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Everyone’s wondering what happens next.  There are brave souls trying to plan the future.

Aside from the dreadful human tragedies, that will haunt us for years, the last five months upended the NHS.  The next five will do it again.

Planning is tricky.  The probability of a resurgence of CV-19, in the middle of the flu season, makes it even trickier.

Perhaps, there are five key issues;

First; there can be no talk of what’s next, without a secure workforce.  That means routine, reliable and extensive testing.

The heroic acts of an already damaged front-line, somehow coping, have disguised the dreadful state of our workforce.  

Key to the medium term is the answer to a question; will the bravery, of the NHS front-line, tempt more to join the ranks or will many say, this looks exhausting and dangerous, PPE was a fiasco, not particularly well paid and there are easier ways to earn a living.

How many colleagues will have struggled through the hiatus and when the labour market opens up again, thank their lucky stars they are in one piece and move on.

Add-in the impact of bulldozering us out of the EU and we could be facing the prospect of a workforce, many with post-traumatic stress, dwindling numbers and a bigger recruitment crisis….

… don’t forget the backlog of un-used annual leave.  Does the NHS buy-it-out, or extend a carry-over?

However, it’s likely there will be millions from service and other industries, unemployed.  Will the NHS restructure, with fast-track training, to provide safe, care-skills, outside the traditional professional pathways?

Second; where will people be willing to work?  

Will they throw the contagion dice and jump on a packed train.  Or, will they say, if I can’t work from home, I’ll find a job where I can.  Blowing a hole in NHS estates, capital charges and the price of every procedure from bunions, to by-pass surgery.

There have been some real productivity gains, using screen conferencing, telecommuting and undoubtedly hours of unpaid overtime, when the office is on the kitchen table.

The NHS has never fully exploited technology to deliver new ways of working.  Now we know, the alternative to commuting, battery-hen offices, fluorescent tunnels and the boiling-to-freezing delights of Portacabins, works.  It’s convenient, cheaper, likely more productive and fits family life.

Third, the ‘customers’, the patients!

What we don’t know is anything about post-covid, patient behaviour.  Having once had perfectly safe and efficient treatment, remotely, it will no longer be for clinicians to set the pace of change. 

Patients are very likely to demand their release from the doctor-slave relationship, that required them to take time-off work, traipse to the clinic, pay a small fortune in the car-park and be kept hanging-about.

As for the three minute window at 0823hrs, on the phone, to get a GP appointment… not any more.  It’s video first or there’ll be droves of patients looking for alternatives.

Future-planners must take into account the shift in demand.  Populations have acquired new digital habits and will expect the NHS to respond.

Fourth; the futility of regulation has been exposed.  

Overnight, services have been redesigned and provided miraculous, safe care without a busybody, with a clip board, in sight.  

What bureaucrat will dare to tell a Covid-veteran how to do their job.  

Post Covid is all about sharing ideas and innovations.  Regulation is finished.  The new era could and must, bring forward advisors and evangelists for best practice.

Five; smart organisations will respect the past and take the best of it into the future. 

How will they collate and keep a memory of all the new innovations and smart changes that have made healthcare work, during the pandemic and embed them into future plans. 

In his latest, exclusive article for us, Ed Smith former chair of NHSI, talks about Covid-Custodians.

Five issues that tell me the future is not at the end of a straight line.  

Planning a future, two meters apart, in offices no one will want to sit in, with staff we may not have, to run services patients won’t want to use… is no future.

The best chance we have, to understand the future, is by looking back. And, that tells us, CV-19 has changed everything and at the very least, if we don’t understand that, it will have been for nothing.

News and Comment from Roy Lilley
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Reproduced at by kind permission of Roy Lilley.