This is how we should rebuild the NHS

We should not be going back down the road we came from before the pandemic, writes Alexis Paton

The government loves a good driving analogy, doesn’t it? Roads and maps are particular favourites – the last two years have been full of them. We’ve had road maps for just about everything from recovering London’s economy to “coming out of” Covid; and the latest has been a “road to recovery” plan for the NHS as it moves forward and “out” of the pandemic.

You see, the thing about roads and maps is that a map is only as good as the cartographer who creates it, and only finished roads take you somewhere. On Sunday night, as the Tory leadership candidates sparred over taxes, wokeness and personal political journeys, how the NHS navigates its way out of the wilderness of backlogs, workforce shortages and a lack of resources seemed to have slipped from the minds of the candidates-in-waiting, leaving NHS leaders looking at an unfinished road to nowhere. Instead, they called for a “realism reset” on how we run our NHS.

Personally, I find all this talk of roads just machismo dressed up as tarmac, but hey, if you can’t beat ’em, join ’em, right? So, taking my cue from the Royal College of Physicians’ latest ethical guidance on the NHS “Road to Recovery”, let’s talk of realistic roads. Specifically, let’s talk about how the NHS travels down the road to recovery safely, steadily, and ethically; building their own moral Bailey bridges as they traverse the gaps.

To begin with, the NHS should not be going back down the road it came from before the pandemic. An overworked, under-resourced and increasingly privatised healthcare system is not somewhere the NHS ever wants to be again. Find some dynamite and blow that road to high heaven. The NHS was not in a great place pre-pandemic – and there is little to be gained from a “return to normal” after it.

Instead, the road to recovery period provides a chance to rebuild and restructure our health services, and we have a moral imperative to strive for something better for staff and patients. This is easier than it seems – we simply need to start looking at a new, more realistic map. Leadership candidates, pay attention.

This new map begins by acknowledging how health inequalities and inequities influence the journey we all take to good or ill health. In building the road to recovery, it is ethically (and practically) essential to recognise the ways in which we can reorganise and redesign the resumption of non-Covid services to consider and mitigate the impact of these inequities on the health of individuals.

Covid has left certain groups in our country worse off in terms of health than others, and to continue down a path that ignores this as we “recover” will only deepen the divide between the ill and healthy. This can – and should – be done explicitly.

From an ethics perspective, the road can be purpose-built to avoid these inequities by, for example, reviewing existing policies and procedures to consider how certain patient groups may be disproportionately negatively impacted by the policies and decisions made moving “out” of the pandemic.

To achieve this goal, it is time to join existing roads together, taking a nationwide approach to supporting the NHS to recovery. The pandemic has shown us that when trusts and regions work together, we can better support and provide services to the population.

The road to recovery must consider how these collaborative practices can continue to be used – even developed further – to help provide care in those areas lacking in services, capacity or both.

As the NHS battles a workforce shortage and crumbling infrastructure, nationwide collaboration that allows, for example, better telemedicine to facilitate specialist consultations, the redeployment of staff between hospitals and trusts, ambulance diverts and integrated social care are all ways to build bridges across existing gaps in the road to ensure the NHS gets to the promised land of recovery.

Finally, the road to recovery for the NHS cannot only be built by NHS staff. Care relationships are integral to good clinical practice. The important role that informal and formal carers play in providing essential non-clinical care such as handholding, translation, and emotional support must be recognised as a key part of how the NHS finds its way forward in the future.

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An ethical road to recovery requires the development of policies that balance the tensions between infection prevention and offering care through supportive therapeutic relationships.

Comfort care such as allowing family to attend appointments – and home leave for children – are all examples of non-clinical care that support good clinical practice. Resuming and protecting these services through road-to-recovery policy will allow families and NHS staff to begin caring again safely.

Once again we find ourselves at a Covid crossroads, and once again the map lacks detail; the roads are unfinished. I’ve been here before with the government – giving directions, arguing that ethics, not politics, is the map that can show us the right road to take. Unfortunately, the government continues to prove that they are skilled at neither map design nor road construction.

But we could build a different road. We could go somewhere new. Ethics is still here, standing on the side of the road, waiting for the political powers that be to stop and ask for directions towards a safer, more secure, ethical future for the NHS. Here’s hoping I’m not again left watching the government drive off, taking the NHS the wrong way.

Dr Alexis Paton is a lecturer in social epidemiology and the sociology of health and co-director of the Centre for Health and Society at Aston University