2020 has been the most extraordinary year in the NHS' 72 year history. As we reach the end of a momentous 12 months, Chris Hopson, NHS Providers chief executive, shares 10 reflections on the features of the last 52 weeks that have most struck him.
- The speed with which the nation, and our health service, was faced with the biggest public health crisis of a generation. There were an impossibly short 12 or so weeks from the first inkling that we were facing a global pandemic that would hit our country to being in full national lockdown. Much of the year feels like it's been run on fast forward, requiring incredible speed of decision making and action and huge personal resilience to cope with that pace.
- How far reaching the impact of the pandemic has been, not just on the NHS, but also on our national life as a whole. I obviously haven't lived through a world war, but it feels like there has been nothing remotely like this in the 57 years I've been alive. The way it's affected how many of us work, how we interact with each other, how we shop and travel and how our children are educated has been enormous.
- The extremely concerning impact the virus has had on widening inequalities. Emily Maitlis' "much commented on" Newsnight piece to camera summed it up well for me. We haven't all been in this together and we haven't all been equally impacted by coronavirus. It's had a much greater negative impact on the disadvantaged in our society. Hopefully that will make us much more focussed, going forward, on how to address those inequalities. It's striking how much addressing health inequalities has gone up the list of NHS priorities. The challenge now is to translate that strategic commitment into concrete progress on the ground. The combination of the disproportionate virus impact on certain ethnic groups and the murder of George Floyd, with the resulting Black Lives Matter movement, helpfully raised awareness of how far the NHS has to go in addressing race inequalities.
- The incredible resourcefulness of the NHS and its problem solving ability. The way the NHS has done a vast array of new things from scratch, or near scratch, at extraordinary pace. Freeing up 33,000 beds; creating the insurance policy of the Nightingales; developing new treatment regimes to combat an unknown disease; conducting clinical trials at record pace to develop vaccines and other treatments; taking a wide range of NHS activity online; helping deliver a mass testing regime and leading the creation of a population wide vaccination infrastructure. It's an amazing list and that's only part of it.
- The way that all parts of the NHS had to mobilise, alongside the general public. The prevailing public narrative on the NHS always tends to focus on hospitals and GPs. But community, mental health and ambulance services have been just as central to the NHS coronavirus response. From helping effect a rapid discharge of medically fit patients in the first phase to standing up a national network of 24 hour crisis mental health services, every different type of NHS provider has played their role. And the public response to a set of deeply onerous restrictions on social contact has played a vital role in controlling the spread of the virus too.
- The boost tackling the virus has given to collaboration at the front line. Every trust leader I have spoken to says that the last 12 months has given a turbocharged boost to collaborative working between trusts, primary care, social care and local authorities. Trusts leaders say this enhanced collaboration was essential to solve the problems COVID-19 threw at them. It'll be interesting to see whether it's this experience of successful closer working on the ground that ultimately proves more helpful in integrating health and care than the structural reforms that national leaders are currently developing.
- The way the virus highlighted, yet again, the crisis in our social care and the ongoing failure of our political class to address that crisis. Crises always, unerringly, find the weakest link in the chain. We've known for a long time that our social care system has an unsustainable funding model, an unsustainable workforce model and an unsustainable provider market. We've reaped a bitter and difficult harvest from the failure of successive governments to deliver on their oft repeated commitments to reform social care and make it sustainable.
- Effective public health crisis management requires excellent public communications and deep trust in political leaders. One of the most difficult features of the pandemic has been how little we know about the virus and how we've been on an incredibly steep learning curve, developing our understanding all the time. Governments all over the world have struggled to communicate effectively against this ever changing backdrop. Although New Zealand has very different features to many countries, for example its population size and density, it's interesting how Jacinta Ardern has been held up as a model of effective communications. She's been particularly praised for her honesty and openness, her communication of nuance and uncertainty and the degree of trust she has built with her entire population.
- The legacy of COVID-19 is going to be with us in the NHS for some time to come. There are a significant number of new demands the NHS will now have to meet, at a point when the service was already under significant strain. Long COVID, recovering elective surgery waiting lists and extra mental health demand are three immediate examples of that extra pressure.
- Most importantly of all, the pandemic has demonstrated, yet again, how incredibly reliant the NHS is on the effort of its frontline staff. It's been particularly helpful, in my view, for the spotlight to not just shine on frontline clinicians but the wider NHS team as well. It's clinicians, leaders, managers and the often unsung support staff working together that has been instrumental in solving some of the more difficult challenges – PPE, testing and setting up the vaccination infrastructure. No-one would pretend we got everything right, but the widespread doorstep public support health and care staff received feels fully justified.