The Tokyo 2020 Olympics were scheduled to be taking place now. We should have seen the grand opening ceremony last month and athletes from around the world competing to be better than the rest, and to ensure their country reached the finish line first. However, we now find ourselves with a very different type of race, with all the world’s countries participating. This is of course the race to respond to and recover from a global pandemic.
The Nuffield Trust has assumed the role of race commentator from the UK’s perspective and finds us limping bravely on. Their latest report reflects the challenge the NHS is facing right now: how to resume health services during a pandemic. It rightly acknowledges that in the race to manage covid-19, while recovering capacity for the essential services they deliver, the NHS’s position was far from strong: its significant staffing vacancies, insufficient capital funding, and under-investment in public health made delivering healthcare services a challenge, even in normal times. Of course, every country had different constraints when the starting pistol went off to resume services, but we must recognise that ours placed the NHS some way behind the starting line.
And having started the race, each country’s health service has had to navigate certain obstacles strewn in its path. The NHS had been running at near-full capacity pre-covid, giving it little room for manoeuvre when demand soared, requiring a major dislocation of routine services and adding to waiting times, alongside serious societal issues associated with long term social distancing—as the report notes: “inequalities are at risk of becoming more entrenched given the economic measures that have gone into containing the virus.” As every country’s health system races onwards, the path to victory is, as the report implies, complex and daunting.
The Nuffield Trust’s report makes the case again for what the sector has called for many times over the years—adequate funding and investment. It further makes the case for real recognition for the staff. I could not agree more that “at every level, the NHS has acted quickly and flexibly to implement new service models that optimised the skills of different staff and reorganised pathways to manage resources effectively while maintaining access to essential care”. The fact that the NHS has coped as well as it has so far is a testament to the efforts of those working across the system.
The report does not credit the role of digital innovation and adoption by the service in the race. Like a good pair of running shoes that boosts speed, so we saw practitioners use this tool to stay ahead. They were able in many cases to transform how they interact with communities from patient triage, referrals and care delivery to help prevent the service from being overwhelmed. Particularly in primary care services.
The report’s examination of our country’s starting point and the response to increase capacity to deal with the crisis logically, reflects where we are now, and the challenges we see in recovering the service to its former capacity—not only to reinstate routine services, but to deal with a second surge, worsening inequalities, and rising demand for care.
However, what strikes me as stark is the fact that capacity should never have been the question for the NHS on which the race hinged. Nor all of the issues that followed. The countries with the most successful responses to the pandemic contained it down quickly and never allowed it to take hold and threaten the population or healthcare capacity.
South Korea has a similar population size to the UK, but living in total habitable space slightly larger than the Highlands of Scotland, and has so far reported just over 14,000 cases and 299 deaths. The nation used its experience of MERS in 2015, moving its well-developed biotech industry to quickly produce testing kits, testing 15,000 people a day within 6 weeks, many through drive-in or walk-in testing booths.
What we need to learn from international comparisons is not how we turn the tools we have to fight new challenges—a global pandemic in this case. But rather that we should open our minds more to learn from those who have deep, proven understanding of the nature of the threat and follow their lead. The race is not over. We still have the opportunity to watch closely and engage with authorities who are getting this right and correct our own route onto a more sustainable path. Specifically, when it comes to an effective test and trace system that is consistently robust across the whole country.
As it turns out, the challenge is not an individual race where we strive to win, earning adulation and glory, but more of a relay, a collective effort. What we are learning is that to “win” we need to ensure we pick up where others leave off, play to our strengths and allow others to “take the baton” where they are strong. There cannot be one winner: all nations are on the same team and no one will reach the finish line alone unless we all work together.
Layla McCay, director of international relations, NHS Confederation.
Competing interests: None declared