Paul Bristow: The biggest challenge for our NHS may still lie ahead, but it’s also an opportunity

30 Jun

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

Our NHS has done an excellent job looking after us during the Covid-19 crisis. But the biggest challenge for our NHS may be about to begin as the service deals with the backlog of delayed operations and treatments.

The lockdown began in order to protect our NHS. This was the early central message. The Government was concerned that hospitals would be overwhelmed as we saw in Italy and elsewhere at the start of the pandemic. This didn’t happen. Our NHS ramped up capacity as former NHS workers came back to serve, new hospitals were built, and a deal was struck with the independent sector. This push for increasing capacity within the system needs to continue.

We need a national effort backed by the Government PR machine – supported by the charisma and optimism of the Prime Minister – to back our NHS and clear the backlog. I have heard personal harrowing stories from NHS patients through my role on the Health and Social Care Select Committee.

Rob Martinez from Bracknell, who needed a double knee replacement, had his operation due in April cancelled. He told our committee that he had taken early retirement. I asked him if he would have continued to work if his operation had taken place – he confirmed he felt he could have worked for another 5 years. What was the most bitter blow is that he has been told there is ‘zero chance’ of his procedure taking place this year.

Another patient from Sevenoaks had her chemotherapy stopped. And while it has restarted, there remains huge concern that the number of patients receiving chemotherapy is far fewer than would be expected. Cancer Research UK estimates more than 20,000 patients did not get treatment because of the virus crisis.

Whilst official statistics have been paused, it is estimated almost two-thirds of Britons with common life-threatening conditions have had care cancelled. The NHS Confederation is saying that NHS waiting lists could rise to 10 million in the autumn, and take up to two years to clear. The Royal College of Surgery has called for a five-year strategy to tackle the waiting list situation.

This is now one of the Government’s central challenges.

We can do this. The NHS has shown its remarkable ability to cope, and yet again the British people have shown great resilience through this emergency. But it needs to be framed as a national effort with the Prime Minister and the Secretary of State personally leading this.

Those who have re-joined the NHS to help with the Covid-19 crisis need to be persuaded to stay. I appreciate staff will be tired, and those that have returned will need to be properly motivated. The appreciation that the public has shown to our NHS staff should help, but efforts will need to be made to make the NHS a better place to work and should be prioritised.

The Prime Minister had it right with the simple message about workforce at the General Election, promising to recruit and retain 50,000 nurses. We need to look with urgency at long-term recruitment issues. The NHS needs staff in almost every setting, as many begin to reach retirement age. According to the latest annual census from the UK Royal College of Radiologists, in 2020 approximately 200 doctors will qualify as radiology consultants – not enough to fill even half of the estimated 466 vacancies.

The Government needs to be alive to the challenges associated with the safety of NHS staff and patients. The need for PPE and new designed layouts will affect theatre capacity. Diagnostics, which underpin clinical activity in hospitals, and a backlog in MRI/CT scans, endoscopy and laboratory tests are also limiting factors.

Back in March, Matt Hancock was right to sign a deal with the independent sector. In peace time this would have been an incredibly courageous thing to do with those on the left gleefully pointing to proof of Tory privatisation. I hope that the Covid-19 emergency has dismissed the lazy assumption that the independent sector and the NHS cannot work in partnership.

A similar long-term deal agreement with independent providers to retain capacity will be crucial in the years ahead. They can help ramp up elective capacity, power through knee, hip and cataract procedures, and improve lives – and in the case of Mr Martinez may even allow him to return to work and generate more tax revenue to fund public services. It will also allow for cancer treatment and cardiology procedures to resume at pace and scale. With appropriate testing arrangements, these could quickly become a significant proportion of the ‘Covid-light’ units that are being regularly discussed as the means to reduce the elective backlog.

