COVID-19 recovery and resilience: what can health and care learn from other disasters?
COVID-19 recovery will demand a well-thought through and holistic approach to health and care services, and in rural areas, the development of Integrated Care Systems may not be the right answer.
A recent publication by the King’s Fund proposes an interesting ‘what next?’ for the NHS’s COVID disaster recovery plan. How do individuals, communities and countries recover from catastrophic events? How do we know what support is needed, which groups should be prioritised and how should efforts be co-ordinated and managed? And what role should the health and care system play in recovery?
As a starting point for the discussion, The King’s Fund points us to other disasters from the past 20 years. Its research from events including 9/11 suggests that recovery needs to focus on understanding what individuals and communities need to recover, and to be in a better position to withstand the next one.
For beleaguered and exhausted GPs and their teams, it is possibly an unwelcome realisation that recovery could be a long haul – perhaps, 10–15 years – and that local interventions will be critical to rehabilitation. Of course, no party is more central to that than the local GP.
It is a vision of the NHS Long Term Plan that all of England will be part of an Integrated Care System by April 2021. Bringing together commissioners and providers of NHS services with local authorities and other partners, ICS aim to plan and manage services at greater scale in order to maximise benefits. Features of ICS include the footprint (usually based on local authority boundaries), and closer co-working by provider collaboratives (eg, NHS and foundation trusts) and national and regional bodies, including the Care Quality Commission (CQC) and the Department of Health and Social Care.
Critics argue that initiatives such as ICS attest less to next-generation multidisciplinary working and more to a tendency by ‘the centre’ to enforce national policies and to standardise general practice ‘by the back door’.
In the rural environment, rural representative organisations such as the Dispensing Doctors’ Association have long warned about the dangers of reengineering tried and trusted care pathways such as the family GP. Rural diversity, local geography and workforce skill mix that can often be diverse as the patients themselves are factors that often get forgotten in urban-centric decision-making. When a local ferry timetable can be enough to derail multi-disciplinary working, it is important that the local voice is always heard. As the UK recovers from COVID-19 it will be mission-critical for NHS policy architects to get rural services right.