Written evidence submitted by The Association of Anaesthetists (CBP0067)

 

The Association of Anaesthetists is made up of over 10,000 anaesthetists in the UK, Republic of Ireland and internationally. We seek to promote patient care and safety, and make advances in anaesthesia through education, publications, research and international work. Along with colleagues in intensive care, anaesthesia is the largest speciality in the NHS.

 

In responding to the Health and Social Care Committee’s inquiry into clearing the backlog in the NHS that has been caused by the pandemic, we surveyed a group of our members and invited them to offer views on the questions that had been laid out by the Committee.

 

What is clear is that anaesthetists need more, and better, support. Anaesthetists were burned out and spread thinly even before having to go above and beyond the call of duty during the pandemic. The Association has been campaigning on fatigue and burnout in recent years. Concerns have also been realised about bureaucracy, and the burden that has placed on already-stretched staff. Added to that, the shortages across the anaesthesia workforce, which if unaddressed, could have a worrying impact on the future of the profession. The Association believes that without a detailed and specific focus on addressing workforce challenges, including in anaesthesia, the Government’s ambitions in the Bill, the NHS Long Term Plan, and the desire to tackle waiting lists will not be met safely or in good time.

 

 

  1. 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?

 

One of the Association’s members said that it was “variable” but that “the NHS was struggling to keep up with demand” prior to the COVID-19 pandemic, and “staff are in need of much more support”. One described the backlog as “significant”, while another said it is “hard to judge from the front-line. But we do see some patients who have been waiting a very, very long time.”

 

  1. 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?

 

One member said “there simply needs to be more investment in producing more trained staff. More training places for medics, nurses and paramedical staff.” Another echoed this, describing the capacity as “very little” and added that “Staff are tired, resources are limited (e.g. still some drug shortages), and beds for elective work are being used for the current (summer 2021) surge.” Another, saying the capacity was “minimal” pointed out a range of challenges, including “old, poorly serviced buildings, increasing retirement (not helped by governmental tax on pensions), staff leaving, staff sickness and exhausted, unsupported staff.”

 

In addition, there is the situation concerning trainees. This year, due to a combination of factors, there are many more applicants for specialist training in anaesthesia than in previous years. At a time of a very significant anaesthetic workforce shortage, it is disappointing and surprising that, to date, there has been no increase in the number of training posts. As a result, the workforce gap will continue to grow. The impact of fatigue and stress, leading to more retirements or move to part-time working, will only further increase the shortage.

 

  1. 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?

 

Substantial financial investment will be needed to tackle the backlog.

 

One of our members urges the Government to reconsider its spending on the Track and Trace programme, saying “A lot of money is being siphoned off to the private sector to reduce waiting... why not just start the clock again and say to patients who have been waiting for 6-12 months, or longer ‘please go back to your GP for a new referral.’”

 

Another said that “Having been previously either against this idea, or at least agnostic, I know think we need investment in real estate to separate elective and emergency work. More importantly, we need to invest in staff - both in terms of numbers and their wellbeing.”

 

  1. 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?

 

Workforce is a key challenge for the NHS, and tackling shortages has got to be a priority in the years ahead. This was summed up by one member who, responding to this question, said “staff, staff and more staff.” Bureaucracy is another important matter, as one member highlighted, “Cut the bureaucracy, support the staff, make the NHS a place that people want to work in.

 

  1. 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?

 

Someone described clinicians’ requirements and the development of resources to help address challenges, “There initially was a decrease in bureaucracy which has exploded in the last few months. Clinicians are very good at solving problems but their requirements need to be listened to and appropriate resources allocated. I was part of a group that developed and ran a wellbeing course that has since been dis-invested in (Wales). During Covid we designed an online resource supported by face to zoom training. Funding for this incredibly valuable resource has been withdrawn.”  Another member referred to “prudent” healthcare in Wales, saying that “only those that need care get it.”

 

Greater flexibility for staff could also support the future work of the NHS.

 

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

 

One member urged more support for and greater insistence on out-of-hours GP services.

 

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

 

Again, there needs to be a great deal of focus on staff, particularly training.

 

But not just training. One member, observing that the value of staff has got to be maximised, said nurses, midwives and ancillary staff need a substantial pay rise. Another said national bodies need to “empower but not force clinicians to try new ways to provide services.”

 

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

 

No comment

 

  1. Additional comments

 

 

 

Sept 2021