In June 2019, NHS England and Improvement and Health Education England published the Interim People Plan. Many of the challenges it highlights endure, and many of the actions it set out have been already implemented across the country, at pace, in response to COVID-19.
It doesn’t feel like we ever stood back and truly reflected on what we had done; we were just going flat out for several weeks – no weekends, no breaks and no leave. The NHS is the best thing about the UK, hands down. Everyone pulls together in times like this and it’s the one place people know they can rely on for help, no matter what their status or background, because that’s what it was created for and that’s what we do.
Chief information officer, London
The box below highlights a small selection of the profound changes that have already emerged through the COVID-19 response so far.
Health and wellbeing of our people: There has been a greater focus on the health and wellbeing of our colleagues, with support offered in teams and organisations. This includes psychological support Schwartz Rounds and workplace ‘wobble’ rooms. Systems have played a key role in providing a co-ordinated approach.
There has also been a greater recognition and support for working carers through the launch of the carers passport. The public and the private sector have also made generous offers to the NHS as well as donating supplies and support – for example through ‘first class lounges’.
Shared purpose and permission to act: Some governance and decision-making has been simplified, with clear outcomes specified, which has helped many people feel empowered to implement changes that have benefited patients, working with more autonomy. COVID-19 has also been a catalyst for greater local partnership and system working, with one forum for partners to agree actions in response to offers.
Highlighting existing and deep-rooted inequalities: The disproportionate impact of COVID-19 on BAME communities and colleagues has shone a light on inequalities and created a catalyst for change. NHS leaders have stepped up, role modelling compassionate, inclusive leadership through open and honest conversations with teams, creating calls to action for boards, and strengthening the role of BAME staff networks in decision making.
Flexible and remote working: This has increased significantly in the NHS, with the average number of weekday remote meetings rising from 13,521 to 90,253 in weeks 1 to 8 of lockdown. This has enabled teams to run virtual multi-disciplinary team meetings, case presentations and handovers, and teaching sessions. Many colleagues across the NHS have noted that this has been more productive, with less time spent travelling (with the additional benefit of reduced air pollution), and better turnout at meetings, as well as improved work–life balance.
Remote consultations: Digital transformation has occurred rapidly across the NHS, with around 550,000 video consultations taking place in primary and secondary care, and 2.3 million online consultation submissions to primary care, in June. Video consultations are now used widely, including in community and mental health services, and in ambulance services. This has enabled staff across primary, community and secondary care to work differently, with some choosing to do part of their work from home.
Returning and new staff: NHS numbers have been bolstered by clinicians returning from academia, retirement and other industries. Students have stepped out of training to increase their direct support to patient care. Staff have been redeployed to areas experiencing pressure.
The role of NHS 111 increased significantly, with more than 500 GPs returning to work alongside 1,000 locums and other GPs to support the Coronavirus Clinical Assessment Service (CCAS) – a new pathway within 111 for callers with more serious symptoms who did not need immediate acute referral but did require further assessment and follow-up. This has been possible because our people, past and present, wanted to contribute to the NHS effort, supported by new arrangements and agreements arranged behind the scenes.
Innovative roles: Our existing NHS people have taken on new roles. For example, healthcare scientists have been deployed into critical care roles in Nightingale hospitals.
Physiotherapists supporting intensive care units (ICUs) have been upskilled to carry out respiratory-related assessment and treatment – improving relationships across multidisciplinary teams and increasing appreciation of each other’s skills. Advanced clinical practitioners have also stepped up, contributing valuable clinical support in critical care and emergency medicine.
Support for care homes: The NHS rolled out a clinical support package which provided a named clinical lead for every care home, as well as wider NHS primary and community support including weekly virtual check-ins, care plans, and medication reviews.
Volunteering: There has been a huge surge in people volunteering to support those in need of help. Thousands have signed up to national and local initiatives, including Rapid Responders through the GoodSAM campaign. This has brought great opportunities but also challenges in making sure that our volunteers are deployed effectively and safely.
Research: Our NHS people have also played a key role in COVID-19 research – in particular, supporting the Recovery (Randomised Evaluation of COVID-19 therapy) programme. This is the world’s biggest randomised clinical trial and brings together the collaborative power of our NHS and pooling resources with our world-leading life sciences sector.
Teams of research nurses and clinical trial assistants have been rapidly assembled to provide a seven-day service to identify and recruit patients. Its success is already improving patient care.
Not everything that happened in the first phase of the COVID-19 response will have been successful for every individual, team and organisation. Our learning from the pandemic is only just beginning. But already, we have seen dramatic changes across the NHS.
Where new approaches have worked well, we should not roll them back but adopt them systematically. Where they haven’t, we must all learn and find other, better ways. In order to successfully innovate, we need to measure the impact to see what works. This will ensure that the NHS rebuilds in a way that is even better than before.
To turn this plan into reality, metrics to accompany and track the impact of the actions in this plan will be developed in partnership with systems and stakeholders by the end of September 2020. Accountability for delivering outcomes will be at all levels of the system and NHS England and NHS Improvement will continue to track progress on people and workforce issues using the NHS Oversight Framework, providing support and challenge to systems and organisations to make progress across this agenda.