Written evidence submitted byProfessor Amelia Hadfield, Head of Department of Politics,
Co-Director of the Centre for Britain and Europe, University of Surrey With Megan Isherwood, James Penny, and Zoe Drapper (CLL0059)
Coronavirus has been the ultimate wake-up call and has forced us all to adapt and innovate to tackle the challenges we face. The NHS, wider health and social care and specialist epidemiology sectors have become the focal points of the UK government's response to Covid-19 and the implementation of Covid-mitigation strategies across the UK. Drawing on extensive research, including stakeholder interviews across the health and epidemiological sectors of Surrey, including hospital, clinic, institute, and cutting-edge research undertaken by the University of Surrey and Royal Holloway (University of London) compiled by the University of Surrey and launched in November 2020 in a report entitled Charting Surrey’s Post-Covid Rescue, Recovery and Growth, the following evidence illustrates both regional and county-based appraisals.
Covid-19 represents one of the most significant global health emergencies in recent history and has pushed our public services and resources to the limit. In reflection, the sector has demonstrated its capabilities to rapidly respond and remain true to its values of care and innovation. It’s imperative that we take the opportunity to review and learn the lessons of the last 12 months and reflect on how we should respond to future public health crises.
As has been seen, due to the varying effects the virus has on different people depending upon their age and underlying health conditions, some people are at higher risk than others - specifically older people and those with existing respiratory illnesses. The recommendation of ‘shielding’ by the government was made in the initial months of the pandemic, to minimise the interaction of higher-risk groups with others, and to attempt to lower their risk of being infected by the virus. To prevent the spread of Covid-19 more generally across the population, the deployment of various measures such as lockdowns and social distancing took place across the UK. These non-pharmaceutical interventions include the encouragement of regular hand-washing, wearing a face-covering in enclosed places, and maintaining a one-metre distance from those, not from the same household; these measures are currently still in place. The ‘Rule of Six’ was also implemented more recently in England, to prevent larger gatherings between people, as well as increased encouragement and capacity for those who feel unwell to get a test.
Social distancing and lockdown measures have had varying impacts on different sectors across Surrey - particularly that of health and social care, such as through the implementation of new procedures in care homes, the retraining and upskilling of NHS staff, and also through leading to burnout and demoralisation across the workforce. However, businesses and working environments across Surrey have also seen substantial changes made, such as through having to implement increased remote working and flexible staffing policies, a consequential reduction of in-house production levels for multinational companies and disruption to supply chains as a result of social distancing measures.
An interview with Professor Melaine Coward around impacts on the social care sector has outlined the fact that Covid-19 has ‘revealed the necessity for healthcare to be integrated with the care and community health sector’, and that benefits to patient outcomes have already been seen from implementations of these changes within emergency departments. There has also been an issue with people labelling care homes as being dangerous areas, which could potentially lead to long-term recruitment challenges across the sector.
When looking at the care sector in Surrey specifically, Surrey Heartlands ‘is a high performing ICS, benefitting from close networks of cross-sector representatives. At the beginning of the Covid-19 pandemic, this network was mobilised to coordinate the regional response and the awareness and knowledge of what each agency could offer enabled a strong response’.
Across Surrey Heartlands (Surrey Heartlands, 2020), new procedures have been implemented to minimise the spread of Covid-19 and to increase care capacity for those affected in both their recovery and rehabilitation. This has been done through the introduction of virtual appointments, the provision of additional support through the Local Resilience Forum (LRF), and of additional hospital capacity through local partnerships.
The Surrey Heartlands Workforce Transmission Team, directed under the LRF managed three workforce groups as part of the Covid-19 response: training, welfare and maximising staff. Within training, the main focuses were placed on upskilling NHS staff moving from different departments, and new staff and critical care training. With the adaption of and training conducted by the Surrey Heartlands team to respond to the pandemic, a series of opportunities were presented such as building stakeholder engagement and cementing strong relationships within the entire ICS. However, challenges have also been presented, including changes to placement opportunities and availability within local organisations and community providers, in addition to the uncertainties posed by Brexit and its potential impact upon the diverse workforce of the sector.
