Covid-19 must mean lasting change for our NHS

By Stephen Boyle, Auditor General for Scotland

The Covid-19 pandemic has resulted in a huge change in our health and care services in a very short time. 

The terrible human cost of that first wave is felt strongly by all of us, particularly those of us who lost loved ones. And we know that the impact of the pandemic hasn’t been equally shared and that it’s the most vulnerable people who have suffered the most.  

We’ve been monitoring Covid-19’s impact as part of my annual NHS overview work. 

The two main things we’re focussed on is how the NHS in Scotland responded to coronavirus and what lessons can be learned, and secondly the financial and operational implications of the pandemic.  

Our financial auditing has been delayed because lockdown pushed back annual account deadlines for NHS health boards by months, meaning we now expect to report our findings in January 2021, rather than in October. 

Before we started this year’s audit work, we knew Scotland’s health boards were under financial pressure, that health and social care integration isn’t happening quickly enough, and that there’s a high turnover of leaders at the senior level. Covid-19 has cast these systemic risks out of the spotlight, but they haven’t gone away. 

Additional pressures in our health and care system have been underlined by the number of people who died in our care homes, the public inquiry into problems at Glasgow’s Queen Elizabeth hospital and the Sick Kids in Edinburgh, and the loss of public trust in mental health services in Tayside

We’ve also got an early picture of how the NHS acted at pace in response to Covid-19. 

The Louisa Jordan hospital was constructed in a fortnight. There was a huge surge in video consultations – from 300 a week in March to around 17,000 a week by June. And there was evidence of increased partnership working as the health system pulled together at a time of crisis. 

Innovations such as these, that would normally have taken years, have happened in weeks. The positives from that period must now be retained as health leaders balance the ongoing demands of coronavirus with re-introducing the full range of NHS services that were interrupted.  

Lockdown fatigue is setting in. Frustration is rising. That’s human and understandable, especially for those individuals and families who have suffered as health resources have been squeezed. 

But there are incredibly tough decisions ahead, and it’s important that there is public understanding of the continuing pull of the pandemic on the NHS. 

There is a large backlog and capacity is limited due to the need for physical distancing. And there’s already been a personal toll on staff who continue to put the lives of others above their own.   

Things will not go back to the way they were before Covid-19. There will inevitably be longer waiting times for people with lower clinical priority. Concerns also remain about a reluctance to seek care early because of fears around Covid-19 transmission. That could have a long-term impact on individual lives and the demand on health services.  

In the meantime, the Scottish Government is committed to redesigning how services are delivered, including considering setting up a National Care Service. But one of the biggest challenges remains planning amidst so many unknowns.  

We simply don’t know how the pandemic will develop and be contained while the world waits on a vaccine. Or whether there will be enough testing capacity to avoid further lockdowns if Covid-19 cases rise sharply. 

We don’t know the terms of the UK’s Brexit deal (although we do know that a no-deal Brexit is looking more likely and the impact that it could have on public service staffing and supply chains). 

And we don’t know how the Scottish economy and budget – including money for our health and care services – will be impacted in the medium to long-term by coronavirus.  

That’s why the Scottish Government, as part of its financial and contingency planning, needs to be clear on its priorities, and which services are essential to maintain. Effective working relationships across the UK and devolved governments have also never been more important. 

In the meantime, we will continue to audit and report our findings on the NHS in Scotland’s future. And if you have any views on how audit can help improve our health system please get in touch with the team. 

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