Covid-19 reader: 22 April

Children's services need dedicated recovery plan

Community Network, blog

The NHS focus is now firmly on addressing care backlogs in elective care and waiting times for diagnosis and treatment. But while this is rightly a priority, community services providers are concerned that similar challenges for children and young people services are being overlooked.

The Community Network, hosted by NHS Providers and the NHS Confederation, have highlighted ‘spiralling waits’ for speech and language therapy, health visiting and specialist diagnostics such as for autism spectrum disorders.

In a blog on the NHS Providers website, the body’s director of policy and strategy Miriam Deakin and the confederation’s communication director Daniel Reynolds called for more attention on recovery in these areas. ‘We are in danger of storing up major health and educational problems for a generation of children and exacerbating health inequalities,’ they said. ‘We mustn't sleepwalk into this crisis. We need a similar focus on the health of children and young people as we are seeing on the elective care backlog.’

Problems are not entirely due to Covid – waiting lists for children’s services were growing before the pandemic. But Covid has made things worse – with 900,000 people now on the waiting list for community services. The pandemic has disrupted children’s social development as well as their education and mental health. As with elective care, Covid has also had an unequal impact, with those in deprived areas being hit harder and likely to be in the majority on current waiting lists.

The blog insisted the long waiting times will have impacts in future. ‘Long waits for speech and language therapy, for example, create barriers to communicating with peers in social settings and at school, which has a knock-on effect on learning and socialising,’ it said. ‘Waits for children's dentistry can impact sleep patterns, behaviour and subsequent educational attainment.’

As with the rest of the NHS, community services have major workforce shortages that predate the pandemic, but which have been made worse by it. As well as increasing sickness absence, enhanced infection control has reduced available capacity.

However, the Community Network believe the issue is urgent enough to require concerted attention from the government. ‘There is a plan and funding to support the recovery of hospital services in an equitable way,’ Ms Deakin (pictured) and Mr Reynolds said. ‘We need a similar concerted effort, funding and support when it comes to supporting community providers to address backlogs of care across community services.’

Pandemic remains public health emergency

World Health Organization, press conference

There has been better news in recent weeks on the Covid position globally, with the weekly toll of recorded deaths falling to the lowest number since the early days of the pandemic. However, the World Health Organization’s International Health Regulations Emergency Committee met in early April and unanimously agreed that the pandemic remains a public health emergency.

WHO director general Tedros Adhanom Ghebreyesus (pictured) said last week that some countries were still witnessing serious spikes in cases, which is putting pressure on hospitals. And it is getting harder to monitor trends as countries have cut back on testing.

The organisation has led the campaign for an equitable distribution of vaccines – arguing that getting vaccination levels up in the poorest countries is the only way to protect the whole world against continued outbreaks through new variants.

But Dr Tedros stressed that it was not just the equity gap that needed to be breached. ‘Just as trickle-down vaccination is not an effective strategy for fighting a deadly respiratory virus; trickle-down treatment and testing are similarly reckless,’ he said. ‘Diagnosing at-risk patients early enough for new antivirals to be effective is essential and should be available to everyone, everywhere. In addition, higher testing and sequencing rates will be vital for tracing existing and identifying new variants as they emerge.’

A number of Omicron variants continue to be monitored including BA.2, BA.4 and BA.5 along with another recombinant made up of BA.1 and BA.2. ‘This virus has over time become more transmissible and it remains deadly, especially for the unprotected and unvaccinated that don’t have access to healthcare and antivirals.

The WHO Europe region this week published a question and answer briefing on therapeutics and how they are being used to fight the disease. The guide covers the different types of therapeutics being used, including those that relieve symptoms and those that help prevent the onset of more severe illness. It also addresses issues of safety and effectiveness against the Omicron variant.

Flaws in the recovery plan

The BMJ,  opinion piece

NHS England's and NHS Improvement's recovery plan to tackle the backlog of more than six million people has major gaps that will need to be rethought and developed, according to an editorial in medical journal The BMJ.

The opinion piece by physician and senior medical editor Jessamy Bagenal argued that the backlog is the result of ‘a poor national response to Covid-19, coupled with an NHS that was under-resourced, underfunded and understaffed even before the pandemic’. ‘The NHS lacked the right balance of hardware (infrastructure, finance, workforce) and software (management knowledge, skills, trust) or any necessary excess capacity to respond to the shock of the pandemic,’ she said.

The article criticised the Delivery plan for tackling the Covid-19 backlog of elective care for failing to acknowledge the legacy of policies introduced over the last decade. Promises to increase elective activity by 30% by 2024/25 fail to recognise that the waiting list grew from 2.9 million pathways in January 2015 to 4.4 million in December 2019, she said. And this means the ambitions of the plan start from the wrong place.

Dr Bagenal further criticised the plan for vague definitions of the systems that will take the proposals forward. And she said that while information is a focus, it is not supported by strong governance. While it will be vital in helping to prioritise patients on the waiting list, it is unclear who will be answerable for prioritisation. She added that having a number of siloed programmes working on the same problem will lead to duplication of effort and create confusion.

Dr Bagenal highlighted the importance of workforce to the recovery plan. But she said that while the plan is big on proposals to recruit nurses internationally, boost support workers and remodel healthcare roles, no consideration is given to who will train them or how decisions will be taken on what tasks can be shifted. She also questioned proposals to allow systems to design a joint approach with the independent sector on workforce. ‘What this means in practical terms is unclear,’ she said. ‘Such loose language could signal major changes in workforce planning and training.’

She concluded: ‘Only a cross cutting, inclusive, and equity based health systems approach that is couched in good governance and better information will be able fairly to reduce the waiting list in the short term, while building resilience for the future.’