Author: Baroness Ilora Finlay of Llandaff, Bevan Commissioner, Honorary Professor of Palliative Medicine, Cardiff University, Chair of the National Mental Capacity Forum and Crossbench Peer.
As the Covid-19 situation develops, health and care services continue to work under unprecedented pressure. Across health and social care, staff at every level have adapted to the unique challenge – taking on great personal risk in the process.
As last Friday’s VE Day celebrations marked the victory and the personal losses of so many 75 years ago, we are all starkly aware of the lives lost to Coronavirus. Each life lost leaves families irreplaceably bereaved.
Just as in the war, shortages of equipment mean improvisation in the face of increased risks, so today staff had adapted rapidly. People have not abandoned their posts. Some of our lowest paid have borne the brunt of frontline duty, exercising great skill and human kindness at the same time.
As we plan to emerge from this crisis, we need as a nation to decide what we value and which old practices we will abandon. In the long haul ahead, Health and Social Care services will need to maintain their vigilance more than ever to ensure that places of care do not become reservoirs of infection.
People with serious non-Covid conditions need treatment in isolation from Covid risks.
The place of remote consultations by telephone, emailed photos and videoconference will become a permanent feature of much of healthcare, with pharmacies accepting emailed prescriptions. For security, they will need remote access to records.
Perhaps the greatest challenge will be how the population views healthcare and people’s expectations from the NHS. Covid has shown us all that the most dangerous of conditions are often out of reach of modern medicine – diseases, like criminals, are one step ahead as we try to catch up to gain some control.
Emergency Departments must be reserved for major trauma and life-threatening urgent conditions. They must never again be crowded places, with people sent there ‘to be checked’.
Those in the community who are ill must be seen, diagnosed and treated in the community – that requires 24/7 services that are rapidly responsive – not sent to Emergency departments where they wait with others before returning home again.
The care sector has been revealed to be the most vulnerable of all – the heroes of yesteryear reside there now. We owe to many of them the freedoms we take for granted and the peace in which most of us have lived all our lives. Their lives are reservoirs of wisdom, experience and resilience. They are the Second World War survivors of the ultimate sacrifice that gave us our freedom; we call them heroes. Yet they have been living out their last days often dependent on social care. Now, during this pandemic those who care for them have been their advocates. Many of these carers sought refuge here in recent times from repressive political regimes and have served this new homeland of theirs by risking their lives to care. It seems history has gone full circle.
The care sector, often relatively neglected and underappreciated, must be brought into the benefits of the NHS. Staff need secure contracts; they need training to build on the skills they already have. In communities, specialist medical and nursing services need to recognise nursing home medicine as a distinct and important discipline to minimise frailty and value lives.
The local cohesion that many describe during lockdown creates a foundation for better communities. Behind closed doors alcohol abuse has flourished, frayed tempers and disordered minds have result in violence, all too often the victims are children. As we emerge, everyone must be open to recognising the unthinkable in our midst and be prepared to step forward to speak up for those who for whatever reason cannot speak up for themselves. It is only by a zero tolerance to abuse in all its forms will the future be better.
During this crisis, we have learnt to appreciate each other, the value of human relationships, the nature around us and our responsibilities to each other and the planet. Days for those bereaved will never be the same. Children suffering loss at many levels will need a strong society, exemplified through excellent teachers, to keep them safe and give them confidence to achieve their potential in their lives ahead.
With the passage of time, the world will reflect on the Covid-19 crisis and seek to identify lessons that can be learned. Ethicists may conclude that the predominant emphasis on individual autonomy and personal ‘choice’ gave way to recognition that we cannot control those things that really matter. No one chose to get Covid, yet many have died from it. Covid has shown the intrinsic value of each human life, however vulnerable, and the powerful interconnectedness of human relationships.
Society may look to politicians to chart a way forward, but the task will not be easy.
Perhaps society has turned on its head; our resilience lies in the ability of every person to rise to the occasion, the creativity to find solutions and to generosity of spirit. We have seen how rapidly, and selflessly, public services have changed to meet the crisis.
Without people in good health of mind and body, who look after each other, our economy cannot be rebuilt and those services that we have taken for granted will not be there.