Campaign themes

The health and care workforce are, and will remain, at the heart of how we deliver care and services to patients and their families. Over the course of the COVID-19 crisis, the spotlight has shone on their hard work and dedication, highlighting the extent to which they are valued by the public. But it has also pointed to a number of underlying issues that must be urgently addressed.

Since May 2020, we have been working closely with health and care organisations to support their response to the pandemic, share best practice and identify what they need to see them through the next few months and beyond.

Our report, COVID-19 and the Health and Care Workforce, summarises our engagement, focused on three core issues.

To support health and care organisations through the second surge and its aftermath, we're calling for national investment to:

• workforce inequality
• staff experience
• workforce supply.
• continue investment in staff mental health and wellbeing services to supplement local initiatives
• grow the clinical workforce and address long-standing and critical workforce challenges, particularly in mental health and learning disability nursing, and smaller allied health professions
• continue to deliver national attraction and recruitment campaigns for health and social care which attract people into both employment and university healthcare training places
• deliver a pay and reward offer that is funded and sustainable, which recognises the skills and talents of the workforce.

While ostensibly a physical health issue, COVID-19 has, and will continue to have, huge implications for mental health providers and the individuals they support.  
 
The impact of COVID-19 on mental health and mental health services will be felt long after the physical health crisis subsides. Self-isolation, financial insecurity, bereavement and increases in substance abuse and domestic violence will affect both people with pre-existing mental health conditions, the general public, and the health and care workforce, with certain demographic groups disproportionately affected.  
 
For NHS-funded mental health services to be given a fighting chance to meet the increased needs of both those with an existing mental illness and the general population, several key conditions must be met: improved modelling and extra resourcing to meet additional demand; system-wide working; support for staff wellbeing; locking in effective innovations; and a cross-government approach to supporting the mental health of the nation. 
 
To prepare for the expected surge in demand, we’re calling for:  

• Urgent work to better understand expected demand and its impact in different areas and groups. 
• Public Health England to lead an enhanced, national, public health approach to suicide prevention, targeted to those most at risk. This strategy must include the continued expansion of employment support. 
• Increased financial support and recognition for third sector organisations that support NHS mental health services. 
• Funding levels to be reviewed in light of the new normal and adjusted where necessary to meet increased levels of demand. 
• The needs of the mental health sector, including additional capital funding and workforce, to be prioritised at system level. 
• PCNs and mental health providers to work together to provide more seamless, integrated mental health care for both the general population and those with an existing mental illness. 
• NHS trusts to look at practical ways they can better support and integrate their third sector partners, such as supporting access to NHS Charities funding and sharing access to digital platforms. 
• A long-term, sustainable settlement for social care, that recognises the specific requirements of working-age adults with mental health needs. 
• Learning from the trailblazer mental health support teams to be used to inform the expansion of the teams to cover 100 percent of the student population, an increase on the current commitment to cover 25 percent by 2023. 
• Health Education England to lead a dedicated campaign to encourage people into mental health careers. 
• Additional, long-term funding to support the increased use of digital approaches. 
• The experience and views of service users to be taken on board when looking at what innovations are maintained post pandemic. 

Find out more in our report: Mental health services and COVID-19: preparing for the rising tide.

The way that core NHS services resume and work alongside COVID-19 will be a key issue for NHS Confederation members and one of the biggest challenges healthcare policymakers, leaders and clinicians will have faced for decades.

Love and appreciation for the NHS and social care have been apparent throughout this crisis. As we move to resume NHS services against a challenging backlog of need and with a workforce that has faced unprecedented challenges, we will need to ensure that services resume in the most appropriate way.

This theme will support members and stakeholders with this task, ensuring that their perspectives are represented as mainstream NHS services come back onstream through NHS England and NHS Improvement’s (NHSEI) Restoration and Recovery Framework. Our areas of focus will largely be set by the key issues identified by NHSEI in their planning for resuming NHS services as well as emerging issues highlighted by members and stakeholders.

The COVID-19 pandemic has thrown into sharp focus the issue of health inequalities in the UK and exposed the consequences of a long-standing failure to tackle this deep rooted and multi-faceted problem. 

Since June, we have been engaging with our members on this issue and how to shift the needle. Our report, Health Inequalities: Time to Act, summaries our engagement and what members have identified as potential ways forward. 

The COVID-19 crisis has required the NHS to operate differently. In days and weeks, our members have transformed clinical practice on a scale that would ordinarily take several months and years.

