Well, all the planning to
celebrate the 75th anniversary of Victory in Europe Day came to
fruition on Friday. Our street, which I think might more properly be called a
road, was decorated with red, white and blue bunting, Union Jacks and balloons.
And then there were the scarecrows. During
the planning stage of the celebrations, I was both enthusiastic about the
scarecrow idea, and also slightly concerned that in this day and age, anyone
would be bothered to make one. I needn’t have worried.
People up and down the street got
into the spirit of scarecrow making. These weren’t those old jackets and trousers
stuffed with straw and placed in a field to scare off birds from growing crops –
no these were works of art. There was a Winston Churchill, various military personnel,
a nurse, a rather strange ET (complete with bike) figure, land girls and many
more. Ours had a chicken theme (what else you might ask?), and although she looked
slightly overweight, I was proud of her. There was a competition for the best
scarecrow, and the winner was an absolutely brilliant cheeky land girl.
It was great fun; everyone had
set up beautifully-decorated tables and chairs on their front gardens, and
during the day we had afternoon tea parties, the odd glass of G&T and or
bubbles, there was food, music playing, we even had a Zoom enabled game of
bingo and a singalong to some old war time classics. Physical distancing was
maintained, but we were able to walk up and down the road looking at the scarecrows,
garden decorations and just to stop and say hello. Of course, we didn’t lose sight
of what we were celebrating, and like many other people across the UK, we all observed
two minutes’ silence at 11am to remember all those who had lost their lives, so
we could enjoy the freedoms we have today. The day seemed a long way away from the
constant coverage of the Covid19 pandemic.
I was aware that there will have
been a great number of people who, because of their work, would not have been
able to be outside in the sunshine and join in the celebrations. For all those
on this new front line, and all those other people who keep us fed, safe and
cared for, I say once again, a big THANK YOU. Just as there have been many
changes to our lives since the first VE Day, so this new challenge to our sense
of what is normal has and I think will continue to have, an impact on our
lives. I chair the Wrightinton, Wigan and Leigh NHS Trust Pandemic Assurance Committee, and the discussions we
have there indicate to me that Covid19 is not going away anytime soon. Like other hospitals and
healthcare services, we are being asked to develop new ways of working for the
future and to do so right across the spectrum of service provision.
This will mean continuing to keep
the gains already made - remote consultations, new referral pathways, much more
self-help being made available using new digital technology, including tracking
and tracing. However, it will also mean developing further a system-wide
approach to service management. It remains to be seen what the impact might be
for individual NHS Foundation Trusts, but the central ‘command and control’
approach is likely to continue for some time yet. NHS England’s regional offices
appear to be the bodies exercising this command and control management.
In some ways this makes a lot of sense.
Whilst hoping that we won’t see subsequent Covid19 waves and peaks, experience of
previous pandemics has told us this is likely to happen. System-wide capacity planning
will need to go on for some time yet, if we are to be able to respond quickly
and effectively to any future peaks. Likewise, the funding arrangements
underpinning service provision are likely to remain in place until the end of
this financial year. This is something that will also impact on the use of capital
spends, as this will also need to be seen in a system-wide way. Local plans
might be shelved in the taking of decisions to use resources for the greater
good of an economy.
Both hospital and out of hospital
care will need to be focused on Covid and non-Covid patients. This might mean
developing the notion previously outlined in the NHS Long Term Plan of having ‘hot’
and ‘cold’ hospitals. In the plan this referred to urgent and planned care. I
strongly suspect we will be looking at something similar being developed in the
very near future, perhaps along the lines of developing clean and Covid19
pathways, with these being delivered in specified services. Clearly regaining
some traction on rebuilding the NHS elective capacity might be best served
using this approach. In some places, developing services along these lines
might be easier to do than in others. I would be looking at London as an early
adopter for such developments. There is already ‘group’ working (bringing individual
hospitals into one centrally-managed group) in London and if one looks at the
track record of the current NHSE London Regional Director, it’s easy to imagine
a rapid spread of this approach.
All of this will require new
forms of governance and oversight. I imagine that the Care Quality Commission
will need to adopt a systems approach to their work and not simply look at individual
service providers. Likewise, the Royal Colleges and other regulatory bodies
will need to re-think their approach to education, training and professional
standards.
Finally, it is clear from our experience
of the Covid19 pandemic so far, that people living in areas of high deprivation
are the one that have suffered the most during this pandemic. They are
populations that also have a high incidence of chronic and long term health
conditions, raising the risk even higher. So the new ways of working will need to
address the inequalities across society in a way not yet seen in the UK’s
recent past. And someone who has seen many changes to life in the UK since the original
VE Day, the Queen, captured the zeitgeist perfectly on Friday as she made a
speech full of hope and determination. She said: ‘our streets are not empty;
they are filled with the love and care we have for each other’. Judging by the
response I saw on Friday; I have to agree with her!
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