The NHS does so many things well. But few would claim – especially staff – it cannot become more productive. We have seen the NHS conduct GP appointments and other consultations through digital challenges. This has worked. It is also worth noting that much of this would have been impossible if it wasn’t for the visible presence of the NHS on our streets in the form of community pharmacies offering that face-to-face reassurance for many routine issues.

This obviously needs to continue, but it is only the beginning. Let’s start a conversation about how the NHS can change many care pathways to become more productive. We can accelerate the uptake of already established treatments, which can keep patients out of a secondary care setting or at least not in expensive hospital beds for days at a time, by the adoption of less invasive procedures.

Changing pathways to enable the adoption of technology has often meant local evidence needed to be established – this could take years and was often completely unnecessary. We can expediate the move to integrated care working, especially with regarded to initiatives such as shared waiting lists and flexibility in payment mechanisms. This is a chance to improve existing practice.

We can be optimistic and ambitious for the future of our NHS. So much goodwill has been garnered and our staff are more valued than ever. But it is also an opportunity for change. A national effort led by a transparent and upfront Government is what is required.

Paul Bristow: The biggest challenge for our NHS may still lie ahead, but it’s also an opportunity

30 Jun

Paul Bristow is the MP for Peterborough and a member of the Commons’ Health and Social Care Select Committee.

Our NHS has done an excellent job looking after us during the Covid-19 crisis. But the biggest challenge for our NHS may be about to begin as the service deals with the backlog of delayed operations and treatments.

The lockdown began in order to protect our NHS. This was the early central message. The Government was concerned that hospitals would be overwhelmed as we saw in Italy and elsewhere at the start of the pandemic. This didn’t happen. Our NHS ramped up capacity as former NHS workers came back to serve, new hospitals were built, and a deal was struck with the independent sector. This push for increasing capacity within the system needs to continue.

We need a national effort backed by the Government PR machine – supported by the charisma and optimism of the Prime Minister – to back our NHS and clear the backlog. I have heard personal harrowing stories from NHS patients through my role on the Health and Social Care Select Committee.

Rob Martinez from Bracknell, who needed a double knee replacement, had his operation due in April cancelled. He told our committee that he had taken early retirement. I asked him if he would have continued to work if his operation had taken place – he confirmed he felt he could have worked for another 5 years. What was the most bitter blow is that he has been told there is ‘zero chance’ of his procedure taking place this year.

Another patient from Sevenoaks had her chemotherapy stopped. And while it has restarted, there remains huge concern that the number of patients receiving chemotherapy is far fewer than would be expected. Cancer Research UK estimates more than 20,000 patients did not get treatment because of the virus crisis.

Whilst official statistics have been paused, it is estimated almost two-thirds of Britons with common life-threatening conditions have had care cancelled. The NHS Confederation is saying that NHS waiting lists could rise to 10 million in the autumn, and take up to two years to clear. The Royal College of Surgery has called for a five-year strategy to tackle the waiting list situation.

This is now one of the Government’s central challenges.

We can do this. The NHS has shown its remarkable ability to cope, and yet again the British people have shown great resilience through this emergency. But it needs to be framed as a national effort with the Prime Minister and the Secretary of State personally leading this.

Those who have re-joined the NHS to help with the Covid-19 crisis need to be persuaded to stay. I appreciate staff will be tired, and those that have returned will need to be properly motivated. The appreciation that the public has shown to our NHS staff should help, but efforts will need to be made to make the NHS a better place to work and should be prioritised.

The Prime Minister had it right with the simple message about workforce at the General Election, promising to recruit and retain 50,000 nurses. We need to look with urgency at long-term recruitment issues. The NHS needs staff in almost every setting, as many begin to reach retirement age. According to the latest annual census from the UK Royal College of Radiologists, in 2020 approximately 200 doctors will qualify as radiology consultants – not enough to fill even half of the estimated 466 vacancies.

