Written evidence submitted by the Royal College of Physicians and Surgeons of Glasgow (CBP0009)

 

The Royal College of Physicians and Surgeons of Glasgow although based in Glasgow has a membership of 15,000 and represents Fellows and Members throughout the UK.

The effects of the Global Pandemic over the last 18 months have been considerable. The changes needed in the NHS to cope with the pressure of large numbers of acutely ill people have been considerable. The system has been under a strain never foreseen, yet in some ways has come out of it as a stronger functioning unit.

Of importance has been the way that the service has been able to change quickly to meet the needs of the population. This means constraints to change have fallen by the wayside for the common good. We would not wish to go back to former ways which constricted the system. This means that planning should be led by clinicians who have to face day to day challenges. Of importance has been the way that the service has been able to change quickly to meet the needs of the population. This means constraints to change have fallen by the wayside for the common good. We would not wish to go back to former ways which constricted the system. This means that planning should be led by clinicians who have to face day to day challenges. In the past this has been met with resistance or conflicting views between clinicians and decision makers, which has resulted in an unacceptable status quo being maintained.

The pandemic has shown that the workforce is important, maintaining its wellbeing to be sustainable in the long term has to be a priority. It is important to give the NHS staff as much care and compassion as its patients, allowing them to deliver the service. This means adequate training, facilities for rest, relaxation and eating to maintain efficiency.

Training opportunities have been lost for many in the pandemic and to ensure that these doctors in training are fully trained these need to be replaced. Consultant staff are trainers and educators for the next generation. They must be allowed time to teach, educate and examine which will need changes in their present contract which is geared to timed clinical services.

We are aware of many consultant positions which are empty or not appointed at interview. Many health boards and trusts are not advertising posts so they do not appear as statistics and are “hidden”.

The range of staff is also important; the NHS needs adequate doctors, nurses care staff, allied health professionals, cleaners, porters and other support staff. In the past it has been reliant on people from outside the UK. The exit of the UK from the EU has meant less EU workers entering and retained within the UK. Changes in visa systems have the potential to reduce immigration of much needed staff from other countries. It is important to realise that this need is not just for highly specialist staff but those at lower grades who keep our hospitals running. At present the visa entry system does not consider them a priority. The pandemic has also emphasised the reliance on care staff of nursing and care homes from abroad and how these homes are vital for efficient movement of patients through the NHS.

The pandemic has meant that certain people who use the NHS have been disadvantaged. This includes those who need face to face care. This is important for those with mental health issues or any long-term conditions such as diabetes or arthritis, etc. Cancer services have been suboptimal and it is certain that those with treatable conditions have moved in to the untreatable category because of delay. Routine surgery has been delayed for many conditions, such as heart disease or musculoskeletal problems.

The pandemic has also highlighted the lack of systems to protect patients from developing infectious diseases whilst in hospital.

 

 

Questions posed by the Inquiry

We sent out a short questionnaire to a group of members and fellows working in the UK. These answers are based on these responses. Although the responses are from a small subset of individuals, we do believe they are broadly representative of a wider view. The College has a membership of 15,000 based throughout the UK and worldwide.

What is the anticipated size of the backlog and pent-up demand from patients for different healthcare services including, for example, elective surgery; mental health services; cancer services; GP services; and more widely across the healthcare system?

The situation is confused and confusing. Many services have difficulty quantifying the backlog. There are patients in the system but there may be patients yet to be referred.

Our respondents report:

GP face to face consultations have not increased over the last 6 months and patients frequently report inability to see their GP in person and continued difficulty accessing GP services in person or by telephone.

What capacity is available within the NHS to deal with the current backlog? To what extent are the required resources in place, including the right number of staff with the right skills mix, to address the backlog?

There is a considerable backlog of services and in many specialties increased demand because of the pandemic. It is not however a matter of switching on the services again or increasing availability. The work force is tired and still under strain.

Our respondents report an insufficiency capacity in their trust or board to cope with the backlog (60% with 30% abstaining). None report sufficient capacity. 50% report insufficient staff to cope with none reporting sufficient staff. 66% report the right skill mix.

How much financial investment will be needed to tackle the backlog over the short, medium, and long-term; and how should such investment be distributed? To what extent is the financial investment received to date adequate to manage the backlog?

Financial investment needs to be continued and sustained. The current investment level will not address the backlog. While some services such as cancer has improved, routine elective surgery often for painful debilitating conditions has not. Our respondents report the need for funding of more fully trained doctors and nurses, including clinical nurse practitioners. However, key is the ability to develop and change services quickly. This must be led by clinicians rather than managers alone. Managerial workforce should be reviewed justified and reduced if necessary so there is the right skill mix. Executive power needs to reside in practising doctors and clinical staff rather than unrepresentative boards and trusts

How might the organisation and work of the NHS and care services be reformed in order to effectively deal with the backlog, in the short-term, medium-term, and long-term?

50% of respondents felt improved workforce planning focused on recruitment and retention was important.  There should be full integration of health and social care service with the funding gap in care services addressed, rather than recognised but postponed as at present.

All employers should prioritise the wellbeing of healthcare staff.

Governments have consistently poorly managed public expectations. There is a need for honest and transparent communications.

A minority felt that development of specific services to reduce backlog on new sites separate from existing service was a priority. Initiatives in this area previously have fragmented services rather than make them efficient. 

 

What positive lessons can be learnt from how healthcare services have been redesigned during the pandemic? How could this support the future work of the NHS and care services?

The pandemic has shown it is possible to redesign efficient services quickly within the NHS when they are clinician-led. We should not return to the previous system which is cumbersome and does not change easily. CCGs in England are too small to be effective. Our respondents felt the priorities were development of adequate manpower and resources to deliver services. Elective and emergency services should be separate and separately resourced.

How effectively has the 111 call-first system for A&E Departments been? What can be done to improve this?

Our respondents consider this measure ineffective. It was inefficient and relies on the public having the ability to make contact. Those with health inequalities and deprivation are less likely to have internet access. In many instances it is a barrier to access of health services and just serves to increase delays. Many report having gone through the system and the algorithm they are told to consult the GP or go to A and E.

What can the Department of Health & Social Care, national bodies and local systems do to facilitate innovation as services evolve to meet emerging challenges?

It is clear our respondents feel that health professionals need to be listened to and consulted. There needs to be a coordinated approach to workforce planning, wellbeing and innovation of practice. This may need the use of upskilled staff such as specialised nurses with recognition of skills, or use of other staff such as allied health professionals, physician, surgeon or anaesthetic associates. It is clear that if only in the short term, immigration control relating to all staffing levels (including care home staff) should be considered.  Bureaucratic planning cycles should be avoided.

To what extent is long-covid contributing to the backlog of healthcare services? How can individuals suffering from long-covid be better supported?

As yet we do not consider that long COVID is having an excessive effect on the backlog.

How can individuals suffering from long-COVID be better supported?

The majority of respondents felt this was best done in a community or primary care setting.

Sept 2021