Community 09.06.20

NHS Reset: Why the challenge to reset is a cultural one

NHS Reset is a new NHS Confederation campaign to contribute to the public debate on what the health and care system should look like post-Covid-19.

In this blog Richard Stubbs recognises that while recent health and care developments are the result of a single challenge, as we reset we must look at how we deliver the wider mission of “health” to the population.

“Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. …we can walk through lightly, with little luggage, ready to imagine another world.” Arundhati Roy, Indian Author, The Pandemic is a Portal

Recovery, Restoration, Renewal, Reset … Since the onset of coronavirus there have been many words used to describe the act of restarting our health and care services. And from early on in the pandemic it was clear that, despite (or because of?) the tragedy of the lives lost every day, this was also a moment to rethink.

Covid-19 has had a profound, immediate impact upon our health and care system. We have responded at pace, with some areas of our services being transformed more in the last three months than in the last decade. Not all of these transformations will endure (or should endure) but there are certainly changes that have been made through crisis that point the way to a more modern, responsive and flexible model of delivery services to our population. These changes should be identified, evaluated and, where appropriate, rapidly adopted across the country.

Above all, the challenge of reset is a cultural one. Our culture will be the biggest reason why we do, or do not, manage to improve and learn through, and beyond, this pandemic.

Are the recent cultural conditions that have supported service transformation sustainable in the longer term? The sustained effort by the front line has been, and continues to be, herculean. Much of the transformation has been possible because the entire machinery of the NHS and government has been focused on one specific challenge. As we reset, we need to be aware of the temporary nature of some of these conditions, but also seek to nurture those that are sustainable, such as the empowerment of clinically-led frontline teams and the supportive intent of lighter touch regulation.

The pandemic has laid bare the stark inequalities in our society. The reset is also the chance to think deeply and act on our wider mission of delivering health, not just healthcare, to the population:

Health inequalities – how can our experience of the pandemic influence a new approach to preventative interventions for long-term health inequalities?

Equality and diversity – Covid-19 is not “the great leveller”; the disproportionate deaths of BAME health and care staff during the pandemic cannot be forgotten when “resetting”.

Economic growth and health – we know that health and wealth are intrinsically linked; the future recession is a future health challenge. How can the NHS better engage with local economies and bodies such as local enterprise partnerships?

Prevention and wellbeing – are we as a society redefining our relationship with health, as well as healthcare, and how does the NHS best support this?

As part of NHS Reset, the NHS Confederation, the AHSN Network and The Health Foundation have come together 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.

Over the next four months, 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, patients 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.

This collaboration will focus on three areas:

  • What‘s working well? Identifying and understanding what’s working for whom.
  • Systematising service innovation: how to make the changes in practice and mindset sustainable.
  • A spotlight on the wider system: how to ensure the focus is retained on the integration agenda, prevention and community, primary and social care.

Working together through the NHS Reset campaign, we will seek to find answers to these areas. And we will need help and further collaboration.