The refreshed NHS Long Term Plan must consider the vastly changed environment since its publication in 2019. Professor Sir Chris Ham and Matthew Taylor highlight six lessons learned during the pandemic that could be embedded in the revisions, to help the NHS tackle some of the biggest challenges in its history.
Shocks generate lessons. In the case of COVID-19, some of these lessons were negative, as in the UK’s lack of preparedness for a SARS pandemic. Others were positive, for example the way in which innovations such as digital technologies, home monitoring of patients using pulse oximeters, and effective treatments like dexamethasone were put in place.
There is a risk that the positive lessons are either forgotten or ignored as other priorities take precedence and business as usual resumes. This would be a missed opportunity when the experience of the pandemic could help the NHS tackle some of the biggest challenges in its history.
It will be imperative for a revised plan to reflect the vastly different environment we now find ourselves in
Over the coming months, NHS England and the Department of Health and Social Care will be refreshing the NHS Long Term Plan, which in 2019 set out a ten-year vision for the health service. It will be imperative for a revised plan to reflect the vastly different environment we now find ourselves in. This presents an opportunity for the key learnings of the past two years to be embedded into the ambitions for the NHS over the remainder of this decade. Six lessons stand out.
The role of local leaders and staff
The first is the role played by local leaders and staff in deciding what changes were required to meet the needs of patients with COVID-19 and other medical conditions. Of course, national leaders created the context in which these decisions were taken but devolved responsibility was one of the hallmarks of the response. Trusting local leaders and staff to improve services in work on recovery from COVID-19 must now be a priority.
For this to happen, the burden of regulation and oversight must be reduced. Governance arrangements should also be streamlined – as happened during the pandemic - to enable faster decision-making and release senior leaders to work on improving services. The process around appraisals and revalidation should be reviewed to create more space for innovations in care. Both the Care Quality Commission and NHS England need to ensure that regulation is proportionate to the task in hand.
The value of mutual aid
The second lesson is the value of mutual aid in enabling providers to manage peaks in demand during the pandemic. Partners in integrated care systems recognised that they were stronger when working together than in isolation and mutual aid was also provided across systems when required. The same principles are helping to reduce the backlogs of care that have built up and should be sustained at least until waiting times return to pre pandemic levels.
An early priority should be work to reduce delayed discharges. Difficulties in discharging patients when their treatment has finished are responsible for overcrowding in emergency departments, patients being held in ambulances until space in hospital becomes available, and long waiting times for ambulances to pick up patients who need urgent care. Patient safety is compromised at each stage of the journey and mutual aid involving health and social care is an essential part of any solution.
Lessons from the vaccination programme
The third lesson concerns the COVID-19 vaccination programme. This was delivered at pace and on schedule by the NHS in partnership with local government, the private sector, the military and volunteers working within a framework set by NHS England. A similar approach, making use of expertise in different sectors and drawing on evidence-based guidelines, could bring huge benefits in tackling major causes of ill health such as cardiovascular disease and cancer.
Data and population health
Fourth, the pandemic demonstrated the power of data in population health management. Information held by general practices and other parts of the NHS enabled vaccines to be administered in line with the recommendations of the Joint Committee on Vaccinations and Immunisations. Likewise, analysis of vaccine uptake supported efforts to achieve equitable coverage in the population. Intelligent use of data should underpin work on other public health priorities.
The power of people and communities
The fifth lesson is the role of people and communities themselves in mitigating the impact of the pandemic. This was evident in high levels of compliance with advice on social distancing, mixing with others, wearing face coverings and working from home where possible. Voluntary and community sector (VCS) organisations, including faith groups, worked closely with public agencies in providing practical support to people who were vulnerable and enabling services to reach different communities.
Much effort is going into changing how care is delivered. A similar focus is needed on how demand arises in the first place
Much effort is going into changing how care is delivered. A similar focus is needed on how demand arises in the first place. Understanding what matters to people seeking care and working with VCS organisations to find effective ways of responding should be the starting point, learning from Wigan and other areas that have shown the benefits of this way of working. Harnessing the power of people and communities has never been more necessary or more urgent, based on robust engagement and co-production with the public.
Virtual wards are being rolled out to reduce pressure on hospital beds and allow people to be treated in their own homes. Anticipatory care and patient-initiated follow up (PIFU), meanwhile, will enable individuals to take a more active role in determining and communicating their own care. Such initiatives are to be encouraged, but they will require a different kind of relationship between clinicians, patients and carers.
The disease of disparity
Last but not least, the pandemic laid bare stark and growing health inequalities across the country. In many areas this has galvanized innovative action on addressing what the Secretary of State has described as the ‘disease of disparity.’ In Norfolk and Waveney, local leaders put addressing inequalities at the heart of the vaccination programme, while in Bradford a proactive care service was redesigned to support people with specific needs.
In acting on these positive lessons, it is important to acknowledge that the NHS will not receive additional funding … on the scale seen during the pandemic, and that staff shortages remain a major constraint
Looking ahead, local action to reduce inequalities must be supported by cross-government action at national level.
In acting on these positive lessons, it is important to acknowledge that the NHS will not receive additional funding from the government on the scale seen during the pandemic, and that staff shortages remain a major constraint. Indeed, given inflationary pressures, ministers have made clear that the NHS will be expected to do ‘more with the same’ for the foreseeable future. Building on what was achieved in the NHS during the pandemic would be a good starting point.
Professor Sir Chris Ham is co-chair of the NHS Assembly
Matthew Taylor is chief executive of the NHS Confederation
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