Covid aftercare piles pressure on ‘understaffed’ community services

This month the national commissioner released guidance for the care of patients once they have recovered from an immediate covid infection and been discharged from hospital.

It said community health services will need to provide “ongoing health support that rehabilitates [covid patients] both physically and mentally”. The document said this would result in increased demand for home oxygen services, pulmonary rehabilitation, diagnostics and for many therapies such as speech and language, occupational, physio, dieticians and mental health support.

One GP heavily involved in community rehab told HSJ: “There is a lot detailed information about what people might experience in recovery, but it doesn’t say what should actually happen.

“We have seen people discharged from hospital that don’t know anything about their follow-up and the community [health sector] hasn’t got any instructions of what they should be doing or what services have even reopened. This guidance needs to go a step further and rapidly say what is expected so local commissioners can put that in place.”

The document recognised that dealing with the increased number of people needing specialist support would create “new challenges” to the system, which will include maintaining infection control; pressures on equipment such as oxygen cannisters and personal protective equipment; staffing; and increased numbers of patients experiencing persistent psychological difficulties post-discharge.

It asked CCGs and providers to “pre-emptively consider how to create psychological input into covid-19 rehabilitation programmes and meet possible increased demand for IAPT and other mental health services”. It also said multidisciplinary teams and new care pathways should be established to deal with the complex and wide-ranging needs of post-covid patients.

Graham Jackson, chair of NHS Clinical Commissioners, which represents CCGs, told HSJ that while the guidance was “very helpful… the financial implications are significant, so may require the re-purposing of funds from elsewhere”. He added: “Commissioners would need to work with “providers and local authorities to ensure resource is targeted to need.”

Andy Whittamore, clinical lead at charities Asthma UK and the British Lung Foundation, said: “We have concerns about the pressure this will place on health teams in the community that are already chronically underfunded and understaffed.

“Sufficient multidisciplinary support in the community should be made available for those being discharged from hospital with respiratory care needs, such as pulmonary rehabilitation. However, this must not come at the expense of those in the community with pre-existing respiratory conditions whose care has already been interrupted.”

Kamini Gadhok, the chief executive of the Royal College of Speech and Language Therapists, also warned the services their members deliver “are in danger of being severely stretched”.

Jonathan Bennet, chair of the British Thoracic Society and respiratory consultant said: “In terms of rehabilitation, we are at the stage we were at in March with acute admissions. No one knows the consequences of [covid] and what number of people we will have to treat. [The guidance] is a difficult ask as not only are we having to deliver this increased care but have to deliver it in a very different way to allow for social distancing.”

He added that as lung function tests are aerosol generating, these services are “going to be decimated” due to the need for constant deep cleaning of equipment. NHS England’s aftercare guidance recommends testing a patient’s lung function 12 weeks after discharge if their breathing has not returned to normal.

When approached for comment NHS England referred to the published guidance and a statement from chief executive Sir Simon Stevens on 29 May, which said: “The next phase of the health service’s coronavirus response will mean expanding and strengthening community health and care services in new ways.”