The Government needs to be alive to the challenges associated with the safety of NHS staff and patients. The need for PPE and new designed layouts will affect theatre capacity. Diagnostics, which underpin clinical activity in hospitals, and a backlog in MRI/CT scans, endoscopy and laboratory tests are also limiting factors.

Back in March, Matt Hancock was right to sign a deal with the independent sector. In peace time this would have been an incredibly courageous thing to do with those on the left gleefully pointing to proof of Tory privatisation. I hope that the Covid-19 emergency has dismissed the lazy assumption that the independent sector and the NHS cannot work in partnership.

A similar long-term deal agreement with independent providers to retain capacity will be crucial in the years ahead. They can help ramp up elective capacity, power through knee, hip and cataract procedures, and improve lives – and in the case of Mr Martinez may even allow him to return to work and generate more tax revenue to fund public services. It will also allow for cancer treatment and cardiology procedures to resume at pace and scale. With appropriate testing arrangements, these could quickly become a significant proportion of the ‘Covid-light’ units that are being regularly discussed as the means to reduce the elective backlog.

The NHS does so many things well. But few would claim – especially staff – it cannot become more productive. We have seen the NHS conduct GP appointments and other consultations through digital challenges. This has worked. It is also worth noting that much of this would have been impossible if it wasn’t for the visible presence of the NHS on our streets in the form of community pharmacies offering that face-to-face reassurance for many routine issues.

This obviously needs to continue, but it is only the beginning. Let’s start a conversation about how the NHS can change many care pathways to become more productive. We can accelerate the uptake of already established treatments, which can keep patients out of a secondary care setting or at least not in expensive hospital beds for days at a time, by the adoption of less invasive procedures.

Changing pathways to enable the adoption of technology has often meant local evidence needed to be established – this could take years and was often completely unnecessary. We can expediate the move to integrated care working, especially with regarded to initiatives such as shared waiting lists and flexibility in payment mechanisms. This is a chance to improve existing practice.

We can be optimistic and ambitious for the future of our NHS. So much goodwill has been garnered and our staff are more valued than ever. But it is also an opportunity for change. A national effort led by a transparent and upfront Government is what is required.

Robert Sutton: Top Tories on Twitter. Case Study 1) Rishi Sunak

29 Jun

Rob Sutton is an incoming junior doctor in Wales and a former Parliamentary staffer. He is a recent graduate of the University of Oxford Medical School.

It seems unsurprising that Chancellor of the Exchequer Rishi Sunak has done well in the rankings. He is behind only Boris Johnson and Theresa May, and given his emergence as a leading figure in the Government’s coronavirus response (Matt Hancock has also done well, ranked five), the ranking seems a fair recognition of his prominence.

He is a long way ahead of his most recent predecessor, Sajid Javid (ranked 8), and despite Jacob Rees-Mogg having almost 60,000 more followers, Sunak ranks a place ahead of him. This is a reflection of the speed of Sunak’s ascent, having only been in Parliament since 2015, half the time as Rees-Mogg.

Highly-respected within the party, Sunak is a stylish figure with a talent for managing the optics of his job. A consistently solid performer during the Covid-19 daily briefings, he laid out the Government’s economic response to the crisis with a confidence and reassurance which has calmed the public and financial markets.

He has worked hard to develop his social media brand, hiring a talented media special adviser, Cass Horowitz, to help craft his image and achieve broader engagement. He balances seriousness with an ease which many of his older and greyer colleagues lack.

He can be light-hearted when necessary and is able to engage in a manner few previous Chancellors have shown. Even when his attempts backfire (see the “Yorkshire tea” fiasco) they generate discussion and media interest.

The challenge for Sunak will be whether he can carry over his current popularity in a post-coronavirus Treasury. His ascent has been so quick that he had relatively little time to make enemies. It remains to be seen whether this will continue as he is inevitably forced to tighten the purse strings.

Rob Sutton: Introducing the top 50 Conservative MPs on Twitter

29 Jun

Conservative MP Twitter power rankings: the top 50

Rob Sutton is an incoming junior doctor in Wales and a former Parliamentary staffer. He is a recent graduate of the University of Oxford Medical School.

