Letter to the NHS Chief Executive about priorities for the future
The Association is engaging with the NHS in considering how our services will need to adapt, transform and refresh to the new medical, social and political landscape following the COVID-19 pandemic.
Read the views of other medical organisations:
Letter to Sir Simon Stevens, Chief Executive, NHS England
Dear Sir Simon
The COVID-19 pandemic has put a huge amount of pressure on the NHS and completely changed the way it functions. As the pandemic becomes more under control, the focus is on the NHS of the future and the ways in which it may look different to the NHS of the past. The Association of Anaesthetists – as a membership organisation representing the largest group of hospital specialists who have been on the frontline throughout the COVID-19 response – would like to share with you our top priorities for the changes we believe need to happen:
Recruitment and retention issues in the anaesthesia workforce need to be addressed
- Healthcare systems should ensure that there are sufficient fully qualified specialists in anaesthesia and intensive care to deliver both unscheduled and planned services.
- The critical care workforce cannot be supported by anaesthesia without considerable expansion in workforce numbers or in anything other than extraordinary circumstances.
- The workforce shortage was estimated as between 4-10% prior to the COVID-19 pandemic. Any change in service delivery models will need to take this into consideration.
- Workload will inevitably increase. There have been, and are likely to be, periods where elective services have stopped or have slowed leading to a backlog of cases.
- Retention of existing staff is crucial. Issues such as the recent contract and pensions disputes, as well as the increasing workload with no extra resource, have impacted on morale. The potential for adverse impact on recruitment and retention of staff is a real threat: as has happened before, trainee doctors may go abroad and senior doctors may retire early or chose not to return after retirement.
- Increasing access to flexible working for all anaesthetists is a priority. This should include both Less Than Full Time as well as rotas that are suitable based on factors pertinent to individuals. (age, ethnicity, disability, personal circumstances)
Wellbeing of all staff has to become – and remain – a priority
- Job plans and work rosters need to be designed to ensure that staff wellbeing is considered as important as clinical work and that support is increased at times of increased need such as during the COVID-19 pandemic surge. Engagement of staff in creating rotas, timeliness of rotas being published and fairness of rotas is important.
- Availability of flexible working patterns, opportunity for a healthy work life balance, high quality training, good career opportunities, appropriate remuneration and a satisfying fulfilling job all add to the positive recruitment and retention value of anaesthesia. As a part of this time needs to be made available for any clinical leadership roles staff may wish to be involved in.
- Appropriate infrastructure including facilities for resting and eating need to be put in place to ensure everyone gets their break and is well rested after long shifts.
- The Association has been leading the Fight Fatigue campaign – calling for better rest facilities and improved education around fatigue – the recommendations from this campaign need to be implemented and the resources made available to all NHS staff – as they have been in Scotland.
- Plans must take into account the capacity for staff to meet the increased workload from COVID-19 and of catching up with "normal activity". Staff need "fallow time" to recover. It is very important that staff are not put under undue pressure to work harder or faster.
- Mental health support should be available to all staff.
Use of technology needs to be maximised
- Significant change and investment is needed in IT facility to support communication between professionals and between professional and patients.
- The increased use of technology is also important for supporting professional education and training.
- Maximising the use of new technology/innovation to reduce patient visits to hospital should be a priority for Trusts/Health Boards. While the Association does not endorse any products, MyPreOp is one example of existing technology supporting community care in preparation for planned surgery; similarly IT can be used for follow-up appointments including provision for continual, live data collection on outcome and quality of care.
- Virtual technologies can be used for remote monitoring and telephone follow up. Stronger links can be developed with primary care through this work.
- Purchasing of software and IT services should follow the same principles of procurement as consumables and drugs. Wherever possible, all organisations should use the same applications and packages for the same task, centrally purchased, to avoid the financial and time costs of tendering and implementation and to promote inter-organisation connectivity.
- The option of performing all non-clinical work off-site should be made available to staff – virtual meeting software means this is now possible.
A conversation with the public needs to be started around what the health service can and can’t do
- We need honest conversations with the public about this choice and what is affordable, as well as what options are available to fund our national healthcare services.
- There will need to be more social responsibility for ongoing health care for some conditions. Healthcare will need long term prioritising unless significant funding and staff recruitment is undertaken quickly.
Settings outside hospitals need to be utilised
- Community and primary care settings may offer advantages over secondary care settings when considering patient safety, wellbeing and outcomes.
- The use of short stay/day case surgery should be maximised by increasing the provision of post-operative care at home, or the usual place of residence, linked to acute pathways: pain teams, antibiotic teams, pharmacy, wound care, physiotherapy etc.
- Health and social care need to be integrated to allow patients to move smoothly between the two and receive the most appropriate care and support.
The whole healthcare system needs to be prepared for future pandemics
- There is a need to develop and maintain resilience in the acute care system to provide the resources and flexibility to manage any future pandemics – this needs to include people, equipment and drugs, as well as facilities.
- Lessons need to be learnt from the response to COVID-19 – this should take the form of a public inquiry.
The Association believes that all these issues need to be addressed in order to make the speciality of anaesthesia – and the health service as a whole – sustainable.
We would welcome the opportunity to meet with you at your earliest convenience to discuss these issues and how our speciality can best feed in to the future plans for the health service.
Dr Kathleen Ferguson
Association of Anaesthetists