As part of the county’s integrated and systematic response to the pandemic, Surrey Heartlands has put in place a digitally advanced system to modernise and unify the response, including elements such as a Digital Wellbeing Platform, a Remote Monitoring Smart Meter Platform and AI Platform, as well as the acceleration of the digitalisation of care homes. This highlights the importance of a unified and cohesive response to the pandemic, in addition to the importance of communication and technology to overcome barriers. Despite the benefits of this new system, there are also challenges to be considered and overcome, such as digital inequality, channel shifting away from face-to-face consultations, and the education of the public around the new formats of appointments.
When discussing impacts of the pandemic around the Nursing and Midwifery workforce, Professor Jill Maben speaks of findings which show a lack of support available for NHS staff, concerns over their demoralisation and burnout, and the potentially harmful ‘hero’ narrative which has been constructed around NHS staff, creating an image that they themselves are not vulnerable or in need of support, highlighting the need for increased support.
Jeremy Hunt, MP for South West Surrey highlighted the progress which has been made in resolving issues concerning NHS supply chains of PPE. Additionally, the Health and Social Care Committee has launched an enquiry into NHS workforce burnout following the peak of the pandemic and aims to tackle the issues arising from this. Long-term workforce projections have not yet been published, but Jeremy Hunt has suggested that if under-resourcing of the social care workforce continues, domestic unemployment could provide a future recruitment pool.
Becky Sharp, Social Care Implementation Lead for NIHR Applied Research Collaborations, Kent, Surrey and Sussex outlined that Social Care is a growing challenge due to the ageing population and availability of family care. It was highlighted that there are existing inequalities in the availability of services both within and between local authorities, as well as the fact that Covid-19 has exposed the issue of under-funding and under-resourcing in the sector, as well as the under-valuing of the care workforce.
Coronavirus has adversely impacted BAME communities and other at-risk groups in many dimensions. The report highlights the significant health inequalities in Surrey and the disproportionate impact of Covid-19 on BAME groups. Additionally, Covid-19 has had a detrimental impact on people’s mental health, particularly due to anxiety caused by the economic challenges it has created. One important contributor to the inequalities faced by the BAME communities is the lack of clear and inclusive public health messaging from the government and public health. Highlighting the importance of recognising that the majority of Covid-19 government messaging and warnings have been delivered in English, failing to account for the large BAME population in the UK who may not have English as their first language.
Alongside this, it is important to understand that the Westminster government’s Covid-19 briefings failed to provide interpretation for those with visual and hearing impairments. There is a need to recognise the importance of education and information available through increasing health awareness and understanding of advice, particularly among older people. This could include championing exceptionally talented people, especially those with protected characteristics or from disadvantaged backgrounds. For example, there are approximately 7% BAME managers, directors and senior officials in academic and non-academic higher education positions.
Likewise, remote services are not accessible to all beneficiaries as many lack access to computers, tablets, or smartphones or may be inhibited by data costs or lack of computer literacy. Local stakeholders continue to face the challenges of supporting community groups that are facing greater impacts and unique challenges due to Covid-19, such as individuals from BAME communities, older generations, economically disadvantaged people and those with disabilities. It's correct to suggest that the rapid response to Covid-19, has developed challenges in inclusion and that some essential voices will be unavoidably missed in the process and this is a significant challenge going forward as the government continues to respond to the coronavirus pandemic.
The response to Coronavirus has highlighted the need for a strategic prior preparedness plan for pandemics. This is not just for the public health system, but also the other key sectors such as education, knowledge, business and local government. The NHS has been forced to rapidly adapt and transform in response to the enormous pressure that Covid-19 has exerted on its services and delivery of care. The NHS Confederation report; Getting the NHS Back on Track: Planning for the Next Phase of COVID-19, lays out how the National Health Service could be effectively resourced and the next stages of the Coronavirus response. This report identifies the key challenges confronting local NHS organisations and proposes changes to policy and practice to resume the numerous services that have been affected by the pandemic. The first key challenge identified is funding to ensure that NHS organisations can meet the rising demands from Covid-19 and support exhausted staff (NHS Confederation, 2020: 3).
