Wuhan Novel Coronavirus (CoVid-19) has claimed over 1,300 lives and infected 60,000 worldwide so far, with no sign of slowing down. The NHS has become an increasingly fragmented service supplied by multiple providers, which is at risk of failing to deliver the co-ordinated, effective response that Coronavirus requires.
The last potential pandemic the NHS responded to was swine flu in 2009. Since then, the NHS has altered significantly – although privatisation was well under way, there were some notable differences that meant it was in a better position to respond to pandemic flu.
At the time there was a clear hierarchy from the top table decision makers: the Chief Medical Officer, Department of Health and the Health Secretary, down to the Primary Care Trusts and GPs. The Strategic Health Authorities operating above the PCTs had power to realign funding priorities between PCTs as needed.
An excellent report from the Centre for Health and Public Interest in 2014 reviewed the response in 2009 and found this hierarchy had a “clear line of sight,” allowing the co-ordinated response that swine flu required. There were flaws, such as a lack of evidence base for the widespread delivery, and the unnecessary stockpiling of anti-influenza medication, but in terms of interdepartmental communication and a joined up response, things worked well.
None of the organisations that existed then remain today, due to the top-down reorganisation that followed the Health and Social Care Act in 2012. We are now undergoing another costly reorganisation with the creation of Sustainability and Transformation Plans and Accountable Care Organisations. £79.9 billion of the NHS budget is controlled by Clinical Commissioning Groups, who purchase services from local providers. There is a fragmented landscape of different providers and disparate service provision across different regions. According to NHS England there are 150 independent providers of health services in England on top of the 233 NHS providers.
The Secretary of State for Health retains emergency powers to demand co-ordinated action, but these are yet to be exercised. It remains to be seen how these disparate services, with different contracts and arrangements, can be centrally directed to deal with a possible pandemic. We have lost the organisational memory that the swine flu response developed. With so many different providers with varying contractual arrangements offering widely differing health care services, an effective response to Coronavirus may be far more challenging.
Monitoring of the contracts with private providers is often poorly done, so it is conceivable that these arrangements might not be conducive to scaling up service provision in the event of a global health emergency. The chaotic healthcare architecture is exacerbated by the continuing cuts to local government public health services, as much as 8% from 2013 to 2018, and by our already overwhelmed emergency departments.
Coronavirus may well spread in large numbers. The neglect and fragmentation of our health service by the last 10 years of Conservative government could make a difficult situation catastrophically worse.
Dr Sammy Luney is a junior doctor and member of Doctors in Unite. A longer version of this article can be found on his Medium page.
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