The COVID-19 pandemic has imposed huge economic, social and human costs on the British, and many other societies, but it has also had a positive effect. It has forced a pace of change in the health and care system few thought was possible.
The last eight months have shown what is possible in terms of innovation as timescales have been shortened and the emphasis has shifted towards making the response to the pandemic as effective and flexible as possible. The development of the Nightingale hospitals (and other UK COVID-19 field hospitals) led the headlines, but the switch to remote consultation in primary care delivery, the rapid expansion of ICU capacity, acceleration of clinical research and the development of new treatments for COVID-19 have all demonstrated the ability of the NHS to respond quickly and effectively to meet changing demands.
Not all change will be right for the long-term, and the NHS must continue to reach informed decisions about which innovations offer best value to patients and taxpayers. However, as we start to emerge from a second wave, it will be important to not to revert back to the status quo.
A decisive moment
There are signs that we may be at a turning point of the COVID-19 pandemic, as we start to see the fruits of the intensive research into a vaccine. The news emerged last week that vaccine developers Pfizer and BioNTech had produced analysis showing that they had developed the first effective vaccine able to prevent more than 90 per cent of people from getting COVID-19. Since then, the American biotechnology company Moderna has also published positive efficacy results from its Phase 3 studies on a potential vaccine, showing it to be nearly 95 per cent effective in preventing the virus. Others will follow.
Although it will take some time for the scaling up of the European supply chains to happen and a fully-fledged vaccination programme to be up and running, the UK’s primary care system is preparing to administer the first doses of vaccines as soon as next month.
There are still challenges
Despite the emergence of strong vaccine candidates and the corresponding light at the end of our lockdown tunnel, in the UK we still find ourselves at the intersection of several major challenges in our health and care system. COVID-19 revealed the best of our public healthcare system, an impressive emergency response. It also revealed the challenges of maintaining the full range of health services (and addressing backlogs in diagnosis and treatment caused by reduced services and demand for non-COVID matters during the first peak) at the same time as managing the myriad – and growing – needs of the ongoing pandemic. These include treating patients with COVID-19 in primary care, secondary care and in the community; running the Test and Trace programme; and now delivering the COVID-19 vaccination programme for many millions of people.
These additional demands on NHS capacity came following years of underinvestment in our health system, and at a time of almost 90,000 vacancies within the NHS, and need to be delivered at a time of increased staff absence due to sickness and isolation; workforce exhaustion due to the physical and psychosocial demands of COVID-19; and reduced estate capacity due to COVID-19 infection control protocols.
Where to go from here
These challenges will not be met by business-as-usual practices and will require embracing new ways of working that include wider use of digital technologies and data. This means harnessing the exponential rise in medical and technical breakthroughs and subsequent acceleration of new diagnostic tools, treatments, medical devices, data and AI-based tools which flow from this.
One place to start will be to look at what is working on the ground to increase capacity and capitalise on opportunities to do things differently. There has been much coverage of the adoption of digital solutions in areas like remote consultations in primary care, but there are also less discussed examples of new ways of working that have been equally impactful. For instance, a new Virtual Cockpit technology was pioneered in the UK for the first time this year at Frimley Park hospital, which enables the delivery of remote scanning assistance, allowing the rapid transfer of specialist knowledge between MRI scanners. The system also allows an experienced radiographer to run multiple CT or MRI scans from a central control room allowing a technician to operate up to three imaging systems at once. This aims to increase the availability of experts and reduce the movement of patients, meanwhile also helping to protect staff, vulnerable or otherwise, from the virus.
We can learn from this kind of innovation as it aims to improve access to clinical experts and efficiency while enhancing the patient experience. This is crucial as with elective care and diagnostic backlogs set to reach 10 million by the end of the year, the NHS needs desperately to streamline service offerings where it can, while not sacrificing the quality of care.
The UK health and care system has also learned that under pressure we need to play to our strengths. The NHS is one of the most data-rich organisations anywhere in the world, which we can use to support the early detection and diagnosis only possible with the right insight. How we use this resource going forwards will define our future healthcare system and ability to deliver the patient care we strive to provide.
However, data is currently not as available and accessible as it needs to be to facilitate these kinds of solutions. Inconsistent levels of digital maturity across the NHS is a key obstacle that we will need to overcome if we are to allow different parts of the system to properly communicate crucial information securely.
Looking internationally and to the future
There has never been a better or more pressing time to pursue digital solutions that can create capacity in a stretched health system and connect up care within the NHS. However, we are not facing this crisis alone. As a result of the global nature of the pandemic, we have seen an acceleration of countries working across borders. Examples of digitally-led cooperation span from global data sharing at the beginning of the pandemic to allow more researchers to have access to the virus’s whole genome sequences, to the new EU interoperability gateway system launched last month to link up the contact tracing and warning apps of participating EU countries.
A key benefit of international work in this area is the opportunity to leverage scale and technology not available on an individual country basis. The EU EXSCALATE4CoV project exemplifies this point – working with 18 partners across seven countries, it is looking to identify molecules capable of targeting SARS-CoV-2 and develop tools for future pandemics using European Supercomputer capabilities. This exciting work would not be possible at a national level and is a strong reminder of the importance of continuing to work collaboratively with international partners, learning and sharing solutions to the trickiest problems.
Layla McCay is the director of International Relations at NHS Confederation.