Concern that non-Covid medical need in Central Lancs could "explode" after pandemic

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The NHS in Central Lancashire says it is monitoring the risk of a spike in demand for non-Coid services after a dramatic decline in the call on the healthcare system during the early stages of the pandemic.

A recent governing body meeting of the Greater Preston and Chorley and South Ribble clinical commissioning groups (CCGs) also heard that the region will have to ensure that it has sufficient capacity for diagnostic tests as the health service returns to some kind of normality.

Members were told that the NHS locally had been drawing up its own so-called “business as usual” plans even before national directives had encouraged them to do so.

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However, chief officer Denis Gizzi warned that the fallout from the drop in demand when the virus was at its peak may yet to be felt.

NHS bosses are considering how to get back to "business as usual"NHS bosses are considering how to get back to "business as usual"
NHS bosses are considering how to get back to "business as usual"

“We are starting to think about identifying the risks associated with those who haven’t presented…with health conditions they would normally present with.

“How do we know that we haven’t got a significant number of people in the community who have been self-isolating and managing their condition and medical need to such a point where the number of cases will just explode over the next two to three months?” he asked.

Papers presented to the meeting revealed that A&E attendence halved during the first weeks of the lockdown, but has since picked up.

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There was also an initial two thirds decline in the number of cancer referrals made under the two-week standard within which urgent cases should be seen by a specialist after being sent via their GP. Figures released since the meeting show a drop in such referrals in Central Lancashire between March and April of 57 percent.

Helen Curtis, the CCGs’ director of quality and performance, described that lack of activity as “concerning”.

“We know we have potentially got a backlog in the community where referrals may not have been made into Lancashire Teaching Hospitals or other organisations for care.

“There remains an issue around diagnostics, so as we ramp up the requirement to get back on track with the cancer activity and so on, we need to make sure that the diagnostic provision is there,” she added.

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Governing body members heard that surgical procedures for conditions including cancer and urological complaints have continued during the pandemic, with use being made of “Covid-free space” at private hospitals which have been turned over to the NHS, as well as within the local trust.

Meanwhile, Chorley and South Ribble CCG chair, Dr. Lindsey Dickinson, said that call volumes at her own Chorley Surgery – and across the wider patch – were close to returning to normal levels, with increasing demand for appointments.

But Denis Gizzi said that some elements of the NHS might never operate in exactly the same way that they did prior to the pandemic.

“We have learned to use technology in a different way, we’ve managed to change the way clinical pathways work much quicker than we would have done normally.

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“We have learned all sorts of things during this pandemic, things that would normally take one or two years to put in place – or sometimes never actually happen, because people will not change the culture.

“All of a sudden, we have managed to do that pretty much overnight, because there has been a willingness. If you’ve got the will, the ideas and the technical skills to execute them…then you can make transformation work really quickly.”

The meeting heard that the system instituted nationally during the crisis of groups of hospitals working together as a single “cell” is likely to continue until the end of the current financial year. In Lancashire, that has been at the level of the so-called integrated care system (ICS), made up of organisations across the whole of Lancashire and South Cumbria.

But Helen Curtis questioned where responsibilities usually held by the CCGs lay as a result of the move.

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“If that’s where it is being managed, who is responsible for the risk and who is being held accountable for the outcome? If we are not managing it locally and somebody else is, how can we be held to account for it?” she asked.

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