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COVID-19 and patient safety: our NHS in a time of national crisis

Solicitor Sarah Moore, who has family members working in the NHS, discusses the strains on the health service which was already overstretched due to years of budget cuts before the coronavirus crisis began

NHS workers
Sarah Moore specialises in product liability and claims for groups of people who have suffered an injury because of unsafe products. She has written a number of articles on topics such as drug regulation, cigarette packaging and food safety.
For the last few Thursday nights, right across the UK, something extraordinary has happened: thousands of us have stood on doorsteps, balconies and at windows and we have applauded our NHS key workers.
 
In that applause we recognise the phenomenal job our healthcare workers are doing, holding our healthcare system together, providing continuity of care for those with existing life-limiting illnesses, and urgent care for the many thousands of us who will require hospital treatment before this COVID-19 pandemic is over.
 
What many of us also recognise is that our frontline workers are providing that care often at significant personal risk, within a healthcare system that has suffered from woeful under-investment for too many years.
 
As the wife of an NHS doctor, the sister of a palliative care nurse and with other family members assembled on the medical frontline of this emergency, I feel both proud of the essential services they are providing, but also, if I’m honest, anxious about the high price they may pay in doing so, not only as medics–  but as medics within the UK, working within our NHS.
 
The relative preparedness of different countries to deal with the COVID-19 pandemic has been variously calibrated over the last few weeks. The Financial Times compared the critical care infrastructure of countries across Europe, by listing the total number of critical care beds per 100,000 population. In Germany the figure is 30:100,000, in the UK it is just 6.6:100,000. The UK has half the average number of critical care beds available in other European countries, including Italy.  Similarly, the New York Times reports that whilst Germany has an estimated 35,000 ventilators, other sources suggest the UK has just 5,000.
 
By any measure the UK comes out poorly. In this context of chronic under-investment, it is clear that the quality of care delivered by our NHS doctors and nurses is too often provided in spite of the system in which our carers work and not because of it.
 
The Government of course recognises that the NHS, and the key workers within it, are going to face huge personal and professional challenges in the weeks to come. In order to deal with those challenges the Government has introduced the Coronavirus Act 2020. That Act, from a healthcare perspective, is an attempt to rationalise resources and refocus priorities right across the healthcare system.
 
In seeking to achieve the aims of the Act over the months ahead our politicians will be forced to re-evaluate the way in which our healthcare system is managed and funded. That exercise is now well underway, with the NHS buying in extra healthcare capacity from private hospitals across the UK; and, with the Chancellor promising an extra £5bn for public services to deal with the COVID-19 pandemic, with the majority of funds ear-marked for the NHS and social care.
 
Nevertheless, as some experts have identified, it is difficult to buy yourself out of a crisis when there are ‘underlying capacity constraints’, or in other words – a limited supply of medical staff, testing kits and other key resources, particularly when the rest of the world is competing for the same supplies.
 
Questions about how well the Government handled the pandemic, and the lessons that must be learned to better safeguard us in the future, will be interrogated in another time, and another forum, most probably the Public Inquiry that many civil servants now recognise will surely come after the present crisis is over. However, global health experts have already pointed out that whilst managing a public health epidemic is a complex business, the WHO plan is clear: test intensively, trace contacts, quarantine and maintain social distancing.
 
Whilst the UK is now earnestly engaged in the latter, we are still a long way from securing adequate testing, tracing and quarantine facilities. Experts warn that we will pay a very high price for failing to implement the WHO plan with all speed. Whether our policy makers’ delay in doing so is a result of poor planning or systemic NHS under-investment, or both, the consequences are clear cut: ‘every day of delay will mean more people become infected and die’.
 
For our NHS key workers, and those of us who will need their care in the coming weeks, these debates cannot be deferred to another forum and another time. If, as some predict, at the peak of this crisis there will not be enough ITU beds, ventilators, testing kits, and PPE, to go around – will our key workers be forced to work out how critical care and resources should be rationed between patients? What will this mean for the safety of our front line workers? And, what will this mean for the rights and safety of patients in their care?  
 
Clearly, there is no quick fix to the COVID-19 pandemic, no matter how much money is promised or spent, and there is equally no quick fix for our healthcare system.
 
Our key workers will do all that they can with the resources they have been given. But whilst we fill our windows with rainbows, as a show of gratitude and solidarity for our key workers, we should avoid the temptation to gloss over the fact that years of NHS underinvestment, and some of the decisions made by our Government in recent weeks, will undoubtedly have caused lives to be lost unnecessarily. That isn’t a political statement, it’s a factual one – and the evidence in support can be seen in the experiences of other countries including Singapore and Germany.
 
However, there is surely hope.
 
When we as a nation stand and clap our key workers, when our chancellor declares that the NHS will get ‘whatever it needs’ to respond to the outbreak, there is evidence of a gear change in public and political thinking that might signal that out of this crisis some good will come and that it will have a lasting benefit on our NHS and patient safety.
 
The NHS was, after all, an institution birthed at a time of national crisis. Out of the collective trauma of the Second World War, and the re-forging of social and national identity that came thereafter, Bevan made real the ideal of care ‘from cradle to grave’ for all, irrespective of income. By focussing policy makers, healthcare officials and taxpayers’ minds on what ‘key’ work really constitutes, and why we need an efficient and well-funded NHS, it might just be that the COVID-19 pandemic provides the backdrop for a long-overdue NHS renaissance, providing our NHS heroes with a healthcare system befitting of their dedication. 

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