Capacity constraints are also a key obstacle, as hospitals are running at significantly lower rates of occupancy and therefore private sector support is required alongside an effective test and trace system to provide reassurance to frontline staff. Likewise, rehabilitation should become a key focus as the Covid-19 response progresses to meet the needs of patients requiring social care, respiratory and psychological treatment (NHS Confederation, 2020: 4). Furthermore, the pandemic has exposed the deeply entrenched health inequalities which must be tackled through targeted interventions.
Additionally, lighter-touch regulations and inspections should be maintained post-Covid-19 to allow greater autonomy and flexibility. The report recognises the impact of Covid-19 in accelerating transformational change through partnership working and it highlights the need for this momentum to be maintained to develop stronger integrated systems. Lastly, the management of public expectations is enforced as a key objective to sustain public support.
The NHS Confederation urges the Government to extend emergency funding across all sectors of the NHS, continue block contracts and provide urgent capital investment in areas such as mental health and social care (NHS Confederation, 2020: 8). The report states that there are currently over four million people on the waiting list for NHS treatment and therefore it is vital that secondary care capacity is expanded (NHS Confederation, 2020: 9). This could be achieved through arrangements with the private sector, the maintenance of the Nightingale Hospitals to respond to future outbreaks and the establishment of a longer-term capacity building programme (NHS Confederation, 2020: 10-11). Likewise, the report highlights the need to invest resources into the rehabilitation of Covid-19 patients, maintain lighter-touch regulation and performance management systems, continue effective partnership working to drive transformation and ensure consistent communication from political leadership for public awareness and transparency (NHS Confederation 2020: 4-5).
In terms of testing and contact tracing, at the capacity-building level, NHS workforce shortages must be tackled, and issues of demoralisation, workforce burnout, lack of adequate safety measures and unreliable access to testing must also be addressed.
From a business perspective, certainty is needed to boost both market activity and consumer confidence. The virus needs to be more proactively controlled by improved testing or vaccine development, in order for consumer and market confidence to promote a recovery in both the UK’s own GDP, and other global economies.
The development of treatments and vaccines has been of paramount importance within the global response to coronavirus and has been deemed as the way forward out of lockdowns and restrictions on our current way of life. A combination of the health, business and knowledge sector have come together around a common cause to work towards the development of treatments and vaccines. Universities have been at the very forefront of research and development with many research labs and staff shifting their work to support the production of treatments and vaccines. For example, at the University of Surrey, the Surrey Clinical research facility adapted its role and is the only non-NHS clinical facility taking part in the Covid-19 vaccine trial.
The University of Surrey’s Professor Dunn-Walters is the current chair of the British Society for Immunology Covid-19 Taskforce on Immunology and is involved in the national effort to coordinate immunology research on Covid-19. In this case, Covid-19 has encouraged more collaboration between immunologists and virologists, including some within the School of Veterinary Medicine and the Pirbright Institute. However, due to the sudden and initial closure of the universities in March 2020 created challenges and slowed down the launch of research projects and the response to the virus. Academics and researchers have discovered collaborative ways to cooperate with both the public and private health sector to support the research to further treatments and vaccines.
Equally, it is just as important to understand the role that business initially played and has since played since the outbreak of the virus in the UK. Firms such as McLaren shifted their operation in accordance with the ‘Ventilator Challenge’ to produce ventilators to support the demand for them as a form of treatment. Demonstrating the role that private enterprise can have in providing public goods in the time of a public health crisis. It wasn't just larger firms that responded, communities of SMEs and Micro-Businesses adapted and innovated to support the research and production of treatments with little government guidance on how to respond effectively. Many of these businesses struggled to effectively respond due to supply chain issues and challenges of government restrictions, however, it was the initiative of business that was the success.
National Health Service (NHS) Confederation. (2020) Getting the NHS Back on Track: Planning for the Next Phase of COVID-19. Available at: https://www.nhsconfed.org/-/media/Confederation/Files/Publications/Documents/REPORT_ NHS-Reset_Getting-NHS-back-on-track_FNL.pdf
Surrey Heartlands. (2020) Managing our Response to Covid-19. Available at: https://www.surreyheartlands.uk/ managing-our-response-to-covid-19/
University of Surrey (2020) Charting Surrey’s Post-Covid Rescue, Recovery and Growth. Available at: https://www.surrey.ac.uk/sites/default/files/2020-11/charting-surreys-post-covid-rescue-recovery-and-growth.pdf