Dancing to a new beat: the next phase of public services’ response to COVID-19

Wednesday, July 29, 2020 - 12:56pm

Blog summary:

As we move out of the lockdown, public services face a new and uncertain ‘new normal’. What are the lessons we can take into this new normal from the initial response to the virus? This article draws on a widely read blog on the ‘hammer and the dance’ published in March 2020.

Like many people, at the start of the pandemic I did a lot of reading about the virus and the options available to public authorities. Among the articles and analysis, a 19 March blog by Tomas Pueyo really stood out. It was called ‘the hammer and the dance’ [opens in new window]. Tomas’ blog has been viewed over 10 million times and has been endorsed [opens in new window] by many experts and thinkers.

The hammer and the dance

The blog sets out a two-pronged approach to manage the pandemic. Initially the aim is suppressing the virus, through the strict social distancing that has come to be known as ‘lockdown’. This is ‘the hammer’. An effective but brutal tool. Effective in halting spread. But brutal in the harm it can do to our mental wellbeing, economic, social and cultural life.

The dance is what comes next, once the levels of virus are very low. It is a more complex phase involving rigorous testing and tracing of cases, with other supporting measures to manage cases and local outbreaks as they emerge. Where the hammer was the relentless predictability of day after day of lockdown and tragedy, the dance is unpredictable. It is about finding a new normal, experimenting with the boundaries of what is safe. All the while seeking out the signs of a less visible, but still deadly, enemy.

Where are we

We are currently in a position where the hammer is lifting. In Wales, the tight restrictions on movement, work and human contact are loosening. We are collectively feeling our way into ‘the dance’.

I started to write this blog in Wales on 6 July. Today, for the first time I can legally travel outside of my local area. My daughter is waiting excitedly for my partner’s sister to join us from England in our newly permitted two-household ‘bubble’ [opens in new window]. But I’m still working from home. Wherever possible I’m still getting my food and drink supplies online. And when I’m outside I wear a face covering and keep a safe distance.

In Wales, we have Test, Trace and Protect [opens in new window] up and running across the country. That system has already been used in localised outbreaks in Anglesey [opens in new window], Wrexham [opens in new window] and Merthyr Tydfil [opens in new window].

As individuals, we are cautiously getting out and about. More aspects of our social and economic life are opening. But we are far from back to normal.

Complexity and the dance

The big challenge is that dance is not a one-way carnival parade through town. It is backwards and forwards. Trying things out, taking new risks, sensing the impacts and perhaps having to row back where the impact is not as expected.

During the full lockdown, it was absolutely clear what people needed to do: ‘stay at home’. The dance relies much more on individual judgement and the public (a) knowing what the right thing to do is and (b) being prepared to act for the greater good. This phase looks and feels a lot more like ‘back to normal’. The risks to individuals are getting lower. In this environment, sustaining the support and active ‘compliance’ with public health measures is ever more difficult. Just look at the exodus to the beaches [opens in new window] when the weather was good.

And, sticking with the metaphor of the dance: we’re not dancing to our own tune. We’re dancing to a beat set by a relentless and deadly virus. A beat we need all our senses to detect and respond to. Up until now, the daily beat has been easy to sense in the data: case numbers, admissions, deaths. All numbers in the hundreds or thousands across the UK. But the virus is getting harder to find. Its rhythm sporadic and faint.

That is why large-scale testing and tracing are so important to managing the risk of spread that goes unnoticed until it is too late.

In short: the dance with the virus requires a whole different mindset and strategy for our public services and the public.

The dance is not just about battling the virus

People and services are adapting to this new reality. Like the economy, public services are restarting or ramping back up. In some places, there are only small numbers of patients with COVID-19 in hospital. The NHS now faces a challenge of what to do about all the non-COVID needs and demands that people have. There has been a lot of focus on delays faced by cancer patients, with some tragic individual cases. But there is also a large back log of non-urgent patients who had already been waiting a long time for new hips, hernia repairs etc.

This is not just a challenge for the NHS. All sorts of public services have paused and redesigned their core work. Staff have been redeployed from the day jobs. Finding the capacity to restart services safely and in a way that allows the flexibility to respond to developments is one of the defining challenges for public services in this phase.

You can’t just flip the switch of the public service and put it back where it was in January. Some of the physical space has changed. In the NHS some operating theatres have been repurposed as intensive care. You can get the builders back in and put things as they were. But we simply don’t know whether we will need that space again if there is a local outbreak or if, as many expect, we get a second wave.

That poses big financial questions as well as practical ones. Spare capacity – like field hospitals – comes at a cost. How long are we prepared or able to fund spare capacity that we may never need? There is no simple formula that gives you the answer.

