Hope on the horizon but challenges for NHS, the year ahead for health - Elsa Maishman

The year ahead will continue to be dominated by Covid-19. How could it not be? The biggest health crisis in living memory is not going to fade any time soon, despite the rollout of the vaccination programme.

The Covid-19 pandemic will continue into 2021.
The Covid-19 pandemic will continue into 2021.

For one thing, that programme will take some time. It’s not clear yet exactly when everyone in Scotland will be offered a vaccine, and it takes around a month from the first dose to maximum protection. That does mean that as we enter the new year the first batch of those vaccinated will be reaching their maximum immunity.

That isn’t complete immunity – it’s around 90 per cent effective – but it’s certainly something to celebrate. The vaccine programme represents a colossal achievement, for all the scientists working so hard to develop each of the vaccine candidates, and for everyone involved in the logistics of the rollout.

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It’s important to note however that we don’t actually know how long these vaccinations will last, as they are so new. Manufacturers have suggested perhaps a year. As we haven’t eliminated the virus in Scotland it’s predicted to become like seasonal flu, resurging every year and needing fresh waves of vaccination on a regular basis.

Resident Annie Innes, 90, talks with a healthcare worker after receiving the Pfizer/BioNTech Covid-19 vaccine at the Abercorn House Care Home in Hamilton.

The latest expectations are for the first wave of vaccination – of those who are in the highest priority groups, including residents and staff of older people’s care homes, those over 80 and health and social care workers – to be finished by the summer.

This will leave the latter half of the year to the rest of the population – and if the vaccine turns out to last less than a year, the Scottish Government will have its work cut out trying to re-vaccinate the highest priority groups again.

However, the first wave of vaccination will encompass the vast majority of those most vulnerable to the disease. Within that group are the majority of the deaths, of the serious cases, and of the resources needed by the NHS to care for them. Maintaining the immunity of that group will be the highest priority.

There has been a lot of talk about “herd immunity”, with public figures in Scotland saying we need around 60 to 70 per cent takeup of the vaccine to protect the population, which seems manageable. It’s very difficult to completely eliminate a virus - in humans there has so far been only one success story, smallpox.

The other crisis

So Covid-19 will dominate the health landscape in 2021. We will hear more news of setbacks and successes around the vaccination programme. There may be further good news about steps to develop treatments, which is another area that scientists around the world have been beavering away at for most of the past year.

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We will begin to take better stock of the pandemic in 2021, and the effect it has had on the population. In the second half of 2020 every new release of population data, from drug deaths to alcohol-related hospital admissions to vitamin D intake, prompted the question: ‘How will Covid-19 affect this?’. In 2021, we will find out.

The results are likely to be negative. The pandemic has taken a catastrophic toll on Scotland’s health services, and this is likely to become clearer next year. The months of NHS non-urgent shutdown and subsequent limited services have created a huge backlog whose extent we are only just beginning to appreciate. We have been papering over some of the cracks to get through the current crisis, but as we move on from a direct danger from Covid-19 we will see another crisis in all the gaps left behind.

Recovery of cancer services

There have already been stark warnings from cancer charities about the thousands of cases which went undiagnosed and untreated during the pandemic. This backlog has continued to grow, and applies to all areas of healthcare. GP surgeries are overrun, with doctors fearing they may miss urgent symptoms from patients who can’t or won’t get an appointment due to the pressure on services. There is also the worry that thousands of minor problems which a GP or dentist could easily have taken action on have been allowed to escalate.

The Scottish Government’s two-year Cancer Recovery Plan will come into force in January, and we will see if any of its mechanisms - including early diagnostics centres, a programme of “prehabilitation” to help patients prepare for treatment, and a single point of contact to support patients, can help to chip away at the backlogs.

Even before the pandemic, campaign groups were warning that Scotland was in the grips of a mental health crisis, with mental health issues in the population on the rise and access to services declining. This has been magnified by Covid-19, with services scaled back and reports across the board that the pandemic has negatively impacted people’s mental health.

The overarching impact of Covid-19 and its associated lockdowns has been to exacerbate existing problems. Like most things, it has a disproportionate negative effect on those in deprived areas, and it has underlined existing health inequalities.

Politics of health

Finally, as the incessant news about Covid-19 may begin to wane somewhat in 2021, those other big headlines will come back to the fore. The impact of Brexit on health and social care will raise its head again, in areas from recruitment to medication supply.

The Holyrood elections in May will undoubtedly bring promises and finger-pointing in the area of health from across the political spectrum. Opposition MSPs have already voted for an inquiry into the transfer of patients with Covid-19 from hospitals to care homes during the first months of the pandemic, and the Scottish Government has countered this with suggestions of an over-arching inquiry at a later date into the response as a whole.

Current Health Secretary Jeane Freeman has announced she will be standing down. It’s clear whoever replaces her will take over in a still unprecedented and extraordinary moment in Scottish health.