Authors
Specific, direct and immediate action is required now if we are to avoid the worst of the winter crisis ahead. Fortunately, as public sector and VCSE leaders and managers, and as citizens, there are things we can all do now to ensure the most vulnerable are supported in a time of need.
It is almost hard to believe, as we recover from recent July heatwaves, that we are rapidly approaching a winter bearing all the hallmarks of yet another once-in-a-generation public health crisis: a third Covid-winter, and potentially the first “full” flu season since 2019, occurring against the backdrop of rises in cost of living which will impact millions of people’s ability to feed themselves and maintain warm, well-lit homes.
In this call-to-action we want to highlight three things:
1. Without substantial, further national action on the cost of living (which is far from guaranteed) our country is facing a situation where a large proportion of the population will not be able to effectively heat their houses and feed themselves and their families.
Disproportionately, the worst affected will be those already experiencing significant health inequalities – those who need good heating and good nutrition the most – including the elderly, families with young children, people living with long term conditions and disabilities, and all who find themselves, through no fault of their own, unwell and in need of assistance this winter.
2. The inability of people to heat their houses adequately through the winter months, combined with a growing mental health crisis exacerbated by pressures on individual finances, will serve to magnify all other existing challenges facing our healthcare system this winter.
These challenges are not difficult to foresee or understand. Poor lighting increases the risk of falls, poor or no heating increases the preponderance of damp and worsens COPD and other long-term health conditions, trade-offs between “heating and eating” impact the ability of people of all ages to stay healthy and well.
There is no single solution that any of us, including central government, can produce to this situation; but nor can we simply resign ourselves to a future involving so much predictable human suffering.
3. We need a system response and a degree of national creativity, of the scale discovered during first two years of the pandemic, if the worst effects of this crisis are to be avoided.
Despite all of our best intentions and efforts, it can too often feel like that singularity of purpose and shared response to COVID have, to a greater extent, already faded; leaving individuals, communities, and organisations who support them to struggle on alone.
This is not designed to be a “thought-piece”, reflecting on the position as a country we find ourselves in and arguing that “something must be done”. We all know something must be done – we now need to figure out how to do it. Many who were involved in leading and managing the COVID crisis response form part of a generation that has spent two, three or more decades working within and alongside public and voluntary and community sector services in England: people who believe passionately in the value and purpose of service, who know services are capable of rapid adaptation when required, and who are committed to being part of the “safety net” that helps sustain our society through the worst of times, for however long those last.
For them, for all of us, this is a call for action. We believe as citizens and as communities, as individuals, organisation and as systems, everyone has a part to play; but that to succeed people will need support from leaders at all levels to do the following three things – today if possible, tomorrow if not:
1. We need to rediscover the shared focus and synergies that characterised the very best of our COVID-19 pandemic response.
Public services need to start planning jointly for winter now; and to be planning for the winter we are all about to experience, not the ones that have gone before.
That means old-style NHS “System Plans” will rapidly need to become “Place Plans”. It means elected councillors and community leaders, amongst many others, working actively together with public sector and VCSE executives and managers to shape these plans into something that will genuinely transform lives on the ground.
We need joint funding for the provision of support, across organisational and sectoral boundaries, to make sure co-ordinated help reaches those who need it; and we will have to acknowledge that this year will involve a much larger group of people than may have needed help before.
2. We need to focus on this as a “human-sized” crisis.
Statutory bodies can sometimes struggle to see the individual, focused as they are on populations as a whole. Nonetheless, over the past 5 years, health and care partnerships have increasingly recognised the value of, and worked actively to develop, person- and community-centred approaches that build on the foundations of true local collaboration. These too are needed now more than ever.
Our health and care services need a successful flu vaccination and Covid booster programmes for all those eligible, and our local partnerships are going to need to support people in crisis as early as possible, to ensure already overwhelmed acute, primary and community teams can respond effectively to those with the most significant physical and mental health needs. Just as the pandemic made integrated working more real for many people, including through the support provided in joint discharge hubs and COVID vaccine programmes, so this winter crisis should be the moment where we recognise these approaches as simply how services work, with local people and communities, and in the places where they are.
This is a big, practical ask of all of us – not just clinicians and other frontline professionals, and not just for those whose job titles suggest they must be the ones responsible.
We should be realistic about what we can do within the constraints of the existing, over-stretched health and social services. We need to re-connect across generations, building on the lessons of charities such as the Cares Family. We need to be routinely checking on our neighbours to ensure that they are able to cope, and to make sure that everyone knows what support is available and how to access it when they cannot. And we may need to embrace fully the power of volunteering, with its significant benefits for patients and service users, for organisations and partnerships, and for volunteers themselves.
3. We need to harness all of our local assets, including public sector buildings and estates.
People will need warm spaces to come to through the day, and access to a range of support quickly if their circumstances change (for example, when they or someone in their household becomes ill).
We are fortunate to have warm buildings already located within communities – including town halls, community halls, libraries and leisure centres, shops and businesses – perhaps not as many as historically, but good places to start. Health, local authority and VCSE partnerships need to be mobilising now to arrange programmes of community activities close to where people live – a place of shelter, with tea and biscuits, newspapers and magazines, and a bit of human company would be a brilliant starting point – and then thinking about what else could be done to help people once they have arrived and settled in. Flu jabs? Covid boosters? Citizen’s Advice Bureaus? Blood pressure checks? Social prescribing? The list goes on….
Such “Warm Hubs” would provide systems and places with invaluable experience in developing all-year-round integrated, neighbourhood models genuinely rooted in proactive and preventative care, ones which build on existing voluntary and community sector networks and “mutual aid” of the type we have seen deployed so effectively since 2020.
None of the above is radical – we suspect that everyone reading this will recognise the situation being described and the common-sense of starting to be practical and creative in the use of resources today. Many may already be doing one or more of the things suggested above.
What will happen though if we fail collectively to scale our response in time? Our country is already facing a bleak winter. Those who will be hit hardest will be the least able to manage and our already unstable social contract will strain even further.
The challenge is that, for lots of public sector leaders and managers struggling with so much else right now, this just isn’t quite urgent enough yet; whilst in reality there is a limited, and diminishing, amount of time to achieve progress at the level required. Doing something now gives us all a chance of coming through this winter together; leave it until the leaves are dropping and we can all see what the months ahead are bringing, and it will sadly be too late.
Many of our leaders talk a lot about population health management these days and collectively we have built networks and tools to enable us to work together better. This includes the 42 new statutory Integrated Care Systems in England. All have key roles to play, but our biggest risk as a society may be in allowing future visions and plans – “the best” – to be the enemy of those small, local, practical things that could make a positive difference in the weeks and months ahead.
During the pandemic, radical action was possible because the crisis was visible and acknowledged by government and society at every level. At the present, the focus is on the challenges of this summer, but the coming crisis will dwarf what we are experiencing now. What is outlined above is not necessarily expensive in monetary terms – but it is about facing squarely the road ahead; responding honestly and effectively to what we see; and making sure that, when we arrive at that point, we have done all we can to protect and support those in greatest need.
