NHS building

COVID-19 and the State of Health and Social Care in England

By John Tingle

The COVID-19 pandemic has exacerbated challenges facing the provision of health and social care in England, a recent report from the Care Quality Commission (CQC) finds.

The CQC is the independent regulator of health and social care in England. Every year they produce an assessment of the state of the country’s health and social care. The yearly lookbacks include information on trends, challenges, successes, failures and opportunities.

The most recent report analyzes service provision both pre- and post COVID-19, and draws key conclusions from this information. From a patient safety perspective, the report contains important lessons about issues the COVID-19 pandemic has brought into sharp focus. The report also highlights trailing patient safety problems that existed before the pandemic, and are still present as England grapples with the pandemic’s second wave.

Quality of care before the pandemic

Pre-COVID-19, the report states that care was generally good. However, there was little overall improvement compared with the previous year, and there were some specific areas of concern identified.

In terms of National Health Service (NHS) acute care, the report states there was some improvement over the year, with 75% of core services being rated good or outstanding compared with 72% the previous year.

But a worrying alarm bell was sounded on some services:

“There are still services where the quality of care needs to improve substantially – more than half of urgent and emergency care services in hospital were rated as requires improvement or inadequate as at 31 March 2020, as were almost a third of medical care and outpatient services. The quality of maternity services has barely changed, with at least one in four rated as requires improvement overall at 31 March 2020.”

The impact of the coronavirus pandemic

The report recognizes the heroic work of NHS staff during the pandemic, which continues under the second wave. Resilience under unprecedented pressure are the key watchwords, and describe how staff adapted to work in different ways while maintaining safety.

Delays and long waiting lists

Waiting lists and delays to care and treatment are sadly a seemingly continuous feature of the NHS care environment, despite the best efforts of successive governments. Scarce financial resources have been a problem for the NHS ever since it was established in 1948. The NHS will continue to fully absorb all the resources given to it as our population gets older with more complex health needs and with the continuing advances of medicine with new treatments.

A foundational principle of the NHS is:

“Access to NHS services is based on clinical need, not an individual’s ability to pay:

NHS services are free of charge, except in limited circumstances sanctioned by Parliament.”

The COVID-19 pandemic has exacerbated the problem of waiting lists and delays as NHS resources have been urgently deployed to deal with it.

Addressing challenges

The CQC report states that the increased waiting lists and backlog of urgent and elective care need to be addressed. Services need to assess and prioritize patients according to clinical need. Those who are on long waiting lists need to be kept safe. The report calls for a balancing of COVID and non-COVID care.

The clear message that now resonates throughout the NHS is: “Going forward, hospitals and other healthcare services need to finely balance the capacity to provide COVID and non-COVID care, and make sure that people have the confidence to come forward for the care and treatment they need.”

Legal aspects

There are legal aspects to the issue of delay in necessary, urgent tests and treatment.

Delay in medical care and treatment is a major cause of clinical negligence. The National Audit Office (NAO) stated in 2019 that long waiting times may lead to an increased risk of more negligence claims against the NHS. Novum Law has shared some of their clients’ harrowing stories relating to COVID-19 treatment delays.

Delays to treatment and long waiting lists are a problem exacerbated by COVID-19 that could result in litigation.  And the longstanding issue of the quality of maternity services persists, with at least one in four rated by the CQC as requiring improvement overall as of March 31, 2020.

Though NHS has had success during the pandemic, it also must deal with major problems, some of which are  longstanding.

John Tingle

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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