Delivering core NHS and care services during the pandemic and beyond

Key points

• Challenging landscape pre-COVID-19:The NHS has achieved significant feats since the COVID-19 pandemic broke out in the UK, yet the difficult landscape the health and social care sector was working in at the start of 2020 should not be forgotten. In many instances the new challenges presented by COVID-19 have served only to highlight existing challenges from workforce vacancies, missed performance targets, financial strains and the NHS’s vital interdependencies with other public services and with industry.
• Supporting NHS and social care workforce: We have seen a rapid transformation in clinical practice, innovative approaches to leadership and provision, and a much greater understanding of the skill, value and flexibility of our people and workforce. The impact of COVID-19 on the dedicated staff providing health and care and wider public services will be significant, with personal sacrifice and loss coupled with the unrelenting and unprecedented demands made of them. We do not yet know what the long-term impact will be on staff mental health and wellbeing.
• Restoring services: The health and care sector is now urgently developing plans to restore critical services. It is doing so alongside severe economic and social disruption, the prospect of higher unemployment and an expected rise in health inequalities. Many of our members are thinking ahead about the needs of patients and providers across their populations, anticipating, for example, the increasing mental health needs and needs within the acute, community and primary care sector. With this, the sector will need clarity on the regulatory and care quality standards that will be re-introduced and how this will be managed during the recovery period.
  
  There will be huge issues in restoring services which many feel will be more challenging than switching to a COVID-19 service in the first place. In part this is because the NHS will need to retain care for COVID patients while restarting other services. The levels of unmet demand, which were already an issue before the pandemic, will be very great and it is likely we will see a very significant increase in the acuity of patients. And winter looms, creating the risk of what one of our members described as a potential perfect storm.
  
  This will require a joined-up approach across health and care, capital and community recognising the interdependency of the whole system. It will also require a move from the top down, command and control mode of operation we have seen during the pandemic. We need to liberate local initiative and especially clinical and professional expertise to shape policy going forward.
• Future changes to system architecture needed: COVID-19 has changed the way everyone works, and it has a profound impact on the health and social care sector. This is already presenting major challenges for NHS leaders but it is also being seen as an unexpected and welcome opportunity to ‘reset’ the NHS and indeed the wider care sector. It will call for a fundamental examination of the relationship between local organisations and systems on the one hand and the national bodies on the other. And at local level it is clear we can no longer regard health and care as two systems and in particular, we must abandon the all too common assumption that integrated care systems are NHS entities.
• Capturing benefits of technology: There has been a number of developments in the NHS including the use and integration of digital services which have spread through the NHS and care sector at a pace previously unimaginable. Removing some of the obstacles that have made keeping up with technological change cumbersome would enable patients to benefit from faster, more personalised and joined up services.