Covid-19 one year on: how can the health and care system recover?

Irrespective of any further inquiry, the anxiety around the damage that successive waves of Covid-19 have done to our health and care system becomes ever greater. What is to be done?

We need to start by simply understanding what has changed in the health of the population and to the state of our services. There will be changes arising from Covid-19 itself and the side effects of treatment, whether that’s managing long Covid or the rehabilitation needs of people intubated for long periods of time. There will be the long-term health impacts for people who either stayed away, or were told to stay away, from health and care providers during the pandemic. Alongside these direct impacts on health and wellbeing, the UK is facing severe economic headwinds that will push many into poverty and that has simultaneously created a historic challenge to public finances. Meanwhile many staff are exhausted by the long haul against Covid, and some are traumatised. It will simply not be possible for overstretched staff (whether in the NHS, voluntary sector or social care) to continue to work at the pace they have during the pandemic.

When trying to understand this challenge it remains the case that the data is best on the acute sector. The dramatic increase in waiting times for hospital treatment is easy for all to see and risks knocking England back two decades to a world where long waits for care were routine. These reductions in non-Covid care were not limited to planned pathways but were also felt in urgent and emergency care as well, and this too will leave a longer-term mark.

But the impact of Covid-19 goes much wider than the acute sector. In mental health, many services made a dramatic switch over to telephone and digital delivery, a giant leap that needs evaluation for its impact on quality of care. At the same time, prolonged periods of social distancing in various forms will have placed great stress on wider mental health at a time when many services were harder to access. In social care, the same reductions in services seen in the acute sector appear to have taken place and the challenge of recovery will come at the same time as exceptional pressure on local government finance. Lastly, primary care too has made a strategic leap toward digital and telephone technology, but there will still have been interruptions to ongoing care and the potential for delayed diagnosis including in dental and optical services.

The very visibility of acute sector waiting times will create a pressure to prioritise them in any recovery plan. There is of course good reason to reduce waits and, in some services (cancer perhaps the most obvious) a pressing one. But does anyone doubt the challenge mental health services faced even before Covid arrived and, equally, that the Covid months will have damaged mental health? Or that even before Covid, general practice was facing a severe capacity crunch, which the promises of extra staff (both new GPs and other professions such as physiotherapists and pharmacists) and the introduction of primary care networks were intended to alleviate? These challenges may be harder to quantify in the way we can in the acute sector but they are no less real.

The response to Covid-19 underlined the power of system-working in many areas. Whether this was mutual aid between NHS providers, work with voluntary, community and social enterprise organisations or closer engagement with local government. This system-working has been the goal of successive policy makers but often proved difficult to progress at pace. Covid-19 changed that (although not everywhere). At its best this should mean that system partners can come together to understand the challenges and opportunities facing their populations, drawing on expertise from across health and care. This should give the acute sector its due weight but also give equal regard to mental health, community and primary care services and to local government and the voluntary sector. Once the priorities have been set, we then need to continue to support this system-based approach to ensure it’s at the centre of delivery as well.

This system-based approach to recovery will be critical for one further important reason. Covid-19 shone a brutal light on health inequalities (indeed, on inequalities more generally). While it is important to make sure that there is equitable access to acute care and the experience of waiting, there is no way that a drive to reduce acute sector waiting times is going to move the dial on inequalities more generally. To do that will need co-operation across the NHS and with local government, the VCSE and other partners.