Has crisis forced us to create a more integrated health service?

Greater use of technology and informal integration of health and social care should outlast the pandemic

June 22, 2020
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The pandemic has brought about massive and immediate changes in the NHS, many of which have been very damaging for patients and staff. Cancers and other conditions have been neglected and there is clearly an enormous build-up of mental health problems as a result of the trauma people have experienced and witnessed. But there have also been some changes for the better, some of which could have long-term benefits.

The technological shift in respect of virtual consultations and wider use of technology has attracted the greatest attention. But perhaps the most radical is the way that many local NHS bodies have begun to work better with other organisations and how health and social care have become increasingly integrated in practice. This working together on common objectives has been impressive, but can it be maintained for the longer term?

Change has happened remarkably swiftly in health, as in other sectors. The speedy development of the Nightingale Hospitals is just one example. Virtual consultations via video and phone have grown dramatically from being less than 2 per cent of all consultations in the NHS to one survey that suggests it is now more than 80 per cent.

I have met many people while researching my latest book Health is made at home, hospitals are for repairs who are from outside the formal health services but are playing a major role in improving health. These are employers, teachers, architects and community leaders who are creating the conditions for people to be healthy and helping them to be so. Their role is vital in everything from healthy housing to good education and fulfilling employment.

Many of them told me how difficult it was to work with the NHS as a partner. One housing director, who I had planned to quote to this effect in the book, has asked me to change her words as a result of the pandemic. The NHS has changed, she said. They are listening and engaging, and she is optimistic about future relationships.

Other people talked about improved teamwork both inside and outside the NHS. Titilola Banjoko, executive managing director of Brighton and Hove Clinical Commissioning Group, told me that she was spending most of her time now working across the whole spectrum of health and care, supporting social care and care homes as well as hospitals and NHS bodies. It was about the NHS and the community.

Rob Trimble of the Bromley by Bow Centre—the pioneering community centre in east London which brings together local businesses, community groups and the local statutory bodies and is the centre of so much activity—told me: “We have been busier than ever over the past six weeks. It’s been like a revolution, without a few years of plotting and drinking coffee!”

It’s all happened very quickly, and the centre has totally transformed its delivery model. “Alongside our usual extensive range of services (which have become virtual)” Rob said, “we have added an on-site food distribution hub for 370 households in partnership with Bow Foodbank; created a new crisis social prescribing service focused on 6,000 vulnerable local residents identified by our primary care team; and formed a new partnership to provide much-needed bereavement counselling. We are now looking to establish a community-based Covid-19 contact-tracing service for our locality.”

“The whole plan,” Rob told me, “is called Thriving, not just Surviving.” It sounds like a blueprint for better communities and for better engagement of the NHS with the people it serves.

NHS organisations are determined to hold onto the beneficial changes wherever they can. Some changes may have gone too far—I expect the number of physical consultations will increase again, but not to the previous level—and some have been very expensive, justified by their urgency but too costly to maintain. But, as so many people have told me, the good progress depended on relationships, people knowing and trusting each other, on being entrepreneurial and on community support. All of these should be harnessed going forwards.

Perhaps the biggest problem will be how to maintain relationships that are based on trust and shared vision and not slip back into a purely contractual relationship governed by finances and processes. The NHS and other bodies will need to be flexible in how they develop their financial and governance systems if they are to succeed.

And it’s vital that they do because Covid-19 has reinforced for us all, if we needed the reminder, just how important employment, housing, social care, communities and education are to our health and wellbeing. And just how important it is to build good partnerships between the NHS, government and the pioneering organisations in these other sectors if we are to create a healthy and health-creating society.

The UK government needs to place this ambition at the heart of a new vision that reflects the experiences of Covid-19 and responds to Black Lives Matter and the disproportionate effect of Covid-19 on people from Black, Asian and minority ethnic groups. And it needs to do so rapidly, while there is still a positive feeling of unity of purpose around the country—and before disillusion and despondency set in.


Nigel Crisp was chief executive of the NHS in England from 2000 to 2006. His latest book Health is made at home, hospitals are for repairs (£9.99) is published on 29th June. Register to attend the launch.