Like our sickest covid-19 patients, the NHS has been on life support since March. Many routine and necessary health services were put on hold. Retired nurses and doctors returned to the frontline, clinical staff were redeployed to unfamiliar departments, and independent hospitals were tapped to supplement care, including urgent surgery and cancer treatment. In England, entire hospitals, known as Nightingales, were built and staffed in a matter of weeks, in anticipation of a wave of cases and in an attempt to shield the NHS from being overwhelmed. This rapid ingenuity paid off: the Nightingales never reached capacity and the health service crisis was, in many ways, averted.
Now that we have passed the peak, what is our plan for stepdown? How do we “extubate” our health service and reanimate our daily work?
To safely restart routine services, it is critical that patient needs and perspectives are given paramount consideration.
Patient-centred care is needed now more than ever
Covid-19 has underscored the need for patient centricity. The diversity of covid disease progressions is such that treatments that work for one patient cannot be relied upon to do the same for others. The term “respiratory virus” fails to capture the ever-evolving range of symptoms reported. The novelty of this disease has reminded us that the patient perspective is essential; we still know very little about this virus, but patients know what is and isn’t normal for them.
Recovering covid patients from all backgrounds are discovering that their health challenges may not be over. Long-term damage to the kidneys, lungs, and heart seem to be an unfortunate potential legacy. And whilst we have high hopes for a vaccine and antiviral treatment, it is clear that we will be living with the Sars-CoV-2 virus for some time. In this next phase, we must contend with meeting the needs of the new covid patients who will continue to arrive, along with the traditional range of acutely and chronically ill patients.
As ever, there is no such thing as an “average patient”, and we design services for a prototype at our peril. Even in the covid context, the key to patient safety is patient centricity: the extent to which the health service is responsive is to diverse patient needs, how it enables patients to voice their concerns, and how it tailors care to individual clinical needs.
Covid-19 is a health issue, but also a wider social issue
NHS business as usual halted during the crisis, but life as usual did not: people still had babies, heart attacks, accidents, and 3 percent of our population still had severe long-term conditions, which during covid required them to “shield” at home without regular in-person care. Furthermore, the mental health consequences associated with isolation, illness, and challenging working environments compound the burden of disease and pressure on the health service.
Covid-19 is proving to be society’s very own long-term condition, wreaking havoc on its vital organ systems—education, housing, industry—and exacerbating existing inequalities. The disproportionate impact of covid-19 on marginalised communities intersects with other inequities, such that certain communities find themselves facing multiple public health crises simultaneously. Recognition of these layered inequalities was evidenced by the global outpouring of support for the Black Lives Matter protests sparked by the death of George Floyd, and the structural racism that continues to place people from ethnic minorities at higher risk of poor health and adverse outcomes.
The pandemic is an opportunity to innovate to for safer care
Whilst some clinical resources must be ringfenced for ongoing covid-19 endeavours, this is an opportunity to innovate approaches for continuing quality improvement. Instead of suspending projects, now is the time to demonstrate adaptability, resilience, teamwork, and technological innovation. By using apps to crowdsource covid-19 symptoms, partnering with young people to support the mental health of their peers, and monitoring patients remotely, we can find new ways to connect with patients at the same time that we curtail the spread of the disease.
Despite the unprecedented challenges faced by the NHS in recent months, the pandemic has also accelerated innovation in fields such as technology, policy, and healthcare service design. Efforts to expedite covid-19 related research—from fast-tracking study approval processes to massive funding boosts, to the popularisation of preprints—have been unprecedented. Telehealth, a technology that has long been waiting in the wings, has been widely adopted virtually overnight. The pandemic has seen the public and private sectors work together to tackle demands for patient beds and clinical equipment, and new hospitals were built in conference centres in a matter of weeks.
The pandemic has reinvigorated a culture of innovation and ingenuity within the NHS. This willingness to adapt quickly, assimilate new teams, share information, and experiment with novel interventions should be maintained. Past the peak of the acute emergency, it is time to define our new normal. Let’s make sure it is holistic and patient-centred.
Katelyn Smalley, doctoral researcher, NIHR Imperial PSTRC
Jackie van Dael, doctoral researcher, NIHR Imperial PSTRC
Ola Markiewicz, clinical research fellow, NIHR Imperial PSTRC and general surgery registrar
Daniela Rodrigues, doctoral researcher, NIHR Imperial PSTRC
Monsey McLeod, research fellow, NIHR Imperial PSTRC and Lead Pharmacist—Medication Safety, Imperial College Healthcare NHS Trust
Kelsey Flott, centre manager, NIHR Imperial PSTRC
Ara Darzi, director, NIHR Imperial PSTRC and co-director, Institute of Global Health Innovation
Competing interests: None declared
The authors are affiliated with the NIHR Imperial Patient Safety Translational Research Centre (PSTRC), part of the Institute of Global Health Innovation at Imperial College London.
The views expressed in this publication are those of the authors and not necessarily those of the NHS, NIHR or Department of Health and Social Care.