The UK healthcare sector finds itself in an unprecedented situation as it tries to deal with the ramifications of the Coronavirus pandemic whilst planning for the UK’s exit from the European Union. However, from a closer analysis of the situation there appears to be some silver linings as this crisis could prompt the healthcare sector to implement some important changes.
Written by Griffin Shiel, Queen Mary, University of London
At the beginning of 2020, before we knew about the devastating impact Coronavirus would have, the UK healthcare sector was making plans to limit the impact of the UK’s impending exit from the European Union. Now, over six months since the first recorded cases in the UK, and just four months until the end of the transition period, the NHS, independent healthcare providers and health insurance companies are tasked with preparing for an uncertain future.
In recent weeks, much of the debate in the UK around the impact of Coronavirus has focused on the economy. Economic concerns have been the key drivers behind the government’s decisions to ease the lockdown despite the UK’s daily infection rate remaining in triple figures. With this shift in focus it would be easy to forget that the Coronavirus pandemic is, and remains, first and foremost a global healthcare emergency.
It is also important to remember that we are far nearer the beginning of the emergency than the end as the pandemic presents a litany of short-, medium- and long-term problems for the UK’s healthcare sector to contend with. In the immediate term, it is estimated that one in six people in England could be waiting for NHS treatment this autumn. This is a result of Coronavirus precautions forcing hospitals to run at 60 percent capacity. 2021, will also prove to be a difficult year as NHS and independent hospitals deal with a huge backlog of cases caused by the virus. To free up the hospital beds needed to treat those with the virus, almost all routine and elective surgeries were put on hold, as were outpatient referrals for patients with cancer and other serious conditions. There are also still fears of a winter spike in cases, and uncertainty about what the longer-term impact of the virus could be on those who contracted it but have since recovered. In short, the UK’s healthcare sector is entering a period of immense uncertainty with no clear end date.
To compound this, it looks increasingly certain that the UK will leave the European Union in January 2021 without a deal. This creates its own set of problems for the healthcare sector. Firstly a no deal Brexit will limit the NHS’s access to migrant workers who have been its backbone since its creation in 1948. Then there is the issue of mutual recognition of qualifications. As it stands, medical practitioners from EU member states can work in the UK with relative ease. Currently there is no agreement on the future of this policy. The health sector is also likely to face issues in respect of the supply of imported drugs and other equipment.
The combination of Coronavirus and Brexit paint a rather bleak picture for the provision of healthcare in the UK, on top of existing financial issues and increasing demands already faced by the NHS before the outbreak of Coronavirus. So what are the main issues which need addressing in the name of damage limitation?
A key issue is the relationship between NHS and independent hospitals. In March 2020, NHS England reached an agreement with the independent sector whereby “all available inpatient capacity and resource” in the independent sector would be part of the response to Coronavirus. This has shown the important role the independent sector has in acting as a reserve pool of hospitals in times when the NHS is overwhelmed. However, the contract is inflexible and given that the aforementioned backlog will likely overwhelm the NHS in 2021 it is vital that the relationship between the NHS and independent sector hospitals is clarified by the government.
There is also the issue of what the “new normal” will be for hospitals and the wider healthcare sector. Matt Hancock has argued for all GP appointments to be done remotely by default. There is certainly merits to this idea. It could take pressure off GPs who currently act as the gatekeepers for medical treatment in the UK. Additionally, it could speed up processes such as cancer referrals, an area in which the UK performs poorly. The proposal will not pass without contestation however as the Royal College of GPs has already criticised the GP-at-Hand arguing that both doctors and patients benefit from face-to-face contact. There is concern that GP at Hand creates a ‘two-tier’ primary care service where those with the greatest clinical need find it more difficult to access timely care when they need it.
Health insurance companies also face several issues. First of all, there is the unenviable task of having to predict the future behaviour of their customers and make adjustments to their insurance plans accordingly. In the last few months, insurance providers have received more claims for mental health issues, but a significant decline in the number of people calling for referrals, a reluctance to go to hospitals and more people using online services. How long this behaviour will persist, and when claim levels will return to normal is difficult to predict. There is also the issue of insurance premium tax which has doubled since 2015. Insurers will be lobbying hard to prevent the government from introducing any further increases to this tax and COVID-19 will no doubt have some bearing on any conversations in this area.
These are the issues which are currently apparent, and it is not beyond the realm of possibility that in the coming days, weeks and months, more challenges for the healthcare sector will become evident. But perhaps among all this is a silver lining. More than at any other time, the UK’s healthcare sector has shown its value and perhaps this will prompt the injection of some much-needed funding to bring about positive change. If out of this we have a healthcare system which puts less pressure on GPs, utilises independent hospitals and stops the rise in insurance premium tax, that will be something small to cling on to. Whether or not this is achievable in a post-Brexit environment is another question.
Photo credit: Sludge G @Creative Commons 2.0