Amongst the social media giants, Twitter is the primary battleground for political discourse. It’s also one of the key avenues by which MPs convey their message, and has near-universal uptake by members in the current House of Commons.

The effectiveness with which Twitter is utilised varies considerably between MPs, but it is difficult to compare like-for-like. How does one take into account the differences between, for instance, a freshman MP and a veteran Cabinet member? Length of service in Parliament and ministerial rank give a considerable advantage when building a following.

In this article, I have compiled a power ranking of MPs in the current Parliament, with the top 50 shown in the chart above. The MP’s follower count was adjusted by factoring in their previous experience, to better reflect the strength of their following and their success at engagement on the platform.

Being Twitter-savvy is about more than just a high follower count: any Secretary of State can achieve this just by virtue of the media exposure their office brings. Building a Twitter following based on thoughtful commentary and authentic engagement requires skill ,and can be achieved by members across all Parliamentary intakes and ranks of Government.

Though the top 10 is still dominated by MPs holding senior ministerial offices, the composition of the list beyond it is far more variable. A number of prominent backbenchers are in the top 20, and four members from the 2019 intake make the top 50, beating longer-serving and higher-ranked colleagues.

I hope that this list serves as recognition of the skill and contribution by Conservative members to public debate and engagement, beyond ministerial duties which so often dominate any mention in the media.

Building a model of Twitter power rankings

Success is judged by number of followers, with higher follower counts indicating greater influence on Twitter. The follower count was adjusted using three key parameters:

  • The number of years since an MP was first elected to Parliament.
  • The number of years the MP’s Twitter account has been active.
  • Their highest rank within Government achieved since 2010.

Higher values for each of these would be expected to contribute to a higher follower count. I built a model using the open-source Scikit-Learn package, and fitted it to data from the current Parliament.

The model was then used to predict how many followers a given MP might expect to have based on these three factors. The steps taken to produce a final “Twitter power score” were thus as follows:

  • Using these three factors, multiple linear regression was used to calculate the expected number of Twitter followers an MP might have.
  • Their true follower count was divided by the expected follower count to produce a single number which represented the MP’s performance at building a following.
  • Finally, a logarithm was taken of this ratio to make the number more manageable and to produce a final Twitter power score.

The final step of taking a logarithm means it is easier to compare between MPs without those who have very high follower counts (such as Boris Johnson) making the data difficult to compare, but it does not affect the order of the ranking.

Compiling the data

Having decided which factors to correct the model for, I collected the required information. All three factors were easy to find reliable sources for. The Twitter page for each MP displays the date the account was created, and the Parliamentary website provides the date of their first election to Parliament and previous government posts.

Members who are newly returned to the backbenches following governmental duties (such as Sajid Javid and Jeremy Hunt) are scored at their highest government rank since 2010 to recognise this. I was able to find the Twitter accounts and required information for 319 Conservative MPs who were included in this ranking.

To build a model based on this data required incorporating the highest government rank numerically. To do this, I assigned scores according to their rank. These grades recognised their relative seniority and media exposure associated with the office, with higher scores assigned to more senior positions:

  • Prime Ministers, Secretaries of State, Speakers, Leaders of the House and Chief Whips are scored 3.
  • Ministers of State, Deputy Speakers and Deputy Chief Whips are scored 1.
    Parliamentary Under-Secretaries of State, Parliamentary Private Secretaries and Whips are scored 0.5.
  • Backbenchers score 0.

When assigning these values, I considered the typical sizes of follower counts of MPs in each category. When comparing Secretaries of States to Ministers of State, the median follower count is around twice the size, but the mean follower count is around eight times the size, as a handful of very large follower count skews the results upwards.

