This week’s leadership message comes from Sarah Muckle, Director of Public Health for Bradford and Deputy Chair of the Yorkshire and Humber Director of Public Health Network

Hi I’m Sarah

It feels like now is the time for some reflection and some refocusing on what we must prioritise in this next year. As we enter the phase of living with COVID-19 (albeit it’s fair to say that it doesn’t feel like that from where I am in our health and care system), pressure is still significant for our hospitals and for many of those who work to keep people healthy and well in our care sector.

With a move away from COVID-19 testing, it will mean less opportunity to anticipate increases in demand and without the ability to plan for it there will no doubt be more periods of uncertainty for front line services, and others.

Professor Sir Chris Whitty recently visited Bradford and I was pleased to accompany Mel Pickup, CEO for Bradford Teaching Hospitals NHS Foundation Trust and Place-based Lead for Bradford District and Craven, in meeting some colleagues in one of our busy Bradford hospitals. I felt honoured to say hello and listen to their experiences.

I learnt a lot about the challenges hospital colleagues have faced over the past two years and more. Having been a nurse myself I thought I already had a good understanding and a grasp of the basic challenges this kind of respiratory illness brings but I in no way understood how ill people were, how much hospital services had to be reorganised and delivered in different ways and how even more complex and challenging delivering care and treatment became. They have gone above and beyond what anyone would have expected, I was full of admiration.

COVID-19 has been an experience where the local, regional, and national systems (and communities) have had to come together to take collective action to minimise and reduce the risks to people in a way that I have never seen before in my public health career. Everyone was affected at the same time and as professionals we all had to look at how we could use our expertise and experience while dealing with a different way of living our lives with family and friends.

Being one of many health and care leaders, COVID-19 often made me feel as though I wasn’t doing enough. It made me question whether I was getting it right – we became obsessed with numbers (It was the first thing people asked me everywhere I went, even my dad who has never really understood what I do) including the number of people and families impacted by this horrible virus.

In the beginning of the pandemic, I remember as though it was yesterday, people began to be really concerned when we hit 50 cases of COVID for every 100,000 people in the Bradford District, not knowing at that point, that cases would eventually reach more than 1000 per 100,000 people. At every point the focus remained on the actions we must collectively take to keep communities safe and our essential services functioning. We were so focused on tracking the virus because that is how we reported whether we were succeeding in our efforts to reduce COVID-19 and most importantly save lives, but it was still important to check in with partners and understand the impact on the local system, the numbers couldn’t tell us everything.

I remember being in an outbreak control board meeting expressing relief that our cases were coming down because we had been under the scrutiny of National Government, whilst recognising that for our acute hospital trusts, the picture remained bleak and for them in their working environments things were getting worse, not better.

Similarly, I realised that implementing social distancing rules in Council buildings had much broader implications than you first think, as everyone automatically thinks of offices – but for schools there were huge implications and lots of questions. What seemed like a simple task for some was the opposite for others and there were issues to consider that I hadn’t even thought of in terms of impact on different working environments. Yes, there was much to think about, and often with flight of foot.

Chris Naylor from the Kings Fund recently wrote in his blog that integrated care systems are intended to be a fundamental departure from previous structures with a different type of leadership based on partnership, in which local partner organisations hold collective responsibility for resource use and outcomes. COVID-19 pushed us out of our comfort zones in so many ways and we often had to use different types of leadership to take on the scale of the challenge we were faced with. It challenged our assumptions, we built new or stronger relationships and we thankfully increased our understanding about different parts of the jigsaw that make up our local, regional, and national systems.

My examples of learning are small, but the impact on me has been tremendous. The number of people who lost their lives, the families, and friends it affected will live with me, like so many others, for the rest of my life. My personal learning has also reminded me of the challenges of system leadership and that each one of us bring something special to this complex West Yorkshire system. Everyone is equally important, and everyone has an essential role. Everyone in equal measure is needed if we are going to get this right for local people’s health and wellbeing.

While I hope COVID-19 will not dominate our thinking and our actions for much longer the lessons we learnt about ourselves, and our leadership shouldn’t be lost. We have lots of challenges that will benefit from us continuing to come together in the same way to tackle complex problems and it’s really important that we roll this forward for future experiences when and should they be needed (which they most probably will).

The first that springs to mind is health inequalities – there is no better example of an agenda that impacts on us all and requires everyone’s expertise to do what we can in our organisations to get it right and collectively address the health inequalities we know exist. COVID-19 brought this back with a stark reality to the forefront of our minds – the desire to turn the curve is stronger than ever before. The time to act has never been more important and we must do so.

Recent feedback on our Partnership (integrated care system) was that our approach to tackling inequalities was strong but the challenge, as always, is how that translates our commitment into improving real outcomes for people. Let’s use the lessons we learnt from coming together for COVID-19 to tackle something that has the potential to have a longer-term impact on far too many people’s health and wellbeing – health inequalities.

Thanks for reading and have a good weekend

Sarah