In this blog Dr Claire Fuller gives six themes the NHS needs to focus on during these challenging times to transform services, relationships and outcomes

What next? We need to form a new compact with the public that honours their faith in us and is true to our mission to enhance health and wellbeing. For me, there are six main themes:

1. Honour the goodwill

2. Invest in staff health and wellbeing

3. Prioritise public health and safety

4. Embrace long-term relationships

5. Build on collaboration and banish competition

6. Embed clinical innovation and technology gains

The NHS was forged in war and was one of our greatest peace dividends. Covid has left us with debt greater than the Second World War, it has claimed more lives than the Blitz and its costs and impact are both insatiable and continuing.

The huge success of the vaccine offers us hope that we can live with Covid, tolerably, but our peace dividend this time will need to equally transformative to repair the destruction and build our resilience. As the leader of a health and care system, I have seen how it has taken every part of our social, caring, commercial, service, scientific, academic, clinical, industrial and community wealth, infrastructure and ingenuity combined working with the NHS, to get us to this point. This is what it really meant to be “all in this together” and what it will take to find and live in a new post Covid peace.

A quick disclaimer, wartime metaphors get you so far. Talk of war, peace, blitz and enemy doesn’t equip to think about disease, want, inequality, trauma, recovery and resilience. It certainly doesn’t help us plan and provide for what happens next.

1. Honour the Goodwill

The public outpouring of appreciation and affection for the NHS and all frontline workers was powerful and humbling. It united people and communities and was an essential source of sustenance to exhausted and traumatised staff. The NHS responded to an emergency magnificently and was there when people needed it. Lockdowns were largely accepted as a price everyone had to pay to ensure the NHS was there for them when they needed it. It has been a heavy, but essential price and we need to continuously demonstrate it was well used and as Covid recedes the NHS is still there for them when they need it. We will need to track, trace and treat everyone who’s care and need has been missed, delayed or displaced by our focus on Covid. We need to move fast to avoid a new wave of Covid victims, who never had it but whose health and care needs were smothered by it.

2. Invest in staff health and wellbeing

Health and Wellbeing of staff must be a real priority that they can see and feel. Resilience (both physical and emotional) has its limits, as we have found to our cost. We asked our staff to give and they gave everything they had. I have never known it any other way, but it has never been needed in such vast quantities over so much time. Our staff surged every ounce of their beings and we need to help them both recover and be supported with the emerging needs their experience and exertion has created. Momentum to support our staff must grow and remain firmly linked into the inequalities agenda. With a workforce that is three quarters female and nearly one fifth drawn from the BAME community, the NHS knows the significance and value of diversity and it needs to translate this into practical workforce initiatives. There is trauma and exhaustion to overcome and a new future resilience to build.

3. Prioritise public health and safety

Covid struck everyone, but it thrived in the vulnerable with existing poor health, poor housing, poorly educated or marginalised. We need to move public and population health to the centre of our efforts. It has been too easy to overlook the overlooked. In some respects Covid has been a leveller and exposed that a healthy community is only as well as the most vulnerable member of that community who can pass the disease on to anyone. Covid has forced us to look and address everyone’s health and care needs. Any future structures should be about emphasising the role of the NHS as an anchor institution transforming communities to drive down health inequalities and improving access of care.

The best way to improve health outcomes for people is to give them a job, lifestyle advice, personal emotional support and a sense of belonging in the local community. The NHS needs to be involved in a broader post-Covid regeneration agenda. Now is the time to learn what it really means to prepare for the future. Uncertainty is a part of life and we need to be more cognisant of that. It needs to be factored in to how we design our public spaces, how we define the way we want to work, how we choose the food we eat and how we make ourselves aware of the lifestyles we are adopting.

4. Embrace long-term relationships

We have been highly inventive during the Covid emergency, innovating and learning quickly to adapt to the new and unknown. But we have also exposed weaknesses in our relationships with communities and partners that have in many cases needed to be reinvented to support our response. We have scrambled to address vaccine hesitancy and Covid scepticism and our relationships haven’t been strong and credible enough with all the communities we serve. Building and sustaining relationships take time and dedication. We have had to invent too many too rapidly and we are all paying a price for having underinvested in relationship building in the past. Local government is more connected to communities than the NHS and if we are to truly put public and population health centre stage we need to invest in relationship building with the public and population. Covid Champions were great, but they were needed because we lacked the deeper connections and relationships that were needed. Too often the NHS engages on specific issues and one-off initiatives or consultations. We need to get much better at this and nurture and sustain long-lasting health and wellbeing-based relationships where no one is hard to reach.

5. Build on collaboration and banish competition

Let’s take advantage of the legislative reforms to focus on the collaborative advantage rather than the competitive myth. The NHS is not a business. It is a truly great public service that needs to be well-led and well-managed but is fundamentally about local care operating to evidence based standards – and it is right to move on now from the internal market experiment and to embrace a new consensus.

The Covid emergency generated fantastic mutual aid and collaborative working. We took to it very easily in fact, within and across organisations, specialties, professions, sectors and boundaries. What would have taken months of discussions and committees succumbed to willing collaboration. The new ICSs must harness that will and achievement and embed the practice and behaviour, because it works so much better than competition which can be more often destructive rather than creative.

6. Embed clinical and technological innovation

Prioritise patient safety by listening to the frontline. Give clinicians the data and empower and enable them to improve the service and outcomes with it. Use data for good to target need by population segmentation and analysis. The vaccine programme has demonstrated what can be achieved by identifying and prioritizing vulnerable groups. Clinicians adore data and evidence and are brilliantly inventive and effective when given the tools and trust.

Equally the technology innovations we rushed in last year were game changing. We must now embed their benefits into business as usual to the full but without losing the personal touch. We have learned in the last year that video consultation and e-consults are nothing to be afraid of for most people and certainly better than the highly infectious and cramped waiting rooms and clinic spaces that the NHS too often has to work with.

I have touched lightly on each of these themes. They are obviously much more complex than this article can explore. But they are clear themes that we will devote our thoughts and efforts to realising the benefits and transforming services, relationships and outcomes. Covid is a continuing trauma and cost to every part of our lives. Learning from the emergency, harnessing the strengths that it highlighted and respecting the vulnerabilities that it exposed are essential to moving forward.

Dr Claire Fuller

Senior Responsible Officer for Surrey Heartlands Integrated Care System and Interim Accountable Officer at Surrey Heartlands CCG