Deciding on weightings requires a (somewhat arbitrary) decision as to which measures to use when comparing between groups, and the scores I decided on were ultimately chosen as a compromise across these different measures, which produced stable results when used in the model.

It is also worth explaining why Prime Ministers are grouped with Secretaries of State, despite the far higher media exposure and seniority of their post. When deciding on the respective weighting for different levels of government post, a sufficiently large pool of MPs was needed to produce a meaningful comparison. The only data points for comparison of Prime Ministers are Boris Johnson and Theresa May, so it is difficult to give them their own weighting without it being either unreliable or arbitrary.

While grouping them with Secretaries of State and other senior positions might be perceived as giving them an unfair advantage in the weighting, I felt it justified given these challenges in determining the “fair” weight to assign them. With this done, I had three parameters for each MP on which to build a model to calculate the expected number of Twitter followers.

Calculating the number of expected Twitter followers

I built a model to calculate the expected number of Twitter followers using the Scikit-Learn, a popular machine learning package in the Python programming language. The model used multiple linear regression to fit the input parameters to the known follower count.

The input data was prepared by removing extreme high outliers in the data which skewed the fit toward high numbers and away from the vast majority of MPs before fitting. Once fitted, an “expected value” of Twitter followers could be calculated for each MP, based on the year of their first election to parliament, the number of years on Twitter and their highest government rank since 2010.

Including more parameters increases the ability of the model to describe the difference between MPs’ follower counts (the variability). By increasing the number of input variables included in the model, more of the variability is captured:

  • One variable captures between 20.3 per cent and 36.1 per cent of the variability.
  • Two variables capture between 39.1 per cent and 43.1 per cent of the variability.
  • All three variables capture 48.7 per cent of the variability.

These three variables are therefore responsible for almost half of the variation between MPs in their follower counts. The remainder of the variability is likely due to a range of factors which the model does not include, of which the MP’s Twitter-savviness is of particular interest to us. I discuss these factors further below.

Limitations in the model

There are multiple other parameters which could be included in future iterations which I did not include in this model. In particular:

  • Membership or Chairmanship of Select Committees.
  • Previous election to a council, assembly, devolved legislature or the European Parliament.
  • Membership of the Privy Council.
  • Government positions prior to 2010.
  • Prominent positions within the Conservative Party, such as the 1922 Committee or European Research Group.
  • Twitter-savviness and effectiveness of their comms team.

Another limitation was not accounting for the perceived relative importance of various governmental departments: a Great Office of State or Prime Minister is scored the same as any other Secretary of State. The difficulties involved in ranking governmental departments were beyond this first model. The length of service in a given government post was also not considered.

Finally, the choice of model to fit the data may not be the optimal choice. Multiple linear regression assumes, per the name, that the distribution is linear. But the large outliers might be better described by a power law or Pareto distribution, or the non-linearities of a neural network.

During next week, ConservativeHome will produce profiles of six individual MPs who have performed notably well in the power rankings, and who reflect the contributions brought by members beyond their ministerial duties, if they have any.

Don’t rule out a second lockdown

26 Jun

We must live with the Coronavirus either until a vaccine against it is available; or until herd immunity, treatments or a viable antibody test reduce its force; or else until or unless it simply runs out of steam.

Which means the “new normal” – complete with face coverings in crowded places, more al fresco eating and drinking, no crowds at big events (at least for the time being), and so on.

Unless we are prepared to risk the NHS collapsing, which is a very distant prospect at the moment, but a long way from being an impossibility.

However, the combination of lockdown fever, furlough, Black Lives Matter, summer and the fledgling test and trace system don’t bode well.

You may well think that polls suggesting support for the shutdown and fear of the virus sit oddly with today’s pictures of teeming beaches at Bournemouth or celebrating crowds outside Anfield.

But those surveys may be out of date; or the respondents have may been telling the pollsters how they think other people should behave, or else different groups of people may have different attitudes.

