Reflections on the Crisis: Returning to the Service

William Roberts is Head of Health and Social Care at Innovation Unit, a social enterprise that grows new solutions to complex social challenges. Previously, he was a member of the senior leadership team at NHS England in the New Care Models and System Transformation Group. William has a clinical background in infectious and tropical diseases. When the pandemic hit, he chose to step again into his frontline role, to support the pandemic response.

When COVID-19 started to peak in March I decided to go back into the NHS to provide support where I could.

In part this was a deeply personal choice. I spent over twenty years working in the NHS prior to joining Innovation Unit and my clinical background is in infectious and tropical diseases. Like the thousands of people who signed up to help out, from local mutual aid groups to staff returning to their profession, I simply couldn’t not contribute, especially after listening to the stories I heard from my wife, coming home from 13-hour shifts in ICU.

I made a call on the Friday and on the Monday I was in my local system.

I’ve done everything from modelling capacity and demand to brokering relationships between key partners and moving beds around a hospital. It has been a bit of a whirlwind. I am in awe of the people I have worked with over the last three months, from health and care workers, to the charities, the estates and facilities staff and members of the public.

Now, three months on, I have a few reflections.

COVID-19 is on a scale none of us has ever experienced, so we are all learning.

I’ve nursed most infectious and tropical diseases and have led large public health initiatives. I worked through Swine Flu and SARS. But I’ve seen nothing like this and friends say the same.

Knowing what you do know, where you add value and that we are all learning is essential if we are going to really make a difference. Once I accepted I was learning, it made the doing a lot easier for me and others.

It’s a marathon, not a sprint.

Everyone says this, and then proceeds to sprint as hard as they can. It’s hard not to and at times I felt myself caught up in this. But I also saw hardworking and passionate colleagues exhausted and struggling.

With a vaccine still months, maybe even years away, we are going to have to find ways to recharge and refresh and slow down our thinking to ensure we can cope with the next period.

People are exhausted and we still have a long way to go. Having run a couple of marathons, it’s all about the training and pacing. Ensuring we support staff to take leave, not seeing everything as urgent, and clearing out unnecessary bureaucracy are going to be key to sustaining our efforts.

Rapid prototyping, freedom to try, and understanding not everything will work.

I’ve led and consulted on major change programmes for the last decade. In that time, I’ve never seen the appetite for trying new things that I have experienced over the past three months. Seeing leaders enable people to try new things, to prototype and accept that not everything will succeed, has been revelatory. Seeing staff working with the permission to test and learn has been a joy.

Frontline staff and managers working towards a common goal with the freedom to act has meant that things that would have taken years to achieve happened almost overnight. Watching leaders be brave and give their teams this explicit permission has been a real privilege, and I hope this is something that will be sustained post COVID-19.

Not everyone has experienced the last three months in the same way.

Whilst we have seen unprecedented change over these last few months, a range of services have rightly been put on hold. For those that haven’t been part of the whirlwind change, and for the service users whose care and support has not been available, we need to move from crisis response to effective recovery and we need to involve our staff and users in that recovery.

The long-term impacts of COVID-19 will be on the wider population health. The last period acts as a sharp reminder that, whilst we have all experienced this, in reality it is the poorest and most vulnerable who have been disproportionately impacted by COVID-19. Our greatest challenge remains inequality, both structural and personal.

Change has happened, and relationships have been built, but it needs to be embedded.

“We’ve made massive strides, and we can’t go back”. This is a thing I’ve heard time and time again over the last three months. In reality, this is easy to say but much harder to do. Like any good relationship, it’s going to take time and effort to make it work.

This means that the effort we made to get to know each other has to be more than a crisis response. We will need to find ways to continue bringing people together to work effectively.

Importantly, this will mean bringing service users to the heart of those relationships so that what we develop for the next phase responds effectively to their needs, rather than just the immediate crisis.