Change happened at an extraordinary pace in every part of the health and care system, built from the bottom up by leaders who united around the shared challenges presented by the pandemic. This was facilitated, in no small part, by the removal of various bureaucratic stumbling blocks that have previously hindered progress, including in improving patient care. 

As we move into the next phase of the pandemic and prepare for winter, healthcare leaders are keen to reflect on and learn from their experiences and develop a new and different regulatory environment.

Our report, Lean, Light and Agile, reflects the discussions, roundtables and webinars held with front line health leaders and partners, including the Care Quality Commission, since the start of the crisis, exploring the learning and what it means for a fundamental reset of governance and regulation in the NHS.

As COVID-19 pressures begin to subside, the integration of health and social care at a local level will need to go ‘further faster’, building on the relationships, structures and learning that have rapidly evolved during the pandemic. 

This theme will define and influence what system and place level working need to look like and how they should be best enabled from the perspective of our members.  

Prior to COVID-19, NHS England and NHS Improvement described 2020/21 as a year for delivering system by default in ‘shadow form’. The expectation was that all systems would achieve integrated care system (ICS) status by 31 March 2021. 

Members tell us that COVID-19 has significantly accelerated transformational change, much of which has been enabled by the structures and ways of working created through partnerships. Examples include significant re-shaping of acute care services at pace into ‘hot’ and ‘cold’ COVID-19 sites, digital transformation, shared leadership from health and care leaders, as well as changes to clinical pathways at a scale never previously seen. 

This theme will engage with members across the NHS and with local government to define and influence what effective system working should look like and how it should be enabled. Key themes will include:

• authority and powers
• influencing national policy around the move to ‘system by default’ 
• the changing nature of accountability and regulation
• shaping the future of clinical commissioning in the context of integrated systems 
• exploring the role of place 
• the changing role of providers 
• exploring different leadership models
• the role of primary care networks in neighbourhoods
• the future financial architecture of the NHS and how to simplify payment systems
• what patients think about some of the service integration that has been enabled at pace.

The COVID-19 health emergency is anticipated to leave a social and economic downturn in its wake. Health services have a vital role to play in the wider recovery and rebuilding of local economies and communities – driving up prosperity, population health and wellbeing. 

This theme will support, promote and facilitate better understanding of the health service’s crucial role in economic and social recovery. 
 
The impact of COVID-19 will reverberate through communities on a previously unimaginable scale, requiring sustained action from national and local leaders across every sector. The typical impacts of a deep recession on health and wellbeing are relatively well known, with significant implications for the tax-based financing of the NHS, increases in demand for a range of services and a general decline in the mental health and wellbeing of the population. 

The anticipated COVID-19 recession will be untypical given the rapid speed of unemployment, unprecedented extent of UK and devolved government intervention and scale of industrial damage. With the UK already one of the most regionally imbalanced countries in the OECD, our ability to narrow existing inequalities will be severely stretched.
 
An important part of the NHS Reset campaign is recognising that the health service across the UK will have an important role to play in the wider recovery and rebuilding of local economies and communities. 

In particular, this will involve transforming public service planning and delivery throughout a time of unprecedented economic and social disruption – pushing the service to understand its impact and value as local anchor organisations well beyond traditional sectoral boundaries. And using the greater system approach now emerging to drive up population health and wellbeing. 

While this will certainly bring challenges for leaders, there are opportunities for a more focused ‘health and wellbeing in all policies’ approach to future decision making nationally. And new and innovative local partnerships focused on issues such as workforce and supply chain development, community working and population health. 

The COVID-19 crisis has one again demonstrated the need for a new settlement for social care and highlighted the critical role the sector plays in the delivery of health and care services. The disparity between the NHS and social care services has been laid bare, exposing vulnerabilities in funding and market stability, workforce and data, PPE and testing, and care home deaths and contingency planning. This has had a marked impact on patients, families and communities.

This theme will push for a fundamental shift in how we think about and fund social care, calling for  social care to be put on an equal footing with the NHS.

The immediate focus has been on dealing with the impact on social care and care homes, but it will be critical to consider the need for longer term reform of social care. 

The fragility of the care home market has been debated widely and features high on the ‘worry list’ for both the NHS and local authorities. Now is the time to work together on a future system redesign to learn from the transformation and develop a sustainable social care system fit for the future. This requires a fundamental shift in how we think and fund social care in the future.

