Julia Scott – A Strategic Advisor for HCC – comments on the Delivery Plan to address the backlog of care across the NHS.

The Delivery Plan for tackling the Covid-19 backlog of elective care published this month is intended to support a reboot of the NHS across England. However, the plan aspires to do more than just that, it aims to increase delivery of elective services by 30% by 2024-25.

So, what are the Knowns?

The plan has 4 focus areas

• Increasing health service capacity,
• Prioritising diagnosis and treatment,
• Transforming the way we provide elective care; and
• Providing better information and support to patients.

All well and good.

Outpatient appointments are cited as an example of transformation. Although the reference to these appointments is now being driven by a focus on clinical risk and need. This is somewhat bemusing (wasn’t that always the idea?), and one cannot but wonder whether clinics redefined as “Dedicated and Protected surgical hubs” may one day be taking over all the retail outlets that now stand empty on our high streets. Either way, improving the arrangements and throughput of outpatient care can only be beneficial to Trusts and more importantly, to their patients.

Another known is the funding commitment, which is in the region of £14 billion including capital funding.

What about the Unknowns?

Well, of course none of us know what will happen next in relation to Covid. Will there be new strains or mutations, will the vaccinations continue to protect, is there much more to learn about the impact of Long Covid. Much like Polio, will it take us 40 years for us to fully comprehend a Post Covid Syndrome?

Another unknown is the number of people that need health care investigations but have remained away from the NHS for the last 2 years. The Plan estimates is could be up to 10 million people.

A significant gap in the Plan is that it does not address the challenges facing other parts of the NHS. For example primary care, community care, urgent and emergency care, and mental health services.  Apparently, there will be separate plans or guidance for these services. So much for no health without mental health, and joined up, integrated care.

Another significant omission is reference to the resources needed to provided essential rehabilitation. Of course, we all want to receive a diagnosis and any necessary intervention swiftly, but many of us will also need to have expert rehabilitation post treatment. The fact that this is not referenced confirms my view that rehabilitation is in real danger of not being factored in as an essential corollary of medical intervention.

And what about Workforce, the Growing and Supporting of which, makes up approx. 3.5 pages of a 49 page plan?

Health Education England is to disappear into NHS England and NHS Improvement. Not a great surprise for many, but I would have liked that Plan to explain how this merger will “achieve a more co-ordinated approach where service, financial and workforce planning are better aligned”.  And certainly, some reassurance that Workforce Planning will become more accurate, sensitive to external influences and more responsive and supportive to deficits in certain professions would be helpful. Of course, I welcome the idea of more post graduate training for Allied Health Professionals (AHPs), but I think that it might also be wise to incentivise more people to become AHPs as well!

As we all know, it takes time to train someone sufficiently to enable registration, so where will we find the staff we need in the short term? International recruitment appears to be the answer, but there is no mention of the updated Code of Practice on ethical recruitment which was published a year ago this month, probably when most Directors of NHS services where quite busy doing other things.

Increasing associate and assistant posts is also encouraged, and given that we need our registered staff to work at the very top of their license, this seems a sensible proposition. And Staff banks are to be made more attractive so that existing staff can do even more work- might this be counterproductive I wonder.

There are passing references to other “people” related factors but what there is not, is much that is new, and that Directors of services will not have already thought about and tried.

Directors of Nursing/AHPs/Midwifery and People may look to the Plan to provide immediate, creative and empowering workforce solutions. I’m not sure that it does, and whilst new technologies will undoubtably speed up, or even replace, some previous types of staff activity, the NHS must remain humane, and services delivered with human kindness and compassion are therefore key components. Staff joined the service because they care about others, they need sufficient time to offer that care to each and every patient, and to do that, as demand grows, we will need many more staff. Does the Plan endorse that proposition, yes, I think it does, but will it make it a reality, I’m not sure. I guess only time will tell.

Julia Scott is a Strategic Advisor for HCC and the former Chief Executive of the Royal College of Occupational Therapists.