Covid-19 has fundamentally changed the way we live, work and play – the way we see the world around us and importantly the way we think, plan and operate. With this in mind, we have created our 5 Keys To Success – a roadmap to guide us and our collaborators through the challenges and opportunities of 2022 and beyond. But we will not be walking alone. On this journey, we will be joined and led our 23 Bevan Commissioners – a team of world class healthcare experts with an enormous breadth of experiences and knowledge who advise us, challenge us and champion us in Wales and beyond who make all of this possible.
Covid-19 clearly demonstrated the gaps and the inequity between the NHS and the social care system. There are missed opportunities to improve and reduce the gap and we need to be able to look back in time and know that we have learnt and created a different future. To achieve this we all need to work together more rigorously for a more equitable and integrated National Health and Care Service, where health, wellbeing and social care are managed more effectively together at a local level, on an equal footing and held to account by local people. Underpinned by Prudent Health and Care, applying the four Prudent Principles and a value-based approach will achieve high quality and sustainable care (whether health or social care) addressing people’s needs, which is safe, consistent, without harm or waste, in a meaningful and compassionate way. Different means to sustain and fund this service will need to be fully explored with the people of Wales.
The economics of wellbeing through access to fair employment, housing and social connections is fundamental to a healthy and wealthy Wales. This is reinforced through the Bevan Commission’s Prudent Social Model of Health and the Wellbeing of Future Generations principles and not just the traditional and medical model of healthcare. A population ‘place based’ social model recognises the importance of preserving physical and mental wellbeing using the assets held within local towns, villages and communities, where people live, work and play. This was seen clearly during the pandemic where local people, services and support played a key role in sustaining and supporting those in need such as the elderly, people from black and other ethnic minority groups, and wider disadvantaged communities, who were most isolated and disconnected from society. Such disadvantage should not be allowed to fester. Our moral compass must look for solutions, such as taxation and other means, to redress this to ensure an equally well Wales.
This includes a health and care system where everyone is able and supported to play a part in taking responsibility for their own physical and mental wellbeing and that of others. It should ensure support is fairly focused around people with greatest needs, addressing health inequalities and the moral and social determinants of health – ‘to improve health requires improvement in every area other than health — When society is flourishing health tends to flourish’.
Covid-19 has further reinforced the need for strong leadership and innovative thinking to ensure high quality systems and services for everyone, irrespective of where you live or what you do. Inequality of access to consistently high quality care is unacceptable.
Leaders across public services play an essential role in achieving this and must be supported and held to account. It will be important to support people as they think and work differently and in a more transformational way, building upon the more radical changes we have seen in the last year. Health and care staff account for 75% of the total budget and they, along with patient voices, must be fully engaged to help co design deliver services for now and for the future. Developing and supporting our future leaders to be prepared, skilled and able to transform systems, will be crucial. The ‘same old leadership’ styles will not be appropriate. We must find different and more dynamic ways, learning from leaders outside of health and care and internationally, to make Wales once again the leader in the field.
We should not take people or our resources for granted. We must continue to bring sustainable solutions to the forefront of our daily lives, consistent with the Wellbeing of Future Generations principles and the wider context of Wellbeing Economics. Sustainability goes beyond economic and environmental impact and includes aspects such as return to work, fair employment and income support. The Global and One Health agenda reinforces the interdependence of human health with wider environment and social determinants of health. Now more than ever resources are, and will continue to be, extremely limited therefore we must find more sustainable solutions for the future beyond Covid-19.
Reducing waste is not only prudent – it is essential for the future, as highlighted by Sir David Attenborough. It makes sense whether considering time, equipment, drugs, food, energy or other resources and will also help to create a healthier Wales to live in. Everyone can play a role in this and be encouraged and supported to take responsibility to use resources, skills and time effectively. Health and care systems, professionals and the public should work together to reduce waste of all kinds, taking joint responsibility for our own carbon footprint in Wales, consistent with developments such as Healthcare Without Harm, Sustainability in Healthcare and the Well Being and Future Generations Act.
Embedding innovation and transformation will be core to the future sustainability and viability of the system and services. This is a core driving force to ensure Wales is able to flex, adapt and be fit for the future. To realise this and to secure sustainable recovery, plans will need to be accelerated. A step change is needed to sustain health, reduce demand and transform services within an environment which supports and encourages everyone to play a part in finding innovative solutions together. Healthier Wales recognised the role that health and care services, universities, industry, patients, people and professionals all play.
Greater focus is needed on maintaining health and wellbeing and ‘what matters to people’ not ‘what’s the matter with people’. Listening to people and their ideas, supporting people’s needs not the ‘systems’ and helping people help themselves not just treating ill health will be imperative.
We must all be open and prepared to think and act differently and supported to make the necessary transformation. Existing resources and ways of working should be reviewed, with Transformation and Innovation Funds used to try out, test and adopt new solutions, models, technology or ways of working, whilst decommissioning and replacing old and no longer viable models of care. National and local system wide transformation should generate and support more radical and integrated ideas working across boundaries, professionals, organisations and communities to find better solutions together, as well as their adoption, adaptation and spread. Everyone should be encouraged and supported to play a proactive role in the adoption and spread of innovation across Wales.