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Earlier this month, we published an update on COVID-19 and restoring rheumatology services looking at where we have come since the outbreak of COVID-19 in the UK, its impact on rheumatology services and the challenges departments will now be facing.

Later, we responded to an inquiry from the UK Parliament’s Health and Social Care Committee on workforce burnout and resilience in the NHS and social care. We’ve discussed what support rheumatology departments, and the wider NHS workforce, need to restore services and build resilience for the future.

Pandemic planning on the fly

One thing we highlighted in both these pieces of work was the amount of pressure being placed on the NHS workforce to prioritise their caseload, redesign services accounting for new ways of working, and now to meet the growing backlog of work. As we know, some health professionals in rheumatology we’re also redeployed to COVID-19 wards, given their experience in general medicine. 

New guidance, such as the NHSE specialty guides, had to be quickly be developed amid the pandemic. Departments had to move to remote working, putting in to place the necessary systems and IT equipment to do so. Some rheumatology departments struggled to get advice out to all their patients, leading advice lines to be overwhelmed.

The NHS found itself without contingency plans, and the pressure was on the NHS workforce to plan for a pandemic as it was happening. What this really underscores is that rheumatology services are under-resourced, with rota gaps, unfilled vacancies and increasing numbers of patients.

We know from National Early Inflammatory Arthritis (NEIAA) data that there's substantial variation in staffing numbers across the UK, and with regards to access to physiotherapy, occupational therapy, podiatry and psychology services. Departments were already stretched before the pandemic.

Restoring services

We’ve heard from some of our members that they are struggling to reinstate face-to-face clinics as their hospital managers question why this work can’t be done remotely. 69% of polled webinar attendees in late August reported their department has struggled to reclaim office and/or clinic space in order to restart their service.

Some departments are also finding it challenging, given the need for social distancing and infection control measures. This means that clinics have had to reduce the number of patients they see in a given day.

Preparation for winter and second wave

In an NHS Confederation member survey, only 2% of respondents felt fully prepared for winter and 5% felt fully prepared for a second wave of COVID-19. We don’t know what's coming over the next few months, but hopefully, early actions and restrictions on the public will avoid the need to pause appointments and elective care as we saw in the first wave of the pandemic.

Luckily, some of the needed planning, guidance and prioritisation work has already been done, if in fact services must stop. What we do know is what work needs to be done in the future to ensure rheumatology departments are resilient and prepared for such events:

  • Consistent UK-wide approach to the implementation of IT software to enable effective communication and remote working
  • Continuity plans developed to facilitate timely responses in future with minimal impacts on staff and patient care
  • Ability to communicate with patients to scale (ie via text, email, website updates)
  • Access to appropriate clinic and office space to allow for necessary face-to-face appointments.

Throughout the pandemic, BSR's provided support to the specialty through up-to-date advice, working with NHSEI and devolved nations equivalents, NICE and others to develop guidance on a range of topics. Our Clinical Affairs Committee continues to produce new advice related to new ways of working and the society continues to advocate for the specialty in reclaiming services and pandemic preparedness.

Please get in touch with us if you want to discuss these issues or need our support in restoring your rheumatology service.

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