The first duty of Government is to protect and defend its citizens. Maintaining a healthy population will be vital to our economic future from which we derive the means to deliver life enhancing projects to our people.
A global pandemic is clearly an exceptional event but, in our densely populated, interconnected world, it may prove to occur more often than we would wish and our need to drive international trade will make the UK more not less susceptible. We need to be much more successful at managing it next time. This should include the following steps:
1. Leadership and Planning
In our catastrophe planning we need to settle the question of leadership and governance of the recovery effort before disaster strikes, otherwise confusion reigns and people die. Strategy should be set centrally but execution should be delivered locally. The job of central government is to set direction and ensure that the right resources are available. Local leaders are then responsible for executing the plan. This needs to be sorted out in peacetime. Quarrels in the playground at the height of the battle are very damaging and do not inspire public confidence at a time when extraordinary sacrifices are required.
We need a reliable set of key metrics in order to manage the situation. This may exist (after we discovered how to count deaths properly) but its not acceptable that there is a gap between Saturday and Tuesday before we know the real trends. Weekends are a peace-time concept; 48 hours delay could turn out to be vital.
Procurement and supply processes and resource provisioning need to be reviewed and strengthened in the light of poor performances.
Having revised our plans based on recent experience, we need to practice our response using war-games that involve all government departments and all regional teams and not just Health. Our catastrophe planning then needs to be adjusted based on learnings from the war games so that we don’t have to learn on the job in plain sight.
2. Manpower, Organisation and Culture
It is clearly nonsensical to staff Health and related services at pandemic levels. However, we do need to ensure that our Health Services are properly resourced for normal times. This is not true at the moment. A side effect of correcting this would also be more capacity to deal with backlogs and waiting lists. We then need to know how we would augment or reconfigure the staff to deal with increased demand. We cannot expect to deal with exceptional events when our Health resources are already overstretched in normal times
More effective local engagement is essential; you will not solve this problem flying a desk in Whitehall. The Regional Public Health teams are the eyes and ears on the ground. They are a vital source of information and also are best placed to direct events locally. They, too, need to be resourced for normal times and they should also operate a local Test and Trace team which can identify emerging threats. They will provide a skilled foundation which can be augmented during peak demands.
PHE needs to be far more open and a ‘Not-Invented-Here’ culture (eg not reaching out to third party lab capacity; not adopting the Google/Apple design for the NHS App) needs to be eradicated. The old Health Protection Agency of pre-2012 would seem to fit the bill far better than the current arrangement.
3. Digital Technology
On health matters, we need to engage with the population more effectively through digital technology than at present. This will provide another vital information feed. Government should encourage the growth of the Digital Channel in Retail because this will increase the penetration of digital devices and, therefore, their acceptance as part of everyday life. Such devices can then be harnessed for Test and Trace and other health apps much more easily ensuring greater take up. Springing an NHS App suddenly onto the population aroused more suspicion than acceptance and limited its value.
4. Social Care and the Patient Care Pathway
There has been much coverage in TV documentaries of the problem of bed blocking in hospitals. At the beginning of the pandemic, there were also many reports of patients hurriedly discharged from hospitals into care homes in order to free up capacity to accept Covid cases. This was undoubtedly the right thing to do although it substantially increased the burden on an already challenged sector made worse by the acute shortage of PPE and basic supplies, opening up a second front.
It seems perfectly reasonable that the Hospital and Care Home sectors should work in partnership so that the patient is placed in the location most appropriate to their needs. When combined with Care in the Community, this trio represents a Care Pathway. However, we seem to consider these three as self-contained stand alone resources when, actually, we should be taking a patient-driven horizontal view across all three, optimising the capabilities of the components so as to deliver the best end-to-end outcome for the patient.
To the layman, the whole care home sector seems to need a re-think. What is the purpose of a Social Care home? Is it a small hospital? Is it a convalescent home? Is it a safe and secure environment for infirm elderly citizens in their twilight years? Not only its purpose, but also its resourcing and funding and the quality of its offering needs revisiting.
Whilst taking this entire sector into state ownership would be hugely expensive, why not follow the route of franchising businesses, namely establish a small number of state operated care homes spread through the regions which then become role models for franchise operators to follow. The state-owned home can then become the monitor of care standards in the franchises in its region and encourage higher standards through competition. Franchisees will then feel that they are being mentored and monitored by fellow practitioners as opposed to ‘someone arriving from the CQC Head Office to help.’ Much better to show leadership by example than by diktat.
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