It is also hard to just flip people back to where they were before the outbreak. Staff in public service have changed. Some of those on the frontline are burnt out and traumatised by their experiences. Some are off sick or shielding. Some have been redeployed. Some have thrived and found their calling as leaders. They may not want to go back to the routine day job. While not comparable, even those of us nowhere near the frontline are permanently changed by the experiences – good and bad – of working from home for months on end.

In short: our public services and public servants have changed in many ways and we need to be making sense of what those changes mean for the next phase of the battle against COVID-19.

Learning lessons

As we shift from hammer to dance, it is important to reflect on the lessons we’ve learnt so far. The challenge with the learning is how to take it forwards in a new context. Here, Maslow’s ’golden hammer’ [opens in new window] is instructive:

‘it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail’.

It is interesting that many people describe this phase we are entering as ‘whack-a-mole’. A game famously played with a hammer. Local lockdowns may well be a part of the dance. But the dance is so much more.

We can learn from others. Many point to the strategy of some countries which have responded with far fewer deaths and cases: South Korea, Taiwan and New Zealand all stick out. But we’re not them. Without wanting to make a case for exceptionalism, we need to find a dance that works for us.

So, to help that processes of developing our dance, I’ve suggested some questions for public service leaders to ask themselves. I don’t pretend that they are comprehensive, but are intended to help build understanding and support planning. These are questions about the lessons from lockdown. But just learning those lessons about what worked and did not in the initial phase is not enough. They also need to be adapted to fit the new environment.

Data: what are the lessons about how well public services did at predicting the spread of the disease and its impact on our public services? What are the lessons on the data we used and published to track trends and manage the outbreak? What data might we need for the next phase, to prevent outbreaks and swiftly manage them when they occur? With an increasing need for the public to make good decisions and do the right thing, what data do we need to make available to enable people to make informed choices about minimising the risk to themselves and, crucially, the wider community?

Leadership: we have seen rapid changes in the approach to leadership across public services, with new control arrangements and support from the military. What have been the benefits of these new command structures and what, if any, downsides have there been? What could be adapted for the future as we move from controlling a crisis to managing uncertainty?

Well-being and harm: At the start of lockdown the priorities were clear: ‘Protect the NHS’ and ‘Save Lives’. So we can ask ourselves – how did we do against those objectives? Also what were the consequences of the immediate prioritisation? We know some people with needs didn’t get the service they expected – some of these are easy to identify because they are on waiting lists. But what other new needs have emerged, what unmet needs and harms from the lockdown itself are there in our communities? More positively, what opportunities are there to build on the self-help and support that have emerged to help people and communities to look out for each other?

Accountability and governance: during the pandemic the governance arrangements of public services have changed significantly. What is the learning, for example from governance – council, parliamentary and health board meetings – moving online? Have we managed to retain an appropriate balance between swift decision making and proper scrutiny of those decisions? We’ve also seen some shift in the accountability regimes – suspending of targets and performance management – what has been the impact, good and bad? What do we want to retain and what can we usefully get rid of to support a more flexible public service in uncertain times?

Innovation: how have we responded to the wider public demands at an unprecedented time? We’ve seen a lot on the rapid transformation in healthcare but what about other sectors? What are the key lessons from the rapid evolution of online services? Before we snap back, how much of the old normal do we really want to put back in place?

Workforce: how did we manage the impact on the workforce? What lessons are there from how we adapted to sickness, shielding, working from home? What are the lessons around redeployment, and getting staff to take up new and unfamiliar roles? Are there lessons that will help us to sustain this flexibility and fluidity of roles over a new and more unpredictable phase?

Organisational values: did we live up to them? Are we proud of our decisions and actions along the way? What compromises have we had to make? Will those values still hold firm in a more uncertain period?

Public service values (for Welsh public bodies). Have we acted as One Public Service? Have we behaved in line with the sustainable development principle and the five ways of working? Have our decisions always taken account of the long-term, been integrated, involved the public, been made with the right partners, and focused on prevention? Have we been mindful of the impact of decisions in enabling a more equal Wales and being mindful of those with protected characteristics and who face social and economic disadvantage?

It is not clear how long we will be dancing. The whole world is waiting for a vaccine. But the timings and efficacy remain uncertain. In the meantime, we all need to adapt to this new normal.

As our Auditor General has said [opens in new window], we are adapting our own work. We will continue to support public services through our COVID learning project, which will continue to share learning on many of the issues raised in this blog around responding and adapting to new circumstances. We have adapted our existing work to refocus projects to take account of the impacts of COVID-19 and we are looking at which of the specific areas of COVID-19 responses merit more detailed audit scrutiny.

 

About the author

mark-jeffs
Mark Jeffs is an Audit Manager in the National Studies Team. He currently manages a range of value for money studies, including studies on fuel poverty, Brexit and our Picture of Public Services work. He has been with Audit Wales and predecessor bodies since 2004