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Ralph Cook

The standout response to Covid-19 has come from local systems

If Covid-19 has highlighted one thing to me in particular, it is the highly effective local system response that has emerged across the country. Local system leaders and frontline staff from different organisations have come together in ways not seen before.

Local system leaders I have spoken to have waxed lyrical about the scale of transformation achieved in recent weeks – change that they previously thought would take years to accomplish. This is testament to their determination to work together with others in order to grip this challenge at a local level. In sharp contrast, the response from central government has been disappointing; tardy, reactive and behind the curve.

The cultural differences between local government and health have been fascinating to observe over the last two months. NHS organisations have willingly and proactively taken up their local challenges, but have always kept an eye open for the publication of top down policy guidance. In contrast, local authorities – whose experience over recent years has left them disinclined to wait for help from central government – have had the confidence to lead the local response. They have leapt into innovating and problem solving with health and local community organisations, getting on with the task at hand in a practical way.

The first UK national guidance and policy, initially focused on hospital discharge, was issued in mid-March. Feedback I have received suggests that the specific discharge guidance was considered an unhelpful distraction by the time it was issued, as local systems were already working closely to free up hospital beds through proactive discharge. With their own solutions already in place, the guidance was largely ignored.

More importantly, it was local systems that recognised that the real risk presented by Covid-19 lay in the community and within care homes. They moved quickly to mobilise a community response, bringing together local government, the voluntary and community sector and primary care, co-ordinating the huge volume of new volunteers to support those being shielded and other vulnerable people in their own homes.

Central government was again playing catch up and was late to the issues around care homes. It published reactive guidance – the Adult Social Care Action Plan – that directed the NHS to isolate patients for up to 14 days in hospitals (because of the spare bed capacity that had been created). This guidance was met with a level of disbelief given that it was at odds with the previous discharge policy, and runs contrary to the primary social care strategy of trying to get people home.

The most recent national guidance highlights the easing of the Covid-19 situation in hospitals. But it also potentially undermines the continued community response, by pulling NHS staff who are supporting the community response back into acute settings. The ambition to ‘lock in’ the new (and better) ways of system working is to be welcomed, but it is also creating local anxiety about how these models of care will be funded after the current Covid-19 funding ends on 31st July.

The opportunity to embed a positive legacy from Covid-19 and reform the health and care system is within reach. But two things should not be forgotten:

  1. This opportunity has been created by the local system response, not the national response.
  2. It will be completely dependent upon local system leaders and frontline staff to make it a sustainable reality.

Everyone knows it won’t be easy. But when I look at what has been achieved over the last two months, I have full confidence that local areas can ‘bounce forward’ rather than just ‘bounce back’.

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