What’s certain is that long periods of repression are sometimes followed by frenzied outbreaks of celebration, like the austerities of Cromwell’s Commonwealth being followed by the salaciousness of Restoration comedy.

Feast-to-famine, famine-to-feast lurches are built into the economic cycle itself, and woe betide those who proclaim  “an end to boom and bust”.

So it may be that while the dangers of catching the virus in the open air are negligible – as last month’s shift in the lockdown rules seemed to suggest – and Ministers therefore shouldn’t fuss about crowds on beaches…

…There is nonetheless a lotus-eating mood around at present, sustained by furlough, and people driven stir-crazy by lockdown are ready to meet and party and mix in relatively confined spaces.

The potential knock-on problems haven’t been helped by the police’s initial surrender to the logic of mob protest in London and Bristol.

Most people don’t pick up much from politics, but are very sharp in reading the signs of the times.  The disturbances two nights ago in Brixton and last night in Notting Hall may be an indication that weakness has consequences.

Twenty-two police were injured in the first incident – by way of comparison, six were hurt after the recent fascist thuggery in central London (a term we prefer to the more loaded “hard right”).

The Government’s planned response to any local outbreaks of the virus is to follow the South Korean model – or, nearer to home, the German one.

Some 650,000 people in North Rhine-Westphalia are back in shutdown after an outbreak at a meat factory (the combination of close working conditions, migrant workers, and cramped accomodation is a dangerous one).

Boris Johnson and Matt Hancock are hoping that a similar model will be implemented in a similar way if necessary. But that would depend on enough testing taking place and enough tracing working well.

Those traced must also be relied upon to social distance voluntarily and effectively.  If all that doesn’t work, we find it hard to see how a second and further national lockdowns can be avoided.

The very last thing anyone wants to think about as we emerged from such a shutdown is going back into it.  And we hope that it doesn’t happen.

But the fact is that the Prime Minister may not have been right when he said in May that “we have been through the initial peak – but it is coming down the mountain that is often more dangerous”.

The disturbing truth is that we may only be in the foothills of the climb.  Or, to change the image. we like to think that the Coronavirus is fading in the rear view mirror.  But it may only be a trick of the light.

Maria Higson: The Coronavirus has already changed the NHS. Now it can be changed more for the better. Here’s how.

26 Jun

Cllr Maria Higson represents Hampstead Town ward in Camden. She works professionally as a strategist for a major London teaching hospital.

As the Covid-19 crisis moves to its next phase, the conversation is already turning to restarting elective care, and the lives taken indirectly in shutting these essential services. However, with ongoing pressures exacerbated by the impacts of the virus, now is a unique opportunity to innovate healthcare provision – not simply to go back to a system which was already struggling to cope.

Public goodwill towards the NHS has never been higher. If the weekly clapping (accompanied by cheering, pan-banging and bell-ringing) doesn’t show this, the speed at which 750,000 citizens volunteered is surely a strong indicator. The idea of awarding the NHS the George Cross is neither unwelcome nor surprising.

This goodwill is not misplaced; the NHS has stood up to the test of the Coronavirus with aplomb. To take just one example: by April 3rd, the necessary workforce, equipment, and space for over 2,500 additional adult critical care beds was found – an increase of over 50 per cent on pre-virus UK levels (and this excludes the Nightingale hospitals). This precious resource has provided headroom throughout the crisis, with over two thousand beds reported as available during the peak.

However, once the crisis is over and the media has moved on (following in the footsteps of Brexit coverage), what next for the NHS?

The pressures faced are as stark as ever, and the macro-trends are concerning. The UK population age 65 and over is due to grow 45 per cent by 2050; the average health spend of this additional 5.7 million people will be over four times as much as those aged 0-64. The potential impact on public health expenditure is enormous under any scenario, and that’s before considering the social care implications of our ageing population.

