‘Independent review of NHS’ ahead of second wave

The Royal College of Anaesthetists said a series of reviews should be carried out, overseen by an independent group formed from clinical royal college representatives, independent scientists and academics.

It would encompass investigation of what happened to care quality during the peak of infection and demand through March, April and May — there are major concerns that harm and death was caused by knock of effects, with some health services closed and people being afraid to use others.

Hospitals were unable to provide many other services as staff, including most anaesthetists, were redeployed to help with critical care.

Ravi Mahajan, president of the Royal College of Anaesthetists, told HSJ areas such as capacity, workforce and protective equipment were key issues to be reviewed.

He said: “We can’t wait for [the pandemic] to finish and then review. [The reviews] have to be dynamic, ongoing, and the sooner they start the better.

“When it struck in early March we ended up switching off a lot of routine NHS activity to accommodate covid activity. We can’t go through the same cycle again if there was to be a second surge. What we have learned from the previous experience is something we should put into practice now.

“How the data is looked at has to be independent. That independence could come from a body from royal colleges, academics, independent scientists […] that sits outside the organisational structures.” He said NHS organisations would have to “buy in and participate in analysis and come up with learning”, however, including supplying data on capacity and care quality.

Intensive Care Society president Ganesh Suntharalingam echoed the calls. He said: “It’s not just about more beds, it’s where they need to be and whether critical care capacity is matched to the population rather than historical patterns. Is the capacity in the right place?

“Capacity is not just about beds but the ability to staff them. It should be about how resilient the system is for future surges, whether for a pandemic or any other emergency.”

The Royal College of Physicians said royal colleges should have a role in joining up findings across trusts, but that most reviews should be trust-led. 

John Dean, clinical director for quality improvement and patient safety at the Royal College of Physicians, said: “Clinicians working in organisations should now be actively involved in reviewing local care and quality of care during covid-19 both for patients with suspected covid-19 and without suspected covid-19.

“There has to be a balance of when these assessments are done with the capacity in the system. They need to be at a scale and size that is respectful of that.

“We’re continuing to care for people with covid-19 so we need to learn from what’s happening now. System leaders need to look at what is the learning we need now which will contribute to the way we care for people over a number of months.”

The Academy of Medical Royal Colleges said reviews into service reconfigurations due to covid-19 should be done on a cross-speciality basis.

AoMRC chief executive Alastair Henderson said: “There will clearly be lots of reviews according to speciality. What is important is that there are cross speciality reviews to pick up issues that run across different areas. It’s essential that the input of patients and their experiences is picked up alongside that of clinicians and organisations.

“Having an independent process is really important. Quite what the best way of doing that is is open for discussion.”