A new report by the Centre for Health and the Public Interest (CHPI) finds that reforms made to the NHS following the Health and Social Care Act of 2012 have impacted upon its ability to deal effectively with a possible flu pandemic.
Getting behind the curve, is the NHS ready for pandemic flu? highlights three potential problems which the new NHS now faces in dealing with a possible pandemic:
- A loss of expertise, personal relationships and institutional memory in dealing with public health emergencies from within the NHS as a result of the 2012 reforms.
- The lack of clear accountability arrangements and a ‘clear line of sight’ under the new system.
- The co-ordination of increasing numbers of private providers of NHS services in a health care system underpinned by contracts.
The report finds that in a pandemic, when there will need to be clear lines of communication and responsibility, with the centre having capacity to direct personnel and healthcare resources towards areas of greatest need, there is instead fragmentation and a lack of clarity within the newly-created organisational structures about who does what and how the system is co-ordinated. The potential problems stretch from the top, with an ill-defined role expected of the Chief Medical Officer, through confusing multiple and parallel structures embracing the NHS, Public Health England and local government, right down to the front line with its increasing number of private providers.
In addition, a now more market-driven health care system underpinned by a series of contracts is ill-suited to the demands of a major health crisis because it prioritises efficiency savings, patient choice and competition between healthcare providers over centralised planning, and seeks to minimise spare capacity in hospitals and other health care facilities. Requiring contracted healthcare providers to act appropriately in an emergency is also extremely difficult, as they will be expected to deliver services in unforeseen circumstances not specified in or funded through their contracts.
Report author, Dr. Hilary Pickles said:
‘The NHS is already struggling to deliver on the ‘day job’ of routine emergency admissions, so would be exceptionally challenged by a crisis such as a flu pandemic. At such a time, limited resources will need to be used to maximum effect, with good co-ordination between local authorities and the NHS in particular.
Instead we have new difficulties from top to bottom, from central policymaking, through loss of expertise resulting from the substantial staffing and organisational changes caused by the re-organisation, down to the ability to deliver at local level.
Even when the new system beds down and accountabilities are mutually agreed, a clear line of sight may still prove more difficult to achieve, and command and control cannot be easily exercised in a system increasingly determined by the market – two elements regarded as of key importance to emergency planners. There are too many new problems for comfort.’
The report recommends a number of measures to address these problems, including:
- Clarifying accountabilities within the current system
- Clarifying the Secretary of State’s emergency powers to direct during a pandemic and clarify arrangements for those expected to provide surge capacity
- Considering the building of more health protection and public health expertise into NHS England
- Tempering the market