increasing pressure felt among patients, staff, residents and the industry as a whole. To learn more, take a look at our latest download below.
The Patient Experience in 2021
While there have been plenty of challenges during this difficult time, there have also been opportunities for innovation and improvement through the use of technology. With digital transformation quickly becoming a reality rather than a plan for the future, we’ve taken a closer look at how it can potentially alleviate pressure on the healthcare system, save costs and present better health outcomes.