AN INDEPENDENT think tank has warned that when the next flu pandemic hits Britain, because the NHS has lost 10,000 staff, the results would be ‘more deadly’ as the NHS would not cope.
The report entitled ‘Getting behind the Curve? Is the new NHS ready for Pandemic Flu?’ is produced by The Centre for Health and the Public Interest (CHPI).
The report points to the severe cuts to the NHS, it said: ‘Both NHS England and Public Health England were slow in filling posts. Virtually no public health professional previously employed in the NHS will now have the same employer as previously. Across the entire system around 10,000 staff were made redundant.’
It is written by Dr Hilary Pickles who is an independent public health consultant, previously district Director of Public Health in Hillingdon and David Rowland who is a health and social care policy researcher for the Nuffield Trust.
The report identifies three major problems, the effects of cuts, a breakdown in organisation and communication and the privatisation of the NHS.
The report states:
‘Problem 1: The effects of re-organisation – the loss of expertise, personal relationships and institutional memory from 2009 to 2013.
‘Problem 2: Confused accountabilities and the lack of a “clear line of sight” under the new arrangements.
Problem 3: Co-ordination of increasing numbers of private providers of NHS services under a market-based health care system underpinned by contracts.
The report continues: ‘The top risk on the UK Civilian risk register is pandemic flu, which the government considers may well happen in the next 5 years.
‘Since the last flu pandemic in 2009 wholesale changes have been made to the structures of the NHS and public health in England as a result of the Health and Social Care Act (HSCA) 2012.
‘This report considers the ability of the new NHS and the wider public health system to respond to this threat. It examines three potential problems:
‘• The effects of re-organisation – the loss of expertise, personal relationships and institutional memory from within the system.
‘• 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 major pandemic the newly reorganised NHS in England is likely to face extra challenges. In part, this is an inevitable consequence of the disruption caused by such a major re-organisation.
‘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 general, a 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.
‘Exceptional powers of direction over the NHS are granted to the Secretary of State under the HSCA 2012 to deal with such an emergency – in effect implying a suspension of the operation of the healthcare market and normal day-to day operational arrangements.
‘However, these powers are unlikely to overcome the basic defects of a fragmented system and they remain untested and hence uncertain.
‘The report concludes by suggesting some short-term fixes, but these can only partially compensate for the basic problems identified.’
On the burning issue of the sweeping new powers which the Secretary of State has been awarded the report states:
‘Emergency powers of Direction on the NHS
‘• The Secretary of State’s emergency powers can be used, and delegated to NHSE, under sections 46/47 of H&SCAct2012, with no explicit definition of what the scope of these powers is.
‘• Guidance explains: “In extreme circumstances such as pandemic influenza, a national fuel shortage or extreme weather, the NHS England national team may take command of all NHS resources across England”
‘• These powers could apply to any provider in receipt of NHS funds.
‘• The powers to direct relate to either providing or ceasing to provide any services for the purposes of the health service.
‘• This differs from the provisions contained within the standard NHS contract, which are limited to the types of activity the NHS provider/supplier usually provides.
‘• There is no precedent for such use of NHS emergency powers, nor has it been subject to planning exercises.
‘• There is no guidance on what the exercise of these powers might mean for contracted NHS providers, e.g. for the transfer of liability or for reimbursement in an emergency.
‘• It is unclear whether the emergency powers would stretch to subcontractors.’
The report concludes: ‘There are political choices to be made over the relative priority to be given to systems that appear to offer maximum efficiencies during times of relatively predictable and routine demand for healthcare, and those that have more resilience when the going gets tough, such as in a pandemic.
‘Even with optimum lines of communication and command and control, a market-based system has fundamental weaknesses for the handling of sudden crises.
‘This can be ameliorated to some extent by good planning. Some advance investment may be costly, but other preparation may be less so, for example consideration of how best to mobilise a supplementary and volunteer workforce to help keep sick elderly people out of hospital.
‘Pandemic flu may be the extreme challenge for social care and the NHS, but it heads the national risk register for a good reason. The systems generated by the HSCA have left new vulnerabilities that will need to be rectified, much of it, we suspect, by non-market cross-system collaboration.’
