People are at the heart of resilient health and care systems
BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1504 (Published 04 July 2023) Cite this as: BMJ 2023;382:p1504Read the full collection: Rethinking Health and Care Systems
- Correspondence to: H Buckingham helen.buckingham{at}nuffieldtrust.org.uk
The covid-19 pandemic reminded us of many things, one of them being that health and care is person centred. Care is provided for people, by people. The setting, technology, and equipment used are simply tools to enable human interactions to be better in themselves, and to deliver better outcomes for those delivering support and those receiving care.
People are at the heart of resilience within the health and care systems. It is people who can spot and prepare for a crisis then manage it to the best of their ability and learn from it. There is plenty of evidence that the lack of investment in the infrastructure of civil society has affected the resilience of the health and care systems and slowed the recovery of the NHS and the wider community from the pandemic. Research by the Nuffield Trust comparing the NHS in England with 16 other countries showed that “the UK entered the crisis with higher bed occupancy rates and fewer doctors, nurses, beds, and capital assets than most other high income health systems” and experienced higher rates of excess deaths during the pandemic.1
Similarly, other Nuffield Trust research found deeply rooted systemic problems in social care, with unclear roles and responsibilities among levels and areas of government.2 Many of the respected commentators on social care referred to the fragility of the sector, and the latest review of the state of the workforce in England cited a shortfall of 140 000 staff even before the pandemic.3 The net result was that people were not able to access the care they needed and large numbers of people relied on unpaid care from families and friends to support them.
Numerous commentators have highlighted the effect of austerity on the wider economy and on the health of our population, and the extent to which whole system shocks amplify pre-existing health inequalities.4 Clearly, improvements in the health and care systems infrastructure are needed, and it is imperative to address rather than exacerbate health inequalities. What more must we do to ensure that the people who work in the health and care systems—including informal carers and volunteers—are resilient?
How to do better
The answer is not “resilience training”; nor is it telling people that they themselves are the problem and that if only they were mentally and physically tougher everything would be fine. A common theme emerging from the articles in the new BMJ collection on rethinking health and care systems (www.bmj.com/rethinking-health-and-care-systems) is that treating people with kindness, dignity, compassion, recognition, value, and autonomy is at the heart of making sure the systems can cope with shocks.
And it starts from the top. A powerful report on the experiences of smaller hospitals during the pandemic identified that even “very senior managers felt that they had no peers within organisations with whom they could freely share their concerns.”5 If we are not able to ensure that leaders have the support they need to be resilient, what hope do we have of ensuring that they are able to support their teams effectively?
It also extends beyond the needs of health and care staff to looking at the needs of carers and of volunteers. In its 2022 report, Carers UK identifies that only 25% of carers had had a carer’s assessment—a local authority evaluation of their willingness to care and the support they need—in the past year. Of the 75% who were not assessed, almost two fifths did not even know what an assessment was.6 The NHS Volunteering Taskforce report published in June 2023 noted that the covid-19 pandemic had highlighted the vital role of volunteering.7 It contains important recommendations for raising the profile of volunteering and the number of volunteers—including in relation to crisis response—but nowhere does it reference supporting the psychological needs of volunteers.
To ensure that we create resilient and sustainable health and care systems we must invest in the people who deliver the care and support and in the buildings and technology that enable those people to work more effectively. This requires a plan, which should be based on pandemic experience and the projected needs of those who are or may be reliant on the services. Learning from the pandemic is key to better planning; otherwise, we walk blindly through a tunnel with no light in sight. Investing in people will create resilience, which in turn will make health and care systems sustainable in the long term.
Footnotes
Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare no other interests.
Provenance and peer review: Commissioned; not externally peer reviewed.
This article is part of a collection proposed by the Health Foundation, which also provided funding for the collection, including open access fees. The BMJ commissioned, peer reviewed, edited, and made the decision to publish these articles. Rachael Hinton and Paul Simpson were the lead editors for The BMJ.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.