Restoration, recovery, reset, reform, a reformation, a renaissance? Personally, I like renaissance, as the challenges ahead present the opportunity to give birth to a new, and hopefully fully integrated, National Health and Care Service.
However, we view the challenges ahead, the impact and continuing presence of Covid19 means that our delivery and understanding of health and social care will never be the same. We are realising the promise of virtual care through on-line consultations, apps and self-care through shielding and social distancing; we have realised the importance of protecting those most at risk; we are learning how fragile existence can be; and we truly value those who place themselves at risk to care for others.
In reshaping our health and care systems, attention is rightly being given to the recovery of care for those in most need, whether through encouragement of cancer referrals, stroke/cardiac presentations or prioritisation through risk stratiﬁcation of lengthened waiting lists for elective treatment. At the same time, however, it is critical that we learn from our experiences in managing Covid19. Primary Care has been transformed through the use and acceptance of online consultations, whilst strengthening its focus on those most at risk, whilst in secondary care ‘virtual by default’ has to be the new coda for outpatient and diagnostic care.
My personal perspective is that Health and Social Care services have cooperated effectively in responding to Covid19 at a local level, where the value of system-wide working has been demonstrated. This may in part reﬂect ‘force majeure’ (and the suspension of certain policy requirements – e.g., continuing healthcare assessments) and I am aware that there are alternative views in that, given the necessity of some command and control, this may yet prove to frustrate collaboration. What is clear is that we must nurture and enable collaborative leadership, the value of mutual respect and relationship management and the effectiveness of system-wide working as we recover and reshape delivery.
At a national level, there has been a slower and belated realisation of the interdependencies of health and social care, with tragic consequences. We have learned too about shortcomings in stock and supply chains, and the risks of reliance on international markets in the absence of an internationally coordinated response.
Looking ahead, can we hope for a renaissance in health and social care?
I believe so – IF we can sustain system-wide working to integrate care, IF this is supported by movement towards a National Health and Care System and IF local initiatives are fueled by trust, goodwill, shared leadership and common objectives – supported by any necessary governance and system reform incentives.
The common objectives, or the ends to which we need to work collaboratively, must relate to population health improvement. The notion of Population Health Management has acquired a evangelistic mystique which can lose sight of its inherently common sense: – the need to target our attention and support to those most at need and those whose needs will grow signiﬁcantly without our tailored support. In enacting this, we must seek to reduce inequalities in health and well-being, ideally through coordinated working with education, housing, employment policies and practitioners, the voluntary sector and community development initiatives.
System, Partnership and Community leadership requires expert relationship skills as well as analytical and cross-cultural understanding to build a broad understanding of current and future needs. The aim must be to avoid the escalation of care wherever possible.
Companies such as Mprove offer a fresh new approach to systems, brokering clients with companies offering accelerated innovation, and providing direct consultancy support to co-create health and care systems and services built on a sustainable platform of population health improvement.
Mprove’s vision for this renaissance leans heavily on the digitisation of services and we are proud to sponsor the HSJ’s Digitising Patient Services award. Like the true master of the renaissance, Lorenzo de Medici, we seek help true artists deliver the changes required.