Published: 4 June 2020
Authors: Professor Donna Hall

 

We have all witnessed a truly remarkable and rapid response from public sector organisations and local communities to the Covid 19 pandemic. Our health and care systems have worked together with tenacity, pace, imagination and creativity since the onset of the Covid 19 Pandemic. The clap for careers and frontline workers has now stopped, but people will never forget the sacrifices made since the middle of March 2020; however, the subsequent transformation that has been triggered beneath the surface will hopefully also be a lasting legacy.

NHS Trusts, local government, social care, housing, police, DWP and other public sector services have worked together with the local community and voluntary organisations and have broken down more of the historic “system rules” that previously appeared to prevent them working together as a seamless team to better support individuals and families.

Organisational cultures that were traditionally very set in their ways and have resisted transformation for many years have responded to the crisis by allowing innovation to happen; whether digitally-enabled consultants’ sessions, telephone appointments or releasing staff and resources to support care homes or urgent and emergency care.

The theories say that only two things tend to bring about deep-rooted organisational culture change and that’s either a change in leadership or a crisis and we are still in the midst of the biggest crisis of a generation.

But we have also been taught invaluable lessons about the importance of working locally as a health and care system in a place around individuals and families rather than around the silos of separate organisations and their national hierarchies. Care Homes were the last to receive support and attention as we focussed on hospitals rather than the people who pass between hospitals and social care. This has been proven to be a huge error of judgement. Protect the vulnerable - save lives would have been a preferable message to Protect the NHS - save lives.

So could the learning from our collective response to CV19 lead us towards a re-imagined health and care system?

Based on our learning including best practice from around the world and nationally, the key elements of our newly reset health and care system could include:

  • Collaborative system leadership from Council, NHS Trusts, CCG, Police, Housing, Schools, DWP, community and voluntary sector that focuses on their people and their place rather than their own individual organisational sovereignty
  • A whole place social contract with local people, similar to the Wigan Deal or a Co-operative Council that applies to all public servants and the way they work to share power and resources with local people through a new Community Paradigm
  • Pooled budgets to enable joint investment in agreed local priorities with a focus on early intervention and prevention
  • A performance management system which moves away from process focussed KPIs to outcome focussed measures for example “years of additional healthy life expectancy added”
  • Integrated strategic commissioning and delivery functions to co-design grassroots services based on the reality of how people live their lives with ease of access, digital options and person-centred approaches
  • Public health and a well-being approach at the heart of all public policy-making including licensing, planning, road and cycleway infrastructure, school expertise programmes, eg the Daily Mile.
  • A ban on the familiar treadmill of national pilots and schemes and a shift towards making the culture change stick beyond the pandemic as “just the way we all work together around here 365 days a year”
  • Shared multi-agency investment in local community and voluntary organisations to build the social infrastructure to support people with mental health issues, social isolation and loneliness and improve physical activity and well being
  • Integrated place-based public service teams based on populations of 30 -50,000 population as set out in the NHS Ten Year Plan; Sharing intelligence and developing plans in partnership with families to support them towards good health and well-being through a relational model, breaking away from the expensive and ineffective revolving door of assessment and referral
  • Frontline staff from all public services harnessing the assets in the local area, community centres, local businesses and open space with the freedom to innovate to work around the family and the individual and build relationships rather than just issue “social prescriptions”
  • A 7 days per week networked primary care offer through primary care networks feeding into integrated place-based teams with ease of access, digital options and online prescriptions
  • Healthy Living pharmacy and dentistry networked as part of primary care networks providing general health and well-being support.
  • Innovative and embedded integrated community care services, bringing together primary care, district nursing, mental health, school nursing, social care and advanced practitioners in whole person, whole family integrated care pathways providing care at or close to home
  • Excellent but smaller acute healthcare services accessed quickly with the right expertise across all our regions and resourced with high-level expertise and robust specialised care services for the times when people need specialist care for acute episodes
  • An integrated workforce plan across all public sector bodies in the integrated care system focussing on the values of the place
  • A workplace well-being programme with major employers to physical activity tackle obesity and improve positive mental health

The importance of local freedoms within a national framework has been shown to be essential during this pandemic, whether it is mutual aid with community groups to support shielded groups, sourcing PPE or delivering an overly centralised test and contact trace system.

With the right leadership and resources, local systems have the ability to truly transform health and care for the long term benefit of not just patients but for all people.