Covid-19 adds long-term pressures both directly and indirectly. Of the thousands of intensive care survivors, up to 45 per cent may require rehabilitation support. In parallel, projections show up to two million people becoming unemployed following the crisis, with serious implications for physical and mental health. We will also need to contend with the backlog of elective care not provided during the pandemic.

Given existing, predicted and Coronavirus-related pressures, we cannot simply insist that the NHS goes back to its old practices; we need our non-virus healthcare services to resume, but in a different way. However, if we really want change in our healthcare services, we need to do more than talk about “transformation”; we need to truly shift the mindset of politicians, professionals, and the public to NHS services.

During Covid-19, service innovation suddenly became possible at break-neck speed. For years, the NHS has been calling for a greater prevalence of remote consultations, allowing patients to be seen quicker and without the risk of attending hospitals; where these had previously been resisted, they have now become commonplace. The NHS App – launched and rapidly expanded under the tech-loving leadership of Matt Hancock – saw a 111 per cent increase in registrations in March 2020. Patients have embraced new service models; this shift needs to stick long after the Coronavirus is over.

The causes of this recent rush towards remote care are clear: closed services, constricted travel, and concern of contracting the virus in healthcare environments. However, as these drivers subside, we need to consider what was stopping people from shifting to them pre-virus.

A core issue of remote GP consultations is that residents can still only register with one practice at a time – which means that signing up to an app-based service such as Babylon cuts you off from face-to-face GP care completely.

However, an app can’t measure blood pressure, take samples, or listen to your chest (at least not yet). Surely the most effective model for an individual’s care would be a hybrid one, in which remote appointments could be used where possible, with the back-up option of requesting a visit to a local surgery; this is not an option under the current restrictions. The one-registration rule was created to allow for a single location of health records, but now that technology allows people to hold their own records – readily accessible on their mobiles – it’s time we scrapped it.

Whereas remote GP services are readily available but not necessarily taken up by patients, remote hospital outpatient services are often not even available as an option. Many hospitals have started to implement new models such as telephone or video appointments and community clinics, but the pace of change pre-COVID was frustratingly slow.

In 2019, the Shelford Group of leading hospital trusts wrote that change should be driven, in part, at regional and national levels. Whilst many hospitals have created innovative solutions, it is prohibitively expensive to expect each organisation to invest individually in the development and implementation of these schemes. The national Outpatients Transformation Programme – still yet to be formally established – must be an NHS priority, either to provide much-needed support to existing partnerships or to lighten the load by sharing best practice and cost.

Funding and resources will need to both enable and follow these new structures. Critically, there will be a large infrastructure cost. The ‘NHS England Med Tech Funding Mandate’ makes organisations responsible for investing in innovation expected to deliver same-year savings, but central funding schemes must be increased and made more readily accessible for major investments.

Implementing new technologies will require a workforce with additional skills and an open conversation between professionals and politicians to tackle our existing workforce shortage.

It will also require a shift in where the workforce sits. The benefits of at-home consultations will only be maximised if follow-up care can also be done in the community or even better in the home as well. In February 2020 just 21.1 per cent of nurses and health visitors worked in the community – down from 24.2 per cent in February 2010. A lack of community nurses contributes to the centralisation of care into hospital settings. We must act to reverse this trend.

Finally, we cannot expect all models to work first time round – successful entrepreneurs often have failures amongst their successes, and we need to give the NHS room to take risks as it improves. One anaesthetist summed up much of the issue in describing the need for “permission” (and a common understanding of it) to try new ways of doing things, and the average tenure of an NHS Trust CEO is just three years – not enough time to implement a major transformation. Politicians need to provide professionals with the air-cover to innovate.

Of course, these are just some of the changes needed to help our NHS services to survive. To truly alleviate the pressure, we need to improve public health, and Boris Johnson is absolutely right to be launching a national anti-obesity drive. However, whilst we’re starting on that journey – which will surely be decades-long – we must continue to protect our NHS past Covid-19 by ensuring it is free to make the step-change towards sustainability it desperately needs.