One of the most striking aspects of the system response to COVID-19 has been the way in which our leaders, clinicians and partners from all sectors have worked in new ways to discuss, develop and deliver services in unprecedented circumstances. It is vital that we now build on this sacrifice and achievement to collectively reset the way we plan, commission and deliver health and care.

As part of NHS Reset, we are working with the AHSN Network and the Health Foundation to focus on how the health and care sector can work with staff, patients and the public to understand, translate and adapt the best of COVID-19-related innovations and initiatives into everyday practice – maintaining momentum, sharing what’s working and improving people’s care.  

This collaboration will build on the knowledge, expertise and national and local reach of the three organisations to support the health and care sector to understand what changes have taken place in response to COVID-19. We will explore what clinicians, leaders and innovators believe should be retained, adapted, reinstated or stopped, and for which populations or settings. And critically, how we should collectively build on the rapid progress made to accelerate the reset and ongoing improvement of health and care planning and delivery. 

Rapid innovation and learning have been at the heart of our immediate response to COVID-19. It must remain at the heart of what we do as we transition to managing its medium and long-term consequences.

Key areas of focus

This collaboration will focus on three important areas:

What‘s working well? Identifying and understanding what’s working for whom

The speed with which the health and care sector has transformed services in its early response to COVID-19 has been extraordinary. At the heart of this progress has been greater empowerment of clinicians and local leaders to adapt and develop their services. It is vitally important that this progress in implementing local service change is not lost in the rush to return to business as usual.

We need a consistent and forensic focus on identifying, analysing and showcasing the innovation that has happened in different settings as we seek to understand which changes are improvements and for whom, coupled with the honesty to accept not everything will stand up to this scrutiny. 

Our work will explore the changes that have taken places in the first months of responding to COVID-19, the conditions and ways of working that have enabled innovation to thrive, and what is needed now and in coming months to sustain this. NHS and social care colleagues need to act quickly to capture the range of innovations that have taken place, gather data about their efficacy and desirability for the future, and understand what it would take to sustain and scale them. 

The race to systematise service innovation: how to make the changes in practice and mindset sustainable

The roll out of new service innovations and products across the sector has been stimulated and supported by a shift in both practical support, and mindsets. Practical support has included the injection of additional finance, and reduced reporting requirements. Many have noted a mindset shift, for example in leadership permission for risk appetite, local experimentation and frontline-led change.

This emergency COVID-19 response funding, while significant, is non-recurrent, putting at risk any new ways of working and innovations that are not fully embedded into daily working practice. In parallel, the return to ‘business as usual’ risks a return to ‘mindset as usual’, narrowing the headspace, autonomy and resources our leaders and clinicians have to understand, iterate and adapt the emerging improvements in service design into routine care.

In effect, we are in a time-limited race to systematise positive service innovation and practice – with local systems and NHS and care organisations requiring, for example, proof of concept in different settings, an understanding of training and development needs, business case agreement, aligned future research priorities and adapted service strategies to ensure all is not lost. What needs to be done to embed changes and modernise how we work before the opportunity to reset how we work is lost? 

A spotlight on the wider system: how to ensure the focus is retained on the integration agenda, and community, primary care and social care

While the impact of COVID-19 has been felt across the whole health and social care sector, it has also exposed the historic lack of focus, resource and support we have given to some parts of the system. Across the UK we have seen innovations created and delivered on the ward, in the community and in the care home. They are all playing a critical role in enabling rapid service change and need to be considered collectively by policymakers and system leaders as we seek to understand what resetting health and care might look like. 

This means placing more emphasis on primary, community and social care settings in particular. How can we support a change in the behaviours, culture and investment in innovation and improvement in these areas? What do patients think of the new innovations driving system change? What good practice already exists that can be interwoven with traditional innovation pathways and partners to build stronger systems from the bottom up? How can having a COVID-19 innovation focus truly support the development of our integrated care systems? 

At the peak of the COVID-19 crisis, many of the traditional ways in which the NHS engages with people and communities were paused out of necessity. Normal methods of engagement and open governance were neither safe nor practical at a time of national lockdown. At the same time, the NHS established a model for the idea of shared responsibility and a new ‘social contract’ with local communities.

Health and care leaders are keen to explore this new relationship and the opportunities to create a new ‘deal’, whereby people are active and engaged partners in the development of healthy places, not merely consumers of NHS services. A new relationship based on meaningful patient and citizen engagement, informed by community insights and underpinned by trust.

Our report considers how the NHS can cultivate a new relationship with people, patients and communities following the pandemic.