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Post-Covid: Major Transformation - Leading the Way Forward

The radical transformation that has occurred in health and care over the last 6 weeks has been both fundamental and at phenomenal speed. A pandemic necessitates that, so how, in the next phase of major transformation, should we 'springboard' from what we have learned and 'not waste a crisis?'

We have learnt many things over these last few weeks and no doubt we will continue to learn over the coming months. It is clear that despite massive challenges – personally, professionally, and for organisations – and at significant personal cost, much has been achieved. We have seen that necessity is indeed the mother of invention; the speed of change can be phenomenal relative to our old life where the process of large-scale transformation was long and very resource intensive, and both the importance of evidenced-based change and the role of strong, decisive, brave leadership have been reinforced.

There are several early emerging lessons - for me, some things already seem clear: the lack of planning for the pandemic, particularly around stockpiling equipment and the ability of British business and the public to step forward and offer support, for example by 'sewing scrubs,' that the chain of command needs to be shorter with more devolved decision making. The sheer professionalism of health and care staff at all levels and in all disciplines and the “demand” to visibly value and reward them, that integration is a 'no brainer' and of course that transforming is all about people and relationships!

We all agree that we need now to go forward, not back to where we were. There must be a new normal designed for the new world we want to live in, so how might this be achieved? For those of you at the forefront of dealing with this disease there will be many clinical 'lessons learned' and it would be good, if you possibly can, to reflect and note them while they are fresh - what are the 'if only we had had this or that in place?' or 'what would have been helpful earlier/ later?' type questions?

The configuration of our hospitals and the need to expedite significant transformation changes has been brought to the fore. The pandemic has reinforced the need to separate, or be able to separate, 'hot' from 'cold' - better described as 'cold plus critical care' - so that cancer surgery can continue and babies can be delivered safely away from wards treating Covid-positive patients. And the controversial question of small A and Es has surely now been answered!

Similarly, general practice, like the rest of us, has completely reinvented the way it works and embraced the digital revolution, so let us enhance and develop this further in order to meet our needs in the 21st century.

Hopefully we can soon begin to paint a picture for the new future and then move on to think about what 'really good' looks like for every clinical service, hospital, system. Where is the 'best' – nationally and, more importantly, internationally - and how do we emulate it? Transformation professionals are here to support front line clinical teams to operationalise and embed the changes they want to make. Seek out your QI team and others skilled in this area - they are here to help you.

Of course, health and care cannot impose transformation on the public even after the crisis that is Covid-19, but we can use our collective experience – clinicians, patients, families and wider public – to make major changes quickly. There remain statutory duties of involving and engaging, equality impact assessment and other requirements, but frontline clinicians and care staff now have compelling stories to share with local people as to what the NHS and social care have experienced, and patients, carers and indeed all of us have our own stories to tell too. We can surely now explain more clearly 'why,' 'what,' and 'how' we want to change, and we must continue to support those displaying brave leadership, as they are now in the pandemic, for new, very radical, fast transformation programmes in health and care.

Leila Williams

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