Repurposing NHS Test and Trace for a cost-effective health service
As COVID-19 case numbers fall, we have a group of potentially redundant clinicians who have developed the skill set to manage health issues with members of the public over the phone. At the same time, it is estimated that 15 million people in England have one or more long-term conditions (LTCs). The WHO has already identified that treating such conditions in acute settings is not an effective treatment nor a cost-effective strategy. Now that telephone health management has become a part of the public consciousness, we should build on the IT systems in place and use the clinicians within Test and Trace to manage and improve LTC patient outcomes.
According to a Commons Select Committee, one of the biggest challenges to face the health service is the management of those with LTCs. However, the NHS has been built to tackle acute issues. The WHO recognises the inability and inefficiency of acute settings to manage chronic conditions. Their briefing paper on innovation in this area recommends that, for developed countries such as ours, innovation in healthcare models is needed, along with mass marketing to shift the thought paradigms within the population. The WHO also recommends a multi-sectorial health body to treat and manage long-term conditions, along with a range of staff utilising phone and digital platforms for the dissemination of information and patient access. Test and Trace, with the utilisation of multi-disciplinary clinicians to contact the public, has in essence become a pilot project to test the medium. Statistics suggest that 70% of the health and social care budget is spent on 30% of the population. The reality of this statistic is that patients with LTCs are visiting healthcare settings regularly and are desperately seeking help and advice to best manage their lives. A general search on the Internet demonstrates the many and varied patient groups that have been set up for those seeking advice and guidance for their diagnosed chronic conditions, from fibromyalgia to arthritis to loneliness. There is a great need in these patient groups for reliable advice from experts to help them understand and manage their conditions. Research has shown that acute settings are not the best places to manage chronic conditions. Presently 111 and 119 offer the telephone as a way for patients to seek advice. However, with Test and Trace clinicians make the call. GPs and local authorities could refer to a rebranded Test and Trace, namely NHS Lifeforce. A mass marketing campaign could promote the service to ensure that the public knows that it is trusted clinicians on the phone line offering evidence-based advice. NHS Lifeforce would be a more appropriate way to treat chronic conditions, with opportunities for regular engagement and motivation. It would also be a more cost-effective way, using the phone, text messaging as well as emails and letters rather than 10-minute GP slots and long-awaited hospital appointments. Support and advice could be scripted and focused on issues such as mental health problems, obesity, diabetes and lifestyle choices. It would also be an opportunity to tackle the silent but deadly issue of loneliness that can so often lead to long-term conditions. NHS Lifeforce also offers a way to utilise the clinicians and the IT systems already created for Test and Trace, rather than discard them or have a reduced staff work to the narrow brief of infection control. For those frontline staff who have become burnt out and may be on the point of retiring, this would offer an ideal setting to use their experience and skills. NHS Lifeforce could work in the same way as Test and Trace with clinicians working a varied pattern of shifts from home and 7 day working 8am-8pm. A pilot project working with patients with “Long Covid” would be an appropriate place to start. There are estimated to be 300,000 to 400,000 patients diagnosed with this type of chronic fatigue condition. In summary, the system set up for Test and Trace should be adapted to offer the public a new, innovative, preventative and thereby cost-effective model for managing long-term conditions.