NHS Reset: Reflections and learning from COVID-19

Since the onset of the pandemic there have been widespread concerns over the outcomes for all patients – COVID-19 and non COVID-19. These concerns are reflected in the national direction set out by Simon Stevens and Amanda Pritchard for the NHS entering phase two of the pandemic response, which involves a significant increase in services that are not related to COVID-19. The experiences of providers across the Shelford Group in responding to the height of the acute phase of the pandemic, highlights a number of themes considered crucial in shaping the response to subsequent phases. These are also relevant to the long-term arrangements for provision in health and care.

Care homes

 The financial fragility and unprecedented workforce challenges facing the care home sector entering the pandemic has been the subject of repeated promises but regrettably characterised by inaction. While there are excellent examples of integrated provision and collaboration across the NHS and social care, there are substantial variations across the country which have been highlighted during the pandemic by extreme variations in outcomes and the desperate nature of the situation overall. The NHS approach to recovery cannot be isolated from social care.

Innovation and research

The strength of the NHS in working alongside universities, charities and industry partners to make the UK a global centre for biomedical research excellence has been brought into sharp focus. Testing, therapeutics, vaccination, artificial intelligence, population health, breathing aids and ventilators: all of these areas demonstrate the prominent role of NHS providers. Supporting this excellence in the long term will prove essential to optimising the UK - and global - response to this pandemic, as well as driving improved outcomes beyond the pandemic. This will require tackling funding challenges which major research charities are facing and ensuring the stability of the university sector. It also presents an opportunity to make the UK a more attractive destination for industry investment, not least by locking in the major achievements that regulatory partners such as the MHRA have delivered during the pandemic response.

System architecture

Now is a good time to reflect on what parts of the NHS architecture, between direct patient interactions in providers and major policy decisions in Whitehall, have genuinely added value to the pandemic response. Listening to provider leaders will offer telling insights into what has worked well in the NHS response to the pandemic and what the implications are for shaping the longer-term thinking about organisational models and governance arrangements. In the acute sector, systems which achieved a rapid coordination in critical care decision making and capacity across providers have been able to demonstrate an adept approach to managing acute COVID-19 patient needs across organisational boundaries. Clinical networks have often been central to these, placing clinical expertise and evidence at the heart of service delivery.

Workforce

Valuing and supporting people across health and social care is rightly a focus of national NHS leaders. There are important insights to be gained from local successes (such as the positive effect early widespread testing of staff has had in some NHS providers) and overseas (particularly from countries responding to SARS in 2003 and their emphasis on steps to address the mental health needs of staff). We need to look after staff. We need to recognise that this will place a constraint on the pace of expanding non-COVID services. We need to realise the opportunity to lock in innovations which have been embraced by the workforce. We need to seize the many positives as a strategic platform for recruiting, training and retaining the workforce across health and care to address the long-term staffing gaps that became pervasive over the last decade.

Deprivation and inequality

The pandemic has created a dynamic which is amplifying inequalities across the population. There are multiple mechanisms involved: the clinical risk profile faced by different groups across society, the skewed impact which economic hardship will have on the most deprived communities and complex effects of social isolation. Major public sector bodies within a city region have an opportunity to forge stronger collaborations across sectors to drive local economic development and address the wider determinants of health. Now is the time for investment, innovation and ambition in public service provision.As we approach the reset agenda together it will be important to find ways to ensure that insights are shared effectively, lessons are acted on and that the spirit of openness and collaboration defines the relationships across every part of the system. This has widespread consequence: hospitals and care homes; think tanks and charities; universities and research bodies; multinationals and SMEs; government and arms-length bodies - we can all strengthen our approach to the next phases of the pandemic by embracing what it means to be an effective partner.

Nick Kirby is managing director of The Shelford Group. Follow them on Twitter @ShelfordGrp.