Perspectives

A major analysis just completed by the World Health Organisation (WHO) finds that 14.9 million deaths were directly or indirectly caused by Covid-19 up to the end of 2021.  WHO director general Tedros Adhanom Ghebreyesus commented: “These sobering data not only point to the impact of the pandemic but also to the need for all countries to invest in more resilient health systems and sustain essential health services during crises, including stronger health information systems.”

These findings will be instructive for health and care leaders in many countries, the UK certainly not least.  The government’s claim to have thrown a “protective ring” around care homes in the early stages of the pandemic has been judged in the High Court to be just as untrue as the statistics already indicated.  Two women brought the case after the deaths of their fathers in care homes during the first wave, when 20,000 residents died of Covid.

Mr Justice Bean and Mr Justice Garnham ruled that decisions taken by the then health secretary Matt Hancock in the first weeks of the pandemic were unlawful because they failed to take into account the risks to elderly and vulnerable residents of asymptomatic transmission.  In the scramble to free up 15,000 hospital beds as the virus spread, older patients – many with dementia – were discharged to care homes without being tested or isolated, even though the potential for asymptomatic transmission was already known.

When the WHO director general called for more resilient health systems, this country might easily have been one of those that he had in mind.  The British Medical Association (BMA) described the court verdict as arising from a tragic situation that was the “direct result of decades of underinvestment in the NHS and poor plannng that left the health service woefully unprepared to cope.”  And years of underinvestment in social care, the BMA might have added.

Fortunately, a public inquiry will eventually shed more light on these blunders.  The great divide between tne NHS and social care will surely be part of it, because the imbalance between the two halves of the “system” accounts for so much that has gone wrong.  Whether it was the dash to discharge patients or the clamour for PPE, social care always came off second best to the NHS, as if they were two ill-matched boxers in a ring.

How instead can we design health and social care that adequately protects and safeguards those most at risk of harm?  The government has promised to “bridge the gaps” between health and social care as part of its social care white paper, People at the Heart of Care, published last year.  The Health and Social Care Act 2022 is now law and will put Integrated Care Systems on a statutory footing from July, bringing together organisations that meet health and care needs in local areas.

A more collaborative culture has been an elusive goal. These measures at least recognise the problem, but much hinges on their success.