COVID-19 has exacerbated many of the health and care services’ pre-existing challenges. But it has also shown what teams can achieve when they have the tools and resources they need. The NHS’ response to COVID-19 has been nothing short of heroic. Now, as the acute crisis transitions into a long-term challenge, it is time to take stock, learn lessons, and build back stronger. Findings from the NHS Reset report can help us do this.
The health service cannot achieve greatness alone. It needs new frameworks, new ways of working, and new funding models. That’s according to a new report from NHS Reset, an NHS Confederation campaign to help shape what the health and care system should look like in the aftermath of the pandemic.
‘COVID-19 is the greatest challenge we have faced as a country for more than two generations. As we head towards what could be one the deepest recessions, its impact will be felt for years to come,’ said the authors.
The triple whammy
Before anyone had even heard of COVID-19, the NHS was already under significant pressure. But despite dire predictions of the pandemic overwhelming services, teams up and down the country coped by working tirelessly and adapting rapidly.
‘Perhaps the most surprising development…has been the way in which so many services have, out of necessity, been transformed – sometimes in ways previously unimagined. Changes that would have taken years have been delivered in weeks.’
As we emerge from the initial crisis, the service is now facing a ‘triple whammy,’ the publication, NHS Reset: A New Direction for Health and Care, continued.
‘It must deal with local outbreaks and a second surge. It has to manage a huge backlog of treatment that has built up during the pandemic. And it must do this and restore services with reduced capacity as a result of infection control measures. On top of this… staff are exhausted.’
The time is ripe, then, for a reassessment of what the NHS can realistically be expected to deliver.
‘What capacity and resources does it need to meet the challenges ahead, and what steps are needed to liberate and empower local leaders to work with and find the right solutions for their communities?’
In a bid to answer these questions, the federation has surveyed 250 NHS leaders and held more than 50 webinars, roundtables, and private meetings over six months. Of the issues the resulting report highlights, all are pre-existing challenges that have been brought into sharp focus by the pandemic.
“Perhaps the most surprising development…has been the way in which so many services have, out of necessity, been transformed – sometimes in ways previously unimagined. Changes that would have taken years have been delivered in weeks”
The second Marmot report, published just weeks before the virus arrived in the UK, found that health inequalities had widened between 2010 and 2020, and that improvements in life expectancy had ground to a halt. As COVID-19 swept the nation, the implications of this were laid bare.
Overall, 90% of survey respondents believed that addressing health inequalities must be at the forefront of the reset process, and 80% said tackling the issue should be a key performance measure.
A national framework that gives local leaders the autonomy to develop community engagement and co-design services that meet local needs, backed up by appropriate, ring-fenced funding, is key, they said.
Dr Mark Spencer, GP and Co-Chair of the NHS Confederation’s Primary Care Network (PCN), said: “We are always telling communities what they need, rather than genuinely listening and co-producing. PCNs have an opportunity to re-frame the narrative, to listen and build bridges and to work with communities in a meaningful way over the longer term.”
Health and care workforce
At the start of 2020, there were 90,000 NHS and 120,000 social care vacancies. The consequences are now starting to bite, said the report, which found that 85% of NHS leaders believed understaffing was putting patient safety and care at risk.
‘Colleagues across all parts of the system have mobilised their resources, including volunteers and students. Current staff stepped up and into other roles; leavers offered to return; and corporate and administrative team colleagues adapted quickly to new ways of working,’ said the authors.
‘But as services are restored, pre-existing workforce shortages are starting to show. At the same time, members are keen to ensure that staff who have worked tirelessly for the last few months are able to take a proper break.’
NHS leaders need investment to support staff wellbeing, and clarity on future recruitment, they told the federation. ‘In particular, they need commitment to increased support for undergraduate study, support for workforce placements of additional healthcare professionals, and continued support for national recruitment campaigns for health and social care.’
Funding and capacity
The NHS was already struggling to meet demand long before COVID-19 threatened to overwhelm the system. Now it is faced with the challenge of bringing services back online, dealing with the backlog of the last few months and surges in demand for mental health and community services, all while managing Covid patients and adhering to infection control measures.
Since the start of the year, there has been a step change in how health services use technology, such as telemedicine and AI diagnostics, to expand capacity – but tech alone is not the answer.
According to the report, NHS leaders need more financial support, a simplified bidding process, and realistic expectations. ‘The commitment of NHS staff to do their best for the public has been demonstrated many times over during the pandemic. Politicians and national bodies need to support the NHS to manage the realities of recovering services, not set unrealistic targets and impose financial penalties,’ said the authors.
“NHS leaders need more financial support, a simplified bidding process, and realistic expectations”
Integration & system working
From working together to acquire personal protective equipment (PPE), to coordinating patient discharge and community outreach, COVID-19 has demonstrated the importance – and strength – of joint working.
Alison Lathwell, Strategic Workforce Transformation Lead at Bedfordshire, Luton and Milton Keynes ICS, said: “The COVID-19 response has propelled joint working across the NHS, social care and wider public sector teams. We have seen rapid decision making and (safe) bypassing of the rule book, which has resulted in more effective up-skilling, such as forward-based staff developing critical care skills or mental health nurses delivering end-of-life care.”
But while the NHS Long Term Plan is clear about a shift to integrated care systems (ICSs), there remain several uncertainties about how they will operate, and the extent to which they will be underpinned by new legislation.
Architecture that supports integration and partnership working, as well as a ‘fit-for-purpose financial framework’ that moves away from the transactional relationships created by payment by results, are vital, the report found.
The pandemic has highlighted the critical role of social care, while simultaneously exacerbating its underlying weaknesses. Staff shortages, a severe lack of funding, the absence of robust data and access to PPE and testing have all exposed the need for ‘urgent government action to fix social care.’
Michael Williams, Chair of the Nottingham City Care Partnership, told the report’s authors: “It has taken the combined efforts of many agencies to tackle COVID-19. It has forced a new level of cooperation and trust.
“It has also exposed, both nationally and locally, the key importance of a more integrated approach to health and social care.”
Professor Donna Hall CBE, Chair of the Bolton NHS Foundation Trust, agreed, adding that the crisis had, more than ever, demonstrated how intrinsically linked health and social care are.
“But it has also exposed the stark divide between the two in our failure to treat them as a single system and offer parity in the value we apply to social care and the NHS,” she said.
If the NHS is to survive, the government needs to immediately provide social care with the funding it needs to respond to COVID-19 and its aftermath, whilst addressing the longer-term need for a multi-year funding settlement. The sector also needs a ‘clear road map’ that supports and runs in parallel to the Long Term Plan, said the report.
The COVID-19 pandemic will change the way health and care services are planned, commissioned, and delivered for years to come.
It may have intensified many of the health and care sector’s pre-existing challenges, but it has also shown how much teams on the ground can achieve when given the tools and resources to do so. The challenge now is to ensure the beneficial changes are sustained, according to the report.
‘Some of our NHS Reset work asks for structural change in the NHS and social care, a changing of priorities, and a change in the way that we think about health and care. But much of what NHS leaders talk about is practical – about supporting the lean, light, agile, and patient-focused culture that developed in the spring,’ the authors explained.
The NHS is not out of the woods yet, and right now, quite rightly, it is focused on managing the extra demand on services this winter.
‘However, with an eye on the longer-term outlook, there has been one enduring message that we have heard from NHS leaders: the health and care system must build on the remarkable progress of recent months to chart a new course,’ they concluded.