Coping with the pandemic has produced better collaboration between different health and care organisations in London and strengthened commitment at leadership level to reducing health inequalities in the capital, according to report by a leading health charity commissioned by the Greater London Authority.
The King’s Fund, which is dedicated to improving health and care across England, says coping with Covid-19 has meant the NHS, local authorities and voluntary sector bodies working together more closely than before, resulting in these partners becoming “more focussed on tackling the major health inequalities that exist in London” and “creating a moment of opportunity for lasting change”
The report examines the response to the emergence of the coronavirus by the five Integrated Care Systems (ICSs) that function across the capital, which have evolved out of reforms designed to join up different layers and types of local health and social care provision that first came into effect in 2016.
It says the urgent common purpose fostered by the pandemic created scope for the different bodies within the ICS structures to collectively adapt to its demands an implement in weeks or even days changes that would otherwise have taken years to make.
The need for frequent, sometimes daily, meetings has led to speedier problem-solving, there is closer work with community organisations and pharmacies due to the need to help older people and others who were shielding, and the provision of contact with doctors and outpatient appointments by phone or video link has been dramatically transformed.
“The response to Covid-19 has rapidly accelerated some service changes that were already planned,” the report says. “Most notably it led to a massive expansion in remote access.”
Protecting the capacity of hospitals to treat the surge of acutely unwell Covid patients meant the stepping up of “rapid response community services” to accelerate the discharge of people who no longer needed to be in hospitals and preventing new admissions that could be avoided, including people with mental health problems going to accident and emergency departments.
It gives as an example close work between the West London Mental Health Trust and the London Ambulance Service “to develop different ways to meet the needs of individuals with mental health needs who were regularly calling 999”.
The risk of Covid transmission in various primary care settings became reduced by the separation of Covid from non-Covid patients and, says the report, “In many areas, local authorities set up community hubs to bring together and coordinate support offered by the council and various voluntary and community organisations, helping to signpost and connect residents to the advice and support they need.”
The King’s Trust’s work began shortly before the pandemic took hold in the UK, with the initial purpose of examining the development of the capital’s five ICSs and building on two previous studies, published in 2017 and 2018. It draws on 27 “in-depth qualitative interviews with health and care leaders across London” and a roundtable discussion held in November with 15 leaders present, including representatives of the GLA and Public Health England.
Sadiq Khan has previously set six tests he wants the reforms to meet before lending his support to further changes. London Mayors have few powers over health and care provision, but are required to produce a health inequalities strategy.
The study says tackling health inequalities has become “an even higher priority as a result of the pandemic”, with some interviewees saying their efforts in this area now take in more of the “wider social determinants of health”, which might include getting in touch with the relevant local authority if an asthma-sufferer’s housing conditions are making their conditions worse.
There has been a sharper focus on “particular groups that have been been strongly affected by the pandemic, including some Black, Asian and minority ethnic communities, people experiencing homelessness and people with a learning disability,” the report says.
It stresses the importance of “locking in” the improvements to the systems the pandemic has brought about, but also notes that the speed of their introduction has meant the usual consultations with the public being bypassed and that this will still need to be done before changes